Reactive or Proactive: What’s your preference?


For most of human history, we’ve attempted to eliminate or lessen pain via a variety of sometimes heavy-handed treatments, such as extraction of teeth or amputation of damaged limbs.

These treatments can be classified as “Reactive”, or carried out in response to a pressing issue.  Modern medicine found its beginnings in treatments that were curative and reactive.  As time passed, we discovered that things like hand washing and clean drinking water made a difference in outcomes, and as a result humankind took a step forward in health and longevity.

An explosion of scientific studies regarding the mechanisms of disease marked the 19th and 20th centuries.  This greater understanding has given rise to a preventative model of medicine that now allows us to predict your risks of disease before you are damaged by that disease…and thus start to notice it.  As such, we’re becoming smarter about prevention and more proactive about addressing risk.

As a branch of medicine, Dentistry’s understanding of disease has exploded in the last several decades.  We now understand not only oral disease works, but also how to prevent it and the pain and problems it causes.  Just as your physician can predict (and thus help you minimize) your risks of stroke, cancer, or diabetes, modern dentists with an awareness of the current scientific literature and treatment models are able to address issues before they become symptoms of an established disease.

Let’s look at an example of a hypothetical patient who presents with some very common issues.  Beth is a 34 year old small business owner with an interest in healthy eating.  She had orthodontics (braces) as a young teen followed by a late growth spurt, and is noticing chipping on her lower front teeth, a broken upper front tooth, and sore jaw joints.  She’s also been getting cavities again (for the first time since childhood), in spite of her sugar-free diet and daily flossing habit.

Traditionally, Beth would be handled by the application of treatments aimed at repairing the damage that has occurred:  filling her cavities and chipped teeth and making her a nightguard.  This approach is a reactive approach that, while dealing with the damage done, doesn’t deal with the cause of the damage. Under this treatment model, Beth has no understanding of the causes of her issues, or how to prevent these same things from recurring.  She’ll be dismayed at her next visit when 3 more cavities are found and the chipped areas that were filled are broken again….and her night guard has done nothing for her jaw joint pain.

In contrast to this traditional “react and patch” approach, my practice revolves around a central theme:  Risk Assessment and Prevention.   Beth’s concerns listed above give key clues about the causes of her diseases. It’s likely that Beth has a cavity susceptibility issue.  Better hygiene and diet won’t stop her decay; she needs help managing her acidity and bacterial population risks.   Regarding her chipping and jaw joint complaints, Beth may not realize that events in her teens, her chipped teeth, and sore jaw joints are likely all part of the same problem…and her problem won’t go away (and stay away) until we go back to its root.

My patients receive a complete risk assessment and a full diagnosis that deals with root causes.   This allows us to discuss not only problems that we may note today, but to go beyond the old paradigm and deal with signs that there may be future issues.   Had Beth understood that her bite disease was causing her broken teeth, she could have taken steps to rectify it before it led to damage that now must be repaired.

Remember:  Signs precede Symptoms, and are often invisible to patients.  Addressing root causes of signs prevents the damage that leads to symptoms.