There's an app for that

By JoAnn R. Gurenlian, RDH, PhD

2014 is going to be an interesting year for changes and innovations in the health-care industry. You've probably already seen the commercial about cell phone accessibility on a wristwatch. That seems to be just the start of new opportunities. Along with cell phones, we're going to see upgrades in wearable medical technology. These devices will be part of a new trend in personal medical technology in which sensors will be able to send meaningful data to physicians to update electronic health records. Management of diabetes and cardiovascular disease may become easier as heart rate and blood glucose monitors become more sophisticated. Imagine health-care providers and consumers using their downloadable medical apps to communicate real-time health concerns and receive answers.

A trend that may change cancer treatment is cancer immunotherapy. Researchers have identified receptors expressed on immune system cells, including CTLA4 and PD-1, that can alter the immune response. Using antibodies to block receptors for melanoma and lung cancer are showing promising results with better outcomes than conventional chemotherapy treatments. Since the immune system has "memory," outcomes appear to be more favorable. This trend in cancer immunotherapy may mean more opportunities to save lives without the concerns about cancer pharmacotherapies not being readily available, or being caustic to the body.

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Genome editing is another advancement that is going to change health care. With the creation of CRISPRs (Clustered Regularly Interspaced Short Palindromic Repeats), gene editing is being used to program an RNA-guided molecule to target defective DNA and replace it with "good" DNA. Altering the genome may revolutionize biotechnology and medicine and change the way we treat genetic diseases. Cell therapy is a similar concept that uses cells from a patient's skin to generate stem cells that can be "gene-corrected." From these cells, induced pluripotent stem cells, or iPS cells, can differentiate into specialized cell types, be placed directly into affected organs, and correct problems. Because these cells contain a patient's genetic code, there is less chance of rejection by the body's immune system.

Another medical advancement involves microbiome research, in which the relationship between the bacterial ecosystem of the gastrointestinal tract and other diseases may lead to new therapies for chronic diseases such as inflammatory bowel disease, allergies, obesity, cancer, neurologic disorders, and possibly even psychiatric illness.

What do these trends in health care tell us? First, it is highly likely that the medical home we know now is going to be radically different in the near future. If that environment changes, we have the opportunity to reframe dental and dental hygiene practice. Imagine a patient calling from his wrist phone to report bleeding gingiva or a painful tooth. Someone can use a new dental app to upload a photo of their problem or even a digital image that can be reviewed by a specialist, and treatment recommendations can be made. Or, a patient can present to the practice feeling unwell with cardiac or hypoglycemic symptoms. A health-care provider can be accessed more readily, an EKG can be transmitted, and real-time recommendations can be made to proceed with dental hygiene care or defer in favor of a medical intervention. Health informatics and teledentistry will explode with opportunities as these advances are made applicable and more user-friendly.

Imagine a scanning system that automatically identifies caries, periodontal conditions, and neoplasias; saliva samples that provide genomic information about oral and general health; and microbiomes that control oral biofilm to reduce oral diseases. Imagine sharing this information with physicians and creating collaborative health diagnoses for each patient as part of an interdisciplinary team.

One thing is certain. Consumers are going to drive change and innovation because they want health care that offers convenience, choice, access, and affordability. As medicine changes, dentistry and dental hygiene should look at options for changes that will allow for a new type of oral health home being made available, with customized care as a central focus.

This may be in the future, but it is likely just around the corner, so start thinking about the role you can play in supporting and fostering these changes to the current oral health system. What you do know is going to end and be replaced by some amazing advances. Are you ready?

JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing-education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and president of the International Federation of Dental Hygienists.

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