Six-Foot Tiger, Three-Foot Cage

by Felix Liao

  “A narrow definition of ‘medically necessary dental care’ currently limits oral health services for many insured persons, particularly the elderly,” notes Oral Health in America. “You cannot be healthy without oral health. Oral health and general health should not be interpreted as separate entities. Oral health is a critical component of health and must be included in the provision of health care and the design of community programs.” (9)

  Insurance coverage—be it copay, deductibles, exclusions, limitations, no coverage, or other “excuses”—is the main reason that half the patients who see me do not start treating their impaired mouths and related problems. Yet to refuse coverage is to ignore all the science we have looked at—science that has clearly linked the mouth with overall health.

  As US Surgeon General Dr. Richard Carmona wrote in 2003, “The report [Oral Health in America] … called upon policymakers, community leaders, private industry, health professionals, the media, and the public to affirm that oral health is essential to general health and well-being and to take action. No one should suffer from oral diseases or conditions that can be effectively prevented and treated.” (10)

  Fourteen years later, only a medical diagnosis of obstructive sleep apnea qualifies for health insurance coverage—and only to varying degrees. This means no coverage until the patient’s health has gone far enough down the hill for Obstructive Sleep Apnea to rear its ugly head—perhaps another reason for the continually rising costs of care in this country and the lack of better outcomes.

  Many people still believe that if a treatment is not covered, then it is not something they need. This certainly is not the case with an impaired mouth and pinched airway. “Doctor, do you take my insurance?” is not the best question to ask for your health. Instead, it should be directed to your insurance carrier, “Why don’t you cover impaired mouth diagnosis and treatment?” and to your employer, “Why do you pick such an inefficient plan for your money?”

  Americans are getting fatter, losing sleep, and feeling more tired and stressed than ever. With all the brilliant minds in medicine, dentistry, insurance, and business today, surely we can find ways to deliver a Holistic Mouth to many more Americans to improve sleep, raise productivity, and reduce disease care cost.

  It is time for employers to provide better coverage options for their employees, and it’s time for health insurers to step up and create more effective plans that say YES to better total health by mouth. It’s time to cover the diagnosis and treatment of an impaired mouth, just like six-month dental checkups and cleanings. Recognizing Impaired Mouth Syndrome and providing coverage for Holistic Mouth solutions can help reverse or mitigate this costly Impaired Mouth domino.

  Healthier Outcomes Require Upgraded Strategies and Tactics

  An impaired mouth is a slow kill. A Holistic Mouth is a fast heal. So what actions are needed to actualize Holistic Mouth as a solution?

  Employers and insurers need to see that paying for Holistic Mouth checkups and solutions is good business. Eliminating the mouth as a source of chronic pain, obstructive sleep apnea, and teeth grinding can greatly reduce downstream costs while raising health and upgrading life quality.

  Better media coverage can help drive better insurance coverage. The number of people suffering from an undiagnosed impaired mouth and related sleep troubles, chronic pain, fatigue, snoring, sleep apnea, and teeth grinding is enormous, and the cost of managing their complications is bankrupting people and nations.

  For public health officials and policy planners, a dental visit can be a useful opportunity to screen for oral-systemic issues and to refer patients for early medical testing and intervention. “In many cases,” notes Delta Dental, “a dentist may be the first health care provider to diagnose a health problem in its early stages since many people have regular oral examinations and see their dentist more often than their physician.” (11)

  Dental offices certified to provide Holistic Mouth checkups can be valuable resources already in place to reduce medical costs and morbidity related to chronic pain and sleep apnea. Until health insurers and employers see the light, what can patients do, and how can their doctors help?

  All Health-Caring Professionals Can Help

  Every health professional who care about patient’s well-being can help put the mouth and airway back on the body map by recognizing an impaired mouth’s signs and symptoms. By attending an online webinar, non-dental health professionals can become Impaired Mouth Investigators. By participating in a one-day seminar, they can become Holistic Mouth Consultants with the ability and opportunity to integrate a systemically-sound mouth program into their patient care.”

  Patients know intuitively that all parts of the body are interconnected, and they appreciate health professionals who know how to integrate mind-body-mouth.

  Trained as doctors of the Holistic Mouth, dentists are in a strategic position to recognize orofacial signs of medical problems and the systemic consequences of an impaired mouth on the airway, blood pressure, sleep, and memory early on. Considerable training beyond dental school and teeth-centered seminars are needed for dentists to acquire the eyes, knowledge, and skill set of a mouth doctor to diagnose and re-engineer an impaired mouth.

  Patients: How to Take Charge of Your Health by Taking Charge of Your Mouth

  For the patient’s part, you need to know if you have an impaired mouth as an overlooked health liability. Getting a Holistic Mouth checkup by a trained Holistic Mouth doctor is the first step. Insurance coverage varies from surprisingly good to nothing, and you can expect denial, long holds on the phone, and jumping through insurance-plan hoops, based on my patients’ experience. The time is ripe for health-insurance innovations from product design to claims review to customer service.

  Until then, you can expect to pay out of pocket for Holistic Mouth checkups and impaired mouth treatment, depending on your plan level being platinum, gold, silver, bronze, or hot air. To get more coverage, you will need to take steps to advocate for yourself through pressure on employers to select more integrative health plans and pressure on elected officials charged with healthcare policy and related spending.

  I propose that a Holistic Mouth be recognized as an essential prerequisite for building and maintaining total health. I will devote my life energy to the cause of making Holistic Mouth happen for as many people as possible through patient education, professional training, Holistic Mouth doctor certification, and integrative collaboration among all health professionals to include this strategy as a natural solution to reduce pain and fatigue and to improve sleep and energy.

  With the right diagnosis of the missing pieces in America’s health-care system and with a concerted effort to implement the treatment plan needed to fix our disease care costs, we can improve oral-systemic health and decrease health-care costs.

  Holistic Mouth Bites

  An impaired mouth is a slow kill. A Holistic Mouth is a fast heal. Holistic Mouth as a solution can predictably improve overall health just as brushing and flossing has done for dental health.

  Recognizing and treating an impaired mouth and a pinched airway early on can help save a brain, a heart, many teeth, and much more down the road. Diagnosing impaired mouth and producing Holistic Mouth across America and around the world is the next paradigm shift in dental care.

  It’s time to provide for insurance coverage for the diagnosis and treatment of impaired mouth, just like six-month dental checkups and cleanings.

  Epilogue

  A Better Second Half of Life: A Chair-Side Chat

  80% of all chronic pain and illness originate between the scalp and the clavicle.

  – Dietrich Klinghardt, MD, PhD

  “Why are so many teeth falling apart on me all of a sudden?” Suzette asked when she came into my office for a broken filling. “I had a bunch of cavities filled as a teenager,” continued this forty-eight-year-old mom of two teens, “but not much has happened since until these two broken teeth and that abscess.”

 
“Chalk it up to mileage and excessive wear and tear,” I explained. “It’s like driving the best car with the front end out of alignment. Your broken and sensitive teeth may well have to do with the combination of old fillings leaking at the seams and causing cavities, AND the stress of jaw clenching and teeth grinding.”

  “Nothing personal, but I get super anxious whenever I have to go to the dentist.” At fifty pounds overweight, Suzette works hard to make ends meet but admits to feeling tired. “Oh, how I wish for a trouble-free mouth for the second half of my life!”

  “It’s still within your reach—when you begin to address the causes of your daily and nightly stress.”

  “I know all about your theory of the six-foot tiger in a three-foot cage, but I just don’t have the money to fix mine right now.”

  “There’s a right time for everything. At this time, you have a couple dental fires to put out,” I answered. “If you really want a better second half of life, though, we can revisit the consequences of ignoring your oral contributions to your total health at your next checkup and cleaning visit.”

  “I’d like that, yes.”

  Every dental visit is an opportunity to connect the mouth with its owner and his or her total health.

  Oral Airway Contributions to Total Health

  In its simplest sense, “WholeHealth” means that all parts of the body are interconnected. Gum inflammation, for instance, has been linked to Alzheimer’s, heart disease, cancer, and more. We might even say that every disease, pain, and illness has an oral connection until proven otherwise.

  Suzette’s dental troubles do not exist by themselves, as if her teeth were not a part of her body. Instead, dental troubles are bodily reactions to some persistent stress, be it mental-emotional, nutritional, or habitual jaw clenching and teeth grinding. Whatever the stress, it knocks the body’s ability to run itself off balance.

  When teeth are stressed, so is the whole body. Book 2 of this Holistic Mouth Solutions series covers more ripple effects of living and sleeping with a pinched airway inside an impaired mouth beyond sleep apnea, including why teeth grinding happens and how it ruins more than teeth. We will explore the relationships between stress, being overweight, chronic fatigue, and an impaired mouth. We will look at the evidence linking diabetes and other leading chronic diseases with the six-foot tiger in a three-foot cage.

  And we will go deeper into what you can do about it, taking charge of your own health and well-being, creating the healthy, happy life you desire.

  Need More Information?

  Many more resources are available for you at HolisticMouthSolutions.com, including:

  Referrals for Holistic Mouth doctors and more resources

  Further educational opportunities such as webinars and resources for patients

  Information for dentists aspiring to become certified Holistic Mouth doctors

  Information for non-dental health professionals to become Impaired Mouth Investigators and Holistic Mouth Consultants

  Information for businesses or organizations seeking Dr. Liao as a speaker or consultant

  Got an Impaired Mouth? Discover Your Holistic Mouth Score

  Is your mouth helping or hurting your health? Is your mouth an asset to your sleep and energy, or a liability? This can be a life-changing question. Discovering your Holistic Mouth score is the place to start finding some answers.

  This self-survey begins to illuminate your mouth’s structural contributions to medical, dental, and mental-emotional symptoms. It’s essentially a checklist of the more common orofacial, dental, and bodily signs and symptoms of an impaired mouth.

  The higher your score, the more likely you have been living with an impaired mouth for a long time.

  You can access and download the digital versions of the following templates and materials at: http://holisticmouthsolutions.com/

  Please note that the Holistic Mouth score is not, at this time, a diagnostic tool. No study has been done on it. But it is an excellent conversation starter with your doctor or dentist to rule out an impaired mouth. This is how I encourage you to use it—to get the ball rolling so that you can get on the path to improved health and vitality.

  Holistic Mouth Checkup

  The next step is a Holistic Mouth checkup by a trained health professional, including appropriate imaging of the jaws and oral airway, as well as a sleep test (as needed) to confirm an impaired mouth diagnosis.

  A dental checkup covers the teeth and gums, which is an important foundation, of course. A Holistic Mouth checkup builds on that foundation by examining the mouth’s role in whole-body health through ABCDES: alignment, breathing, circulation, digestion, energy, and sleep.

  To find a properly trained Holistic Mouth doctor near you who can provide you with a Holistic Mouth checkup, visit HolisticMouthSolutions.com. Because Holistic Mouth is a brand new concept and practice, Holistic Mouth doctors will be in very short supply. If you cannot find one, please consider referring your own dentist to this website.

  Your Daytime Sleepiness:

  The Epworth Sleepiness Scale

  The Epworth sleepiness scale is a tool doctors use to evaluate daytime sleepiness—one of the most common signs of sleep apnea and often a clue to airway issues that result from an impaired mouth.

  Think about each of the situations listed below, and then rate how likely you are to doze off while engaged in the activities described:

  0 = not at all likely

  1 = slightly likely

  2 = moderately likely

  3 = very likely

  Situation

  Chance of dozing

  Sitting and reading

  Watching TV

  Sitting in a public place

  Riding as a passenger in a car for one hour

  Lying down in the afternoon

  Sitting and talking with someone

  Sitting quietly after a lunch with no alcohol

  Stopped for a few minutes in traffic

  Source: The Epworth Sleepiness Scale, by Dr. Murray Johns,

  http://epworthsleepinessscale.com/about-the-ess/

  The average score is four to eight. If you score higher than this, you should talk with your doctor—especially if your score is sixteen or above.

  Please note that the survey presented here is not the official diagnostic tool but is shared as a means of self-assessment, to recognize whether daytime sleepiness is an issue for you so that you can seek help as needed from your health-care providers.

  Children’s Holistic Mouth Development: A Parents’ Guide

  Your child’s orofacial and dental development starts well before birth. In the WholeHealth approach, a partnership between parents and a doctor of Holistic Mouth is encouraged, with the following ideals in mind:

  Preconception

  Sound and sensible nutrition for six to twelve months

  A dental checkup to ensure healthy teeth and sound gums for the mom-to-be

  A Holistic Mouth checkup to rule out a pinched airway and more

  Immediately after Birth

  Breast-feeding – nature’s way for a baby to develop a wide upper jaw

  Check for tongue-tie and upper lip-tie if breast latch is problematic.

  Check for cranial distortion from birth trauma, and seek a cranial osteopathic doctor or craniosacral therapist if crying, irritability, colic, and/or spit-up persist

  First Eighteen Months

  After about a year of breast-feeding, follow Baby-Led Weaning: http://www.babyledweaning.com/.

  During weaning, watch for signs of allergies, ear infections, stuffy nose, mouth breathing, and dry lips.

  For nutritional information to grow good teeth and faces, visit the Weston A. Price Foundation: http://www.wapf.org.

  Once your child can walk and run, watch for a slouched posture with forward head, and encourage active play using all four limbs rather than just the two thumbs.

  Dental Care and Holistic Mouth Checkups

  Brush teeth as soon as t
hey come into mouth to develop this healthy habit.

  Take your child to a family or pediatric dentist once their molars start to come in.

  A positive first impression can last a lifetime. A helpful way to visit the dentist for the first time is as a guest during a parent’s or older sibling’s checkup/cleaning.

  Parents are responsible for children’s teeth brushing and flossing until nine or ten years old.

  Space between front teeth is desirable in baby teeth, except in cases of tongue thrust or lip-tie.

  Look for facial symmetry, and watch for the red flags listed below.

  Have the child tip her/his head back and the parent can look up from below the chin

  Red Flags of Impaired Mouth Development in Children

  Medical Clues

  ____Allergies, frequent colds, inflamed tonsils, headaches

  ____Earaches, recurrent ear infections, or stuffiness

  ____Accidents, head trauma, broken nose, falls, scars from stitches

  ____Attention deficit or hyperactivity

  ____Tiredness, low energy, socially withdrawn

  Facial Appearance

  ____Forward head (ear hole ahead of shoulder point in profile), slumped posture

  ____Uneven ears or eyes

  ____Narrow nostrils

  ____Small (weak) chin

  ____Dry or parched lips, lack of lip seal

  ____Deep chin cleft

  ____“Gummy” smile

  ____Overly long “horse” face or overly flat “bulldog” midface

  Dental Clues

  ____Teeth grinding

  ____Thumb-sucking

  ____Open bite (space between upper and lower front teeth for thumb or tongue)

  ____Crowded or crooked (rotated or turned) front teeth

  ____Deep bite (upper front teeth overlap more than half of lower front teeth)