A Modern Approach to A Modern Approach to Healthcare:Healthcare:

Bridging Dentistry, Bridging Dentistry, Medicine, Pharmacy, and Medicine, Pharmacy, and

the Allied Health Professions the Allied Health Professions in Health Care Deliveryin Health Care Delivery

Pre-Medical Society of La Sierra Pre-Medical Society of La Sierra UniversityUniversity

Brian H. Bergh, DDS, MSBrian H. Bergh, DDS, MSApril 15, 2007April 15, 2007

• B.S. Physical Education, B.S. Physical Education, Cal Poly State Univ, San Cal Poly State Univ, San Luis Obispo, 1985Luis Obispo, 1985

• D.D.S., Loma Linda Univ D.D.S., Loma Linda Univ School of Dentistry, 1990School of Dentistry, 1990

• M.S., Craniofacial Biology M.S., Craniofacial Biology and certificate in and certificate in Orthodontics, USC 1992Orthodontics, USC 1992

• Clinical Assistant Clinical Assistant Professor, USC School of Professor, USC School of DentistryDentistry

• Full-time private practice Full-time private practice in Orthodontics, in Orthodontics, Glendale, CAGlendale, CA

• Husband and father of 3Husband and father of 3

Healthcare: a RetrospectiveHealthcare: a Retrospective

Healthcare: a RetrospectiveHealthcare: a Retrospective

• Middle Ages: illnesses were self-Middle Ages: illnesses were self-limiting; patients either got well or limiting; patients either got well or died.died.

Healthcare: a RetrospectiveHealthcare: a Retrospective

• Middle Ages: illnesses were self-Middle Ages: illnesses were self-limiting; patients either got well or limiting; patients either got well or died.died.

• Late 19Late 19thth Century: the role of Century: the role of healthcare expanded due to the healthcare expanded due to the understanding of infection and understanding of infection and development of safe anesthesia.development of safe anesthesia.

Healthcare: a RetrospectiveHealthcare: a Retrospective

• Middle Ages: illnesses were self-Middle Ages: illnesses were self-limiting; patients either got well or limiting; patients either got well or died.died.

• Late 19Late 19thth Century: the role of Century: the role of healthcare expanded due to the healthcare expanded due to the understanding of infection and understanding of infection and development of safe anesthesia.development of safe anesthesia.

• Early 21Early 21stst Century: delivery of care Century: delivery of care still heavily based upon models over still heavily based upon models over 100 years old, but changing.100 years old, but changing.

Aging PopulationAging Population

Aging PopulationAging Population• 100 years ago average lifespan was 100 years ago average lifespan was

less than 50.less than 50.

Aging PopulationAging Population• 100 years ago average lifespan was 100 years ago average lifespan was

less than 50.less than 50.

• Today, life expectancy is about 80 Today, life expectancy is about 80 and climbing.and climbing.

Aging PopulationAging Population• 100 years ago average lifespan was 100 years ago average lifespan was

less than 50.less than 50.

• Today, life expectancy is about 80 Today, life expectancy is about 80 and climbing.and climbing.

• In 1900, 13% of population 50 or In 1900, 13% of population 50 or older.older.

Aging PopulationAging Population• 100 years ago average lifespan was 100 years ago average lifespan was

less than 50.less than 50.

• Today, life expectancy is about 80 Today, life expectancy is about 80 and climbing.and climbing.

• In 1900, 13% of population 50 or In 1900, 13% of population 50 or older.older.

• In 2002, 27% of population 50 or In 2002, 27% of population 50 or older.older.

Aging PopulationAging Population• 100 years ago average lifespan was less 100 years ago average lifespan was less

than 50.than 50.

• Today, life expectancy is about 80 and Today, life expectancy is about 80 and climbing.climbing.

• In 1900, 13% of population 50 or older.In 1900, 13% of population 50 or older.

• In 2002, 27% of population 50 or older.In 2002, 27% of population 50 or older.

• In 2020, 35% of population 50 or older.In 2020, 35% of population 50 or older.

Aging PopulationAging Population• 100 years ago average lifespan was 100 years ago average lifespan was

less than 50.less than 50.

• Today, life expectancy is about 80 and Today, life expectancy is about 80 and climbing.climbing.

• In 1900, 13% of population 50 or older.In 1900, 13% of population 50 or older.

• In 2002, 27% of population 50 or older.In 2002, 27% of population 50 or older.

• In 2020, 35% of population 50 or older.In 2020, 35% of population 50 or older.

• In 2002, the median age was 34.In 2002, the median age was 34.

Aging PopulationAging Population• 100 years ago average lifespan was 100 years ago average lifespan was

less than 50.less than 50.

• Today, life expectancy is about 80 and Today, life expectancy is about 80 and climbing.climbing.

• In 1900, 13% of population 50 or older.In 1900, 13% of population 50 or older.

• In 2002, 27% of population 50 or older.In 2002, 27% of population 50 or older.

• In 2020, 35% of population 50 or older.In 2020, 35% of population 50 or older.

• In 2002, the median age was 34.In 2002, the median age was 34.

• In 2020, the median expected to be 38.In 2020, the median expected to be 38.

Aging PopulationAging Population

• Baby boom generation – 76 million.Baby boom generation – 76 million.

Aging PopulationAging Population

• Baby boom generation – 76 million.Baby boom generation – 76 million.

• More demanding.More demanding.

Aging PopulationAging Population

• Baby boom generation – 76 million.Baby boom generation – 76 million.

• More demanding.More demanding.

• More sophisticated.More sophisticated.

Aging PopulationAging Population

• Baby boom generation – 76 million.Baby boom generation – 76 million.

• More demanding.More demanding.

• More sophisticated.More sophisticated.

• More knowledgeable.More knowledgeable.

Aging PopulationAging Population

• Baby boom generation – 76 million.Baby boom generation – 76 million.

• More demanding.More demanding.

• More sophisticated.More sophisticated.

• More knowledgeable.More knowledgeable.

• Will need more comprehensive care.Will need more comprehensive care.

Aging PopulationAging Population

• Baby boom generation – 76 million.Baby boom generation – 76 million.

• More demanding.More demanding.

• More sophisticated.More sophisticated.

• More knowledgeable.More knowledgeable.

• Will need more comprehensive care.Will need more comprehensive care.

• Geriatric care in all areas will Geriatric care in all areas will increase in demand.increase in demand.

ObesityObesity

ObesityObesity

• In 1991, 22% of Americans In 1991, 22% of Americans considered obese.considered obese.

ObesityObesity

• In 1991, 22% of Americans In 1991, 22% of Americans considered obese.considered obese.

• In 2002, 30% of Americans In 2002, 30% of Americans considered obese.considered obese.

ObesityObesity

• In 1991, 22% of Americans In 1991, 22% of Americans considered obese.considered obese.

• In 2002, 30% of Americans In 2002, 30% of Americans considered obese.considered obese.

• In 2025, 42% of Americans expected In 2025, 42% of Americans expected to obese.to obese.

ObesityObesity

• In 1991, 22% of Americans In 1991, 22% of Americans considered obese.considered obese.

• In 2002, 30% of Americans In 2002, 30% of Americans considered obese.considered obese.

• In 2025, 42% of Americans expected In 2025, 42% of Americans expected to obese.to obese.

• Obesity threatens to undermine Obesity threatens to undermine many health gains made over the many health gains made over the past 20 years.past 20 years.

ObesityObesity

• Collaboration and cooperation Collaboration and cooperation between all health care providers will between all health care providers will be needed to help treat and combat be needed to help treat and combat this problem.this problem.

ObesityObesity

• Collaboration and cooperation Collaboration and cooperation between all health care providers will between all health care providers will be needed to help treat and combat be needed to help treat and combat this problem.this problem.

• AARP has partnered with USA AARP has partnered with USA Triathlon – Tri-Umph Classic Triathlon Triathlon – Tri-Umph Classic Triathlon for 50+ (has an optional 6-8 week for 50+ (has an optional 6-8 week training program.training program.

Prevention, Wellness and Prevention, Wellness and FitnessFitness

Prevention, Wellness and Prevention, Wellness and FitnessFitness

• Heart disease, cancer, stroke, Heart disease, cancer, stroke, chronic obstructive pulmonary chronic obstructive pulmonary disease and diabetes cause 2/3 of disease and diabetes cause 2/3 of deaths in the US.deaths in the US.

Prevention, Wellness and Prevention, Wellness and FitnessFitness

• Heart disease, cancer, stroke, Heart disease, cancer, stroke, chronic obstructive pulmonary chronic obstructive pulmonary disease and diabetes cause 2/3 of disease and diabetes cause 2/3 of deaths in the US.deaths in the US.

• 1 out of 10 American lives affected 1 out of 10 American lives affected on a daily basis from these diseases.on a daily basis from these diseases.

Prevention, Wellness and Prevention, Wellness and FitnessFitness

• Heart disease, cancer, stroke, Heart disease, cancer, stroke, chronic obstructive pulmonary chronic obstructive pulmonary disease and diabetes cause 2/3 of disease and diabetes cause 2/3 of deaths in the US.deaths in the US.

• 1 out of 10 American lives affected 1 out of 10 American lives affected on a daily basis from these diseases.on a daily basis from these diseases.

• All health professions are important All health professions are important in the treatment of these diseases.in the treatment of these diseases.

Health Care DeliveryHealth Care Delivery

Health Care DeliveryHealth Care Delivery

• In 1960, Health care spending was In 1960, Health care spending was 5% of GDP.5% of GDP.

Health Care DeliveryHealth Care Delivery

• In 1960, Health care spending was In 1960, Health care spending was 5% of GDP.5% of GDP.

• In 2004, Health care spending was In 2004, Health care spending was 16% of GDP.16% of GDP.

Health Care DeliveryHealth Care Delivery

• In 1960, Health care spending was In 1960, Health care spending was 5% of GDP.5% of GDP.

• In 2004, Health care spending was In 2004, Health care spending was 16% of GDP.16% of GDP.

• In 2014, Health care spending is In 2014, Health care spending is expected to be 18.7% of GDP.expected to be 18.7% of GDP.

Health Care DeliveryHealth Care Delivery

• In 1960, Health care spending was In 1960, Health care spending was 5% of GDP.5% of GDP.

• In 2004, Health care spending was In 2004, Health care spending was 16% of GDP.16% of GDP.

• In 2014, Health care spending is In 2014, Health care spending is expected to be 18.7% of GDP.expected to be 18.7% of GDP.

• In the 21In the 21stst century, costs have century, costs have climbed several times faster than climbed several times faster than inflation or personal income.inflation or personal income.

Health Care DeliveryHealth Care Delivery

• Out of pocket expenses for health Out of pocket expenses for health care for people over the age of 65 care for people over the age of 65 averages approximately 19% of averages approximately 19% of income.income.

Health Care DeliveryHealth Care Delivery

• Out of pocket expenses for health Out of pocket expenses for health care for people over the age of 65 care for people over the age of 65 averages approximately 19% of averages approximately 19% of income.income.

• For those without Medicaid, health For those without Medicaid, health care expenses are over 50% of care expenses are over 50% of income.income.

Health Care DeliveryHealth Care Delivery

• Para-professional care providers will Para-professional care providers will be needed to help control costs of be needed to help control costs of health care.health care.

Health Care DeliveryHealth Care Delivery

• Para-professional care providers will Para-professional care providers will be needed to help control costs of be needed to help control costs of health care.health care.

• Continued emphasis on the Continued emphasis on the prevention of diseases will be prevention of diseases will be necessary.necessary.

Health Care DeliveryHealth Care Delivery

• Para-professional care providers will Para-professional care providers will be needed to help control costs of be needed to help control costs of health care.health care.

• Continued emphasis on the Continued emphasis on the prevention of diseases will be prevention of diseases will be necessary.necessary.

• A central data base will be needed to A central data base will be needed to provide appropriate care and provide appropriate care and medication, including natural and OTC medication, including natural and OTC medications taken.medications taken.

Coordination of CareCoordination of Care

Coordination of CareCoordination of Care

• All healthcare professionals will need All healthcare professionals will need to have the increased capacity to to have the increased capacity to know the treatments and know the treatments and medications each patient is using.medications each patient is using.

Coordination of CareCoordination of Care

• All healthcare professionals will need All healthcare professionals will need to have the increase capacity to to have the increase capacity to know the treatments and know the treatments and medications each patient is using.medications each patient is using.

• Relying on patients to provide an Relying on patients to provide an accurate history of treatments and accurate history of treatments and medications will continue to cause medications will continue to cause problems.problems.

Coordination of CareCoordination of Care

• All healthcare professionals will need All healthcare professionals will need to have the increase capacity to know to have the increase capacity to know the treatments and medications each the treatments and medications each patient is using.patient is using.

• Relying on patients to provide an Relying on patients to provide an accurate history of treatments and accurate history of treatments and medications will continue to cause medications will continue to cause problems.problems.

• A centralized data base will become A centralized data base will become more necessary in the future.more necessary in the future.

Coordination of CareCoordination of Care

• From a dental perspective.From a dental perspective.

Coordination of CareCoordination of Care

• Sleep ApneaSleep Apnea

Coordination of CareCoordination of Care

• Sleep ApneaSleep Apnea

• Requires the diagnosis by a sleep Requires the diagnosis by a sleep physician.physician.

Coordination of CareCoordination of Care

• Sleep ApneaSleep Apnea

• Requires the diagnosis by a sleep Requires the diagnosis by a sleep physician.physician.

• Historical treatments have included Historical treatments have included surgery and CPAP units.surgery and CPAP units.

Coordination of CareCoordination of Care

• Sleep ApneaSleep Apnea

• Requires the diagnosis by a sleep Requires the diagnosis by a sleep physician.physician.

• Historical treatments have included Historical treatments have included surgery and CPAP units.surgery and CPAP units.

• More and more apnea sufferers can More and more apnea sufferers can be treated minimally and effectively be treated minimally and effectively with a special dental appliance.with a special dental appliance.

Coordination of CareCoordination of Care

• Periodontal DiseasePeriodontal Disease

Coordination of CareCoordination of Care

• Periodontal DiseasePeriodontal Disease

• Silent, generally non-painful.Silent, generally non-painful.

Coordination of CareCoordination of Care

• Periodontal DiseasePeriodontal Disease

• Silent, generally non-painful.Silent, generally non-painful.

• Recently linked definitively to Recently linked definitively to increased chance of heart disease.increased chance of heart disease.

Coordination of CareCoordination of Care

• Periodontal DiseasePeriodontal Disease

• Silent, generally non-painful.Silent, generally non-painful.

• Recently linked definitively to Recently linked definitively to increase chance of heart disease.increase chance of heart disease.

• Significantly increased chance with Significantly increased chance with smokers.smokers.

Coordination of CareCoordination of Care

• Temporo-Mandibular Joint Temporo-Mandibular Joint Disease (TMJ/TMD)Disease (TMJ/TMD)

Coordination of CareCoordination of Care

• Temporo-Mandibular Joint Temporo-Mandibular Joint Disease (TMJ/TMD)Disease (TMJ/TMD)

• Diagnosis – physician to rule out Diagnosis – physician to rule out systemic/neurological problems prior systemic/neurological problems prior to dentist treating.to dentist treating.

Coordination of CareCoordination of Care

• Temporo-Mandibular Joint Temporo-Mandibular Joint Disease (TMJ/TMD)Disease (TMJ/TMD)

• Diagnosis – physician to rule out Diagnosis – physician to rule out systemic/neurological problems prior systemic/neurological problems prior to dentist treating.to dentist treating.

• Dentist may treat with dental Dentist may treat with dental appliance only and/or refer to appliance only and/or refer to physical therapist, psychiatrist, etc. physical therapist, psychiatrist, etc. for additional care.for additional care.

Coordination of CareCoordination of Care

• Medications/TherapyMedications/Therapy

Coordination of CareCoordination of Care

• Medications/TherapyMedications/Therapy

• NSAID’s – inhibit tooth movement.NSAID’s – inhibit tooth movement.

Coordination of CareCoordination of Care

• Medications/TherapyMedications/Therapy

• NSAID’s – inhibit tooth movement.NSAID’s – inhibit tooth movement.

• Biophosphonates – inhibit tooth Biophosphonates – inhibit tooth movement and cause osteo-necrosis.movement and cause osteo-necrosis.

Coordination of CareCoordination of Care

• Medications/TherapyMedications/Therapy

• NSAID’s – inhibit tooth movement.NSAID’s – inhibit tooth movement.

• Biophosphonates – inhibit tooth Biophosphonates – inhibit tooth movement and cause osteo-necrosis.movement and cause osteo-necrosis.

• Radiation therapy – can cause osteo-Radiation therapy – can cause osteo-necrosis and tooth loss.necrosis and tooth loss.

Coordination of CareCoordination of Care

• ImagingImaging

Coordination of CareCoordination of Care

• ImagingImaging

• CAT Scan.CAT Scan.

Coordination of CareCoordination of Care

• ImagingImaging

• CAT Scan.CAT Scan.

• MRI.MRI.

Coordination of CareCoordination of Care

• ImagingImaging

• CAT Scan.CAT Scan.

• MRI.MRI.

• Tomography.Tomography.

Coordination of CareCoordination of Care

• ImagingImaging

• CAT Scan.CAT Scan.

• MRI.MRI.

• Tomography.Tomography.

• 3-D imaging (cone beam 3-D imaging (cone beam technology).technology).

The FutureThe Future

The FutureThe Future

• Exciting!Exciting!

The FutureThe Future

• Exciting!Exciting!

• Fun!!Fun!!

The FutureThe Future

• Exciting!Exciting!

• Fun!!Fun!!

• Unbelievable!!!Unbelievable!!!

““Somewhere, Somewhere, Something Something

Incredible is Incredible is Waiting to beWaiting to be

Known.”Known.”

Carl SaganCarl Sagan

Thank you!Thank you!