Editor’s Note
Calor, Dolor, Rubor, Tumor
A
patient in a dental school clinic presents with a chief complaint of “bleeding and discomfort of the gums.” The dental student examining the patient describes her periodontal findings to her faculty member at the end of the exam: “generalized mild marginal erythema, swelling and rolled margins, blunted papillae.” Heat (calor), pain (dolor), redness (rubor), swelling (tumor)—the classic signs of inflammation originally recorded by the Roman encyclopedist Celsus in the first century A.D. In 2004, Time magazine’s cover highlighted the recent interest in the relationship between inflammation and systemic health with this phrase: “Inflammation: The Secret Killer.”1 The accompanying article described inflammation as “the body’s first defense against infection” and noted that “when it goes awry, it can lead to heart attacks, colon cancer, Alzheimer’s, and a host of other diseases.” Indeed, the associations between periodontal disease and systemic health continue to be elucidated. Recently, Jeffcoat et al.’s article “Evidence from Insurance Data for Five Systemic Conditions” reported how, in 2011-13, they analyzed medical and dental insurance claims data from 338,891 individuals with both medical and dental insurance coverage.2 They concluded that periodontal therapy may improve health outcomes that could lower overall medical costs. Our new understanding of the relationships between inflammation and systemic health presents us with a potential model to teach the basic and clinical sciences in an integrated, interprofessional way. Imagine the scenario at the beginning of this editorial being presented to a first-year dental student or to a group of other health professions students. The clinical signs and symptoms of inflammation could be used as a starting point for coursework in oral infection and immunity (microbiology, immunology, and
September 2014 ■ Journal of Dental Education
infectious diseases), clinical diagnosis (normal and diseased periodontal tissues), the effects of inflammation on systemic health (normal and abnormal organ systems/physiology), and case discussions among health professions students. The goal for these teams of heath care providers should be to improve our patients’ overall health by knowing about and lowering any sources of inflammation. In this month’s JDE, several articles outline ways of teaching dental, allied dental, and other health professions students the latest science in the arena of oral-systemic health and having them monitor our patients’ systemic health (regarding hypertension, diabetes, etc.). In the study by Friesen et al., faculty members evaluated their students’ clinical decision making in light of periodontal risk factors and the oral-systemic links that had been identified. In another article looking at practicing dentists’ behaviors and barriers regarding oral-systemic links, Wilder et al. conclude, “Dental schools need to prepare dental students for future roles in the assessment, management, and interprofessional collaboration that will be needed in the future.” Three articles (by Price et al., Czarnecki et al., and Conway et al.) address various modes of interprofessional education, while another (by Anders et al.) describes students’ reactions to diabetes counseling, monitoring, and screening. Heat, pain, redness, and swelling: inflammation. A theme that binds many disciplines and specialties together. —Nadeem Y. Karimbux, D.M.D., M.M.Sc.
REFERENCES
l. Time, February 23, 2004. 2. Jeffcoat MK, Jeffcoat RL, Gladowski PA, et al. Evidence from insurance data for five systemic conditions. Am J Prev Med 2014;47(2):166-74.
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