Rooted in Health: Diving into Periodontics and Oral Hygiene

Podcast Transcript

Paul Bryson: Welcome to Head and Neck Innovations, a Cleveland Clinic podcast for medical professionals exploring the latest innovations, discoveries, and surgical advances in otolaryngology - head and neck surgery.

Thanks for joining us for another episode of Head and Neck Innovations. I'm your host, Paul Bryson, Director of the Cleveland Clinic Voice Center. You can follow me on X, formerly Twitter, @PaulCBryson, and you can get the latest updates from Cleveland Clinic Otolaryngology-Head and Neck Surgery by following @CleClinicHNI on X. That's @CleClinicHNI. You can also find us on LinkedIn at Cleveland Clinic Otolaryngology - Head and Neck Surgery, and Instagram at Cleveland Clinic Otolaryngology.

Today I am looking forward to speaking with my colleague, Dr. Sasha Ross, a periodontist in our Section of Dentistry and Oral Surgery. Dr. Ross, welcome to Head and Neck Innovations.

Sasha Ross: Thank you.

Paul Bryson: Well, let's start by having you share some background on yourself for our listeners, where you're from, where you trained, how you came to Cleveland Clinic, and some of your interests within your specialty and dentistry, and what drew you to it.

Sasha Ross: Yeah, so I grew up here in Cleveland. I actually went to the Orange School system and graduated from Orange High School. I went to college at Northwestern where I studied biochemistry and anthropology in Evanston, Illinois. Then headed over to Boston where I did my dental school training at Harvard and then went back to Chicago to UIC to do my Periodontics residency. And I actually moved back to Cleveland to be a part of a private periodontal practice in Beachwood that was started by my cousin Dr. Fred Rosenberg, and I learned so much from him. A few years into being there, I got recruited by a former prosthodontist here at the Cleveland Clinic, Dr. Brian Chang, who said that The Clinic was looking for a periodontist and I'd always wanted to work in a hospital environment. I love the idea of collaborating with physicians and working as an interdisciplinary team and came on part-time and then ultimately decided to transition here full-time a few years ago. So it's been great. And as far as particular interests go, I love that I get to work with a lot of my patients over a long period of time and really get to establish a great relationship with them, particularly those that have periodontal disease. I love regrowing bone, regrowing lost gums, saving teeth and working with people to have a healthy mouth and a mouth that they're proud of.

Paul Bryson: Yeah, I mean, I think it's really interesting. Within otolaryngology, we have a number of subspecialties within dental medicine. There's a number of subspecialties, and I think it's sometimes as a lay person or as a non-trained person in that area, it's sometimes hard to approach. Just describe periodontics, maybe to our listener, our listeners may be otolaryngologists, other health professionals. What's some of the foundational things that you can expect in periodontics?

Sasha Ross: Yeah, so Periodontics is centered on the diagnosis and treatment of periodontal disease, which is a bacterial infection in the gum tissue that causes gum inflammation and ultimately leads you to lose bone around your teeth, which is the foundation of your tooth support. And really sort of a third of what I do is treat periodontal disease, both non-surgically and surgically. We try and save teeth and grow bone around teeth when possible. A third of what I do is treat gum recession, so through gum grafting and a lot of very minimally invasive techniques. And then a third of what I do or more is doing extractions and dental implants and growing bone in the preparation of dental implants. And actually implants came out about 30 to 40 years ago. And so now we unfortunately start to see some issues around implants. So periodontists are the key dental specialists trying to salvage dental implants and get them healthy if they have different issues. And I guess finally, I also sort of dabble in treating disorders of the gum tissue, things like lichen planus or mucus membrane pemphigoid, different disorders like that. I do a little bit of and do gingival biopsies for sure.

Paul Bryson: So it really covers quite a bit of ground for patients that could be listening. They might present at their primary care appointment really any medical appointment and might have issues like red or swollen gums or gums that bleed, loose teeth, dental infections. We've heard there's an increased risk of even heart disease with poor oral health. Can you talk a little bit more about the connection that you see between overall oral health and maybe a person's overall health?

Sasha Ross: Yeah, so I find it always very interesting and a little bit sad when I see patients that go to their primary care doctor for these types of issues, and that don’t have access to dental care if they don't have somebody that they can go to firsthand in the dental field. But oral health and systemic health are intimately related, and I think many doctors can just have a patient open their mouth and really what you see is often reflective of what's going on in a patient's whole body. There is a very strong link, particularly in the periodontal disease world with periodontal disease and diabetes, which both of them are often undetected and because periodontal disease doesn't hurt usually, I should say, and there is a very strong link with periodontal disease and things like cardiovascular disease, Alzheimer's disease, rheumatoid arthritis, low birth weight, babies, the list sort of goes on and on. And I think some of the factors, there's certainly a genetic component to it. A lot of times there are shared risk factors, people who smoke or drink, diet and exercise, all of these things influence it. And then periodontal disease is an inflammatory condition, as are a lot of these other conditions it's associated with. So it just sort of speaks to inflammation throughout the body.

Paul Bryson: I appreciate you sharing that. So if a patient is referred to you, what can they expect with yourself if they see you or even another member of your team?

Sasha Ross: So when patients come in, obviously I like to hear what brought them in, especially people that maybe haven't been to a dentist in many, many years. Are they in any sort of discomfort? What are their goals for treatment? What's been their past dental experience? A lot of people have a lot of anxiety around dental appointments, and we talk about that. I go into different medical conditions that they have in medications that they're on, so we spend a lot of time just talking. Generally speaking, I will require some sort of X-rays in order to make a diagnosis. So either patients will bring them or will take them. I look in their mouth and do a full exam, and sometimes we take molds of their teeth, and depending on the case, sometimes I ask that they come back at a separate visit to come up with a plan if I need to speak with other dentists or medical providers. But we generally try and provide options for them as far as treatment goes and really try and give them a diagnosis.

Paul Bryson: No, I appreciate that. Just as a patient of the dental clinic, I can attest to sort of the holistic and comprehensive and thorough approach that you can receive as a patient. Yeah, we try. Oh, yeah. I mean, we've previously had Dr. Coy and Dr. Khan from your section on the podcast. They're terrific. And I'd encourage our listeners go back, check out those episodes. There may be some more things that they can learn about sort of the whole portfolio of care that you and your group offer. I wanted to ask too, I understand, do you do a bit of education for trainees or students that may want to spend time with you? Is that a part of your day to day?

Sasha Ross: So we have, as part of the clinic, three general practice residents. So there are dental students who completed their training and chose to do one extra year with us. We have had other students that are in dental school or even some college students come through and sort of shadow us and see if it's something that they may be interested in going into. So we even had one that was looking into going to dental school that served as a scribe for us for a while. So yeah, we like to give opportunities when we can to learn.

Paul Bryson: Yeah, it's a great way to introduce people to your field and to see what resonates and help them with decision making.

Sasha Ross: It's for sure the best way.

Paul Bryson: So looking into the future, what's on the horizon as far as research or other things, even interesting programmatic developments that you have in the way that you're approaching periodontal disease?

Sasha Ross: It's a great question. I am, full disclaimer, not an expert in this at all, but I think the ultimate goal in our field is to be able to regenerate teeth rather than having to have something pulled. So I know that the Forsyth Institute and a lot of our research institutions mainly out east, have been looking for years into this, and I don't think it's that far off actually using stem cells to grow teeth rather than having to place a dental implant to replace a tooth, that kind of thing. So that's very appealing. Within my own field. We also can look into assessing the types of bacteria that are in your mouth, even your salivary pH. There's different sorts of assessments, and if we can use that information to potentially modify treatment, that would be something that I'd say my field is looking into. We're always looking into developing the most minimally invasive techniques and looking at new products for growing bone, growing gum tissue that's always on the horizon. And as well with dental implants, I know that there has been a movement towards ceramic dental implants that still, I think is one of those things that is okay in certain cases. And yeah, I'd say periodontics is a field that's heavily research based, so I think it's something that we're constantly looking to learn and to do things better and more effectively.

Paul Bryson: Yeah, it's just so interesting that the regenerative medicine opportunities that you articulated, we often don't think about that, but it could be a real game changer for people in terms of maybe having their own tissue..

Sasha Ross: Absolutely.

Paul Bryson: …sort of be the soil for teeth and gum, I was going to ask. I really appreciate your time and coming on the podcast. Any final take home messages for our listeners or other topics that you wanted to highlight?

Sasha Ross: Yeah, I would say for me in particular as a specialist here, I see patients that are employees of the hospital, but I also see people just from the general community. You don't have to be an employee to see me. And I as well don't require a referral from a dentist. So patients that maybe haven't seen a dentist in many, many years, I can be sort of that triage person. If you want to send your patients my way, I can sort of work them up, get them where they need to be, whether it be with me or someone else in our department. And our department does such a nice job. I mean, we have a number of general dentists. We treat sleep apnea, we treat TMJ disorders, we treat some special needs patients, and we have several maxillofacial prosthodontists coming on board to help with big reconstructions for cancer patients and patients with really complex dental needs. So we sort of do it all, and we work with patient’s doctors all the time, particularly patients with complex medical conditions on blood thinners, all these things we do day in, day out. So we're happy to work with anyone in the hospital and see anyone and do all the time. We have people that come from far and wide as everybody does here to see us.

Paul Bryson: Yeah, I think it's an exciting time for your department. There's been a lot of growth.

Sasha Ross: Absolutely.

Paul Bryson: And like you articulated, just so many options for patients just overall.

Sasha Ross: Yeah, absolutely. And anyone's free to message me directly if they need help getting their patients in.

Paul Bryson: Well, thanks for coming on.

Sasha Ross: Thank you so much for having me.

Paul Bryson: For more information on periodontal disease treatment at Cleveland Clinic, please visit ClevelandClinic.org/Periodontics. That's ClevelandClinic.org/Periodontics. And to connect directly with our section of dentistry and oral surgery or submit a referral, visit ClevelandClinic.org/Dentistry or call 216.444.6907. That's 216.444.6907. Thanks for joining Head and Neck Innovations.

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