Using Electronic Records for Improved Diabetes, Warfarin and other Complex Patients

Personalized medicine is about integrating all patient information into the treatment plan, and some really exciting advances are being made with respect to dentistry. In particular, Dr. Brilliant made this presentation at a genomics conference overviewing the interactions between existing conditions, genetic variants and dental care. For instance, pharmacogenetics can make a big difference in understanding genetic variants and their impact on medication–for instance, warfarin often has to wear off before patients can undergo dental treatments, and two gene variants can impact that dramatically. Similarly, a gene variant has been identified that alters pain response. Imagine having that information available in the dental EHR, to allow for straightforward, targeted treatment.

Dr. Brilliant and his research group (Personalized Medicine Research Project at Marshfield Clinic) are also interested in finding dental patients to understand the interaction between that existing condition and the microbiome in the mouth, particularly for susceptibility to Type II diabetes.

This kind of integrated research and data provides key insight into how dental care will become an increasing part of overall health, due to the need to link, share and view holistic patient information. Dentists may be at the forefront of capturing salivary samples, setting health sights on health information as a complete, shared platform for treatment. This kind of complete patient information for warfarin patients, diabetes patients and other complex patients can place dentists at the center of standardizing and expanding EHR data. As the questions and answers portion of this video reveal, warfarin treatment is a complex matter for primary care physicians, surgeons and other health specialists, and dentists may be a better starting point for tracking and sharing that data than other health professionals.

Group practices, simply because of the volume of patients seen, are especially in need of understanding the research about drug interactions. However, all dentists need to be aware of interactions and concerns for the oral-systemic connection, and drug effects.

Lessons Learned:

  • Warfarin withdrawal is crucial for all surgery, is poorly understood by practitioners, and is affected by known genetic variants that can be tested for, stored in an EHR and thus inform treatment.
  • Dentists may be key collectors of salivary pharmacogenetics data, and as such may be key to the standardization and spread of genetic data via the dental EHR to all health care professionals.
  • The microbiome of the mouth is important for several conditions (like diabetes) and tracking it in the dental EHR may provide predictive and treatment information to patients and clinicians.

Brilliant, Murray (2011) “Pilot Demonstration Project Group 2: Periodontal Microbiome” Genomic Medicine Centers Meeting II, Dec. YouTube: