Behind a Smile with Dr. Shauntel Ambrose

Pioneering Dental Health: Dr. Ahmad Hamdan on the Evolution of Periodontics and Oral Care Innovation

• Shauntel Ambrose • Season 2 • Episode 2

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Join the enlightening journey with me, Shauntel Ambrose, as I sit down with Dr. Ahmad Hamdan, a periodontist  par excellence from the University of Jordan, whose academic and clinical journey has taken him from the historic halls of Parisian institutions to the cutting edge of dental innovation. Dr. Hamdan, a figurehead in periodontal disease and biomaterials, shares his captivating evolution from a dentist to a vice dean and international expert in Periodontology. 

As we navigate the intricate connections between dental health and broader wellness issues Dr. Hamdan underscores the power of patient education and the significant collaboration between general practitioners and periodontists in revolutionizing patient care. The discussion advances into the future of periodontics, where the paradigm is shifting from extraction to preservation, and where the treatment of both teeth and implants demands meticulous, lifelong care. Get ready to be inspired by a visionary who leads the charge in shaping the future of dental health, and don't forget to bring your curiosity as we tease the upcoming discussions on leadership and the orchestration of successful multi-practice operations.

Speaker 1:

I'm Shantel Ambrose and I'm a dentist and I host a healthcare business podcast that shares tips from the healthcare industry leaders. So, whether you're a startup or needing a push in the right direction, a family business or just looking for mentorship, join us. Hello everyone, I am speaking to an amazing guy today from the University of Jordan. So I'm speaking to Dr Ahmad Handan and he is an associate professor. I'm really excited to have you on board today. I want to just share with our listeners. First, just a little bit about you. So you graduated from the University of Jordan in dental surgery. You've done your masters in osteoarticular biology, biomaterials, as well as bio functionality. You've gone to the University of Diderot in Paris and you did a master's degree in periodontology. You know you've you're trained in periodontology and implanted dentistry and you're an associate professor and consultant periodontist in Jordan, so welcome.

Speaker 2:

Thank you very much. I'm really excited, privileged and honored to be with you today. Thank you very much for the introduction. Yes, I did my training in Perio in Paris and has shaped my life in multiple ways.

Speaker 1:

When I met you and you told me oh, you know, just off the cuff, you know, I did do a little bit of training in Paris, I think anyone who does the circles of academia. We understand that it is a very rigorous process and one that is very respected, and was the first thing I even remember about our interaction when we met was that it is no easy fate, and I do want to chat a little bit about that. But let's first start off with how did you get into this industry of dentistry and then specializing in periodontology?

Speaker 2:

Well, actually I wanted to be in the medical field since my childhood. I was always fascinated by doctors. It was not dentistry per se, it was not specifically dentistry. I actually wanted to be a vascular surgeon at the beginning, but circumstances, fate and destiny ended up leading me into dentistry. So I did my dental school in the University of Jordan and then, thanks to the fact that I learned French during my childhood, I ended up securing a scholarship from the French government to my university, to the University of Jordan. This is how I started my journey with periodontics. I went to France. I spent six years there where I did my master degree in research in biomaterial and osteoarticular biology and biofunctionality, and then I did another master in periodontics, my PhD and my specialization in periodontics and implant dentistry.

Speaker 1:

This is amazing. I really congratulate you on that, and I know that now you're doing quite a number of different positions, so can you share with us what's your current position now in Jordan and do you serve on any of the Associative Boards? Give us a little bit of an idea of your roles that you currently play.

Speaker 2:

Nowadays I'm serving as the Vice Dean for Hospital Affairs.

Speaker 2:

I am responsible of everything related to the hospital because we are part of the Jordan University Hospital, so we have a hospital based practice in dentistry where we have a big dental department at the University Hospital with almost 50 specialists, as well as our students. But I'm responsible mainly for the affairs related to the hospital and the functions, daily functions and daily work of the hospital, especially that we are working now on establishing a new dental hospital. It will be one of the biggest in the region with almost 340 dental chairs. So it's quite a busy period now. That's why I'm not sitting on any other board. I used to be part of the elected board of the Jordanian Dental Association a few years ago and now, as I told you, it's only the faculty board, the School of Dentistry Board, where I think I have quite a good experience and a good bunch of job and work to do these days. But in addition, I am part of the international team for implantology. I am the study club director for Amman and that's it.

Speaker 1:

Yes, well, I think that just earlier on we were talking about how you just recently come back from Germany, and what I really admire about your capacity is that, despite you being tremendously busy, you're still able to make up a large percentage of your time to keep on going in terms of keeping yourself current and involved in the current trends. So tell us a little bit about your trip abroad.

Speaker 2:

Actually, I went to Germany to learn about new techniques and relatively new technique in bone grafting. I always wanted to learn that technique and I think that we always need to continue learning. Learning is a lifelong process and the moment we decide that we learned everything, we would start to become ignorant. This is my motto, the thing that I believe in every single day, and this is what makes me moving. It was a very, very enriching experience and trip, both on the medical or technical part of it, along with the other part. I am a history lover. I love history. I always like to learn new things about the history of the places where I visit. So I went to three or four museums related to the history of Germany First World War, second World War and it was very enriching experience.

Speaker 1:

Well, thank you for sharing that with us. Now I know that you also are involved with patients in private practice, and can you give us an idea now of really now your exposure? I'm sure that during your studying time in Paris and then you've come over to Jordan, what are the main differences between patient profiles? That from your perspective and from your experience.

Speaker 2:

The patients differ in the same way they differ culturally. So it's the cultural difference between patients. However, when we go and talk into more details about the profile of periodontal disease, we end up having the same thing, because periodontal disease is not culturally based. It is related to the evolution of human being. Periodontal disease has been there since thousands of years and it is related to the relationship between our organism and the bacteria and the microorganisms that are living in symbiosis with us. When we talk about the bifilm, the microbiome, we are living in symbiosis with these microorganisms that are living on our skin, in our mouths, in our guts. So if we talk about the pathogenesis or about the mechanisms by which the disease establishes itself, there is no difference. However, the access to care, the response of patients to the treatment or to the advices or the educational messages given to them, is a bit different because of the cultural differences between different societies and their capacity to get access to care.

Speaker 2:

If we talk about France, france is one of the most advanced countries in the world. It has a very good income per capita and they have one of the most sophisticated and efficient healthcare systems where all people have access to care. So they have a better access to dental care, along with other domains in medicine In Jordan. In the country it is a medium to low income country. People are struggling to get everyday basics in their lives, so they might not be able to get good dental care because they need to secure much more important and primordial things before starting thinking about their dental care. So because of this we end up having a bit more severe cases. Although I don't have any figures, so this is only based on a personal deduction. Sometimes we see advanced and severe cases in Jordan at a relatively younger age.

Speaker 1:

Thank you for explaining that so well. Peridontal disease is something that we as generalists. We see the patient and we get to know the patient, we get to know the environment and we wait quite a long period of time. We do have the limitations in South Africa that could be comparative to something that's quite similar, from what I can understand, in Jordan. So we do have now this middle to low income base. People are struggling to get healthcare and a lot of their decisions in healthcare based on costs and these costs are quite phenomenal when we are at a late disease stage. And from listening to a lot of the information that you provided, I really thought about it as a generalist and I thought what can we do differently as generalists to try to get patients to you, to periodontists, before they reach a late stage, to help them regenerate a lot of what they can regenerate. So what are we missing as generalists from your perspective? What can we do better?

Speaker 2:

I think it is. It could be related to the screening methods that we use as generalists and the examination methods. I don't know why, but in different parts of the world, even in Europe and the United States, in the West, I think we miss the detailed part of the examination in periodontics. So we usually tend to miss the fact that we need to do a full mouth chart for our patients, especially those who might be at a higher risk or those who are presenting certain signs or symptoms of an ongoing periodontal disease, because it is time consuming, it is a bit painful for the patients, so we usually end up doing what the patient came for and not paying that good attention that we need to pay for or to the fact that we need to examine the gums a bit more deeply.

Speaker 2:

So I think it is a bit related to the way that we examine our patients and the fact that, as we said before, our patients have a limited access to care. So when they come to visit us, they come for a specific problem. Usually it is a pain related one and they ask us only to do that problem and take care of that pain, which also sometimes lead us to a treatment approach that is related to the patient demand. That's why I always tell my students that you need to get the holistic image. You need to do a full examination. Even if you are going to become a periodontist later on or an orthodontist later on, you need to do a full examination so you can identify all the problems that are present there and then help your patient to get the care they need in terms of the problems that you are going to find. So the answer to the question is a bit complex and it has many facets that need to be dealt with to be able to find a good and long term based solution.

Speaker 1:

At the end of the year we do an evaluation change of all of the systems and processes that we have in place and remember we have changes that come from the 2023 year over to the 2024 year for the clinics and we are designated by a lot of boards that will give us an indication of what are fair prices and things like that. So this reevaluation that happens on an annual basis was where I was at when I returned from a congress that we were both at and I thought to myself what am I doing? That will, what can I change about the medical history? What is going to give me the clue that I need to go deeper and to go into what is called here an 8102. 8102 is a paid code just in South African camp talking about and I'm sure that throughout the world, four of our listeners that are listening that each one of us have now a simple consult where it is not periodontally based and we do not do a full mouth examination, and then there's a different tariff for an extended care visit where that includes now the periodontal health and for majority of the patients that we see I would say about 55% show up some systemic background.

Speaker 1:

So it's either they have rheumatoid arthritis or it's going to be diabetes. There's a chronic aspect somewhere along the line. I have a post spreading Peds and I do a lot of management and I have done a lot of management for pregnancy. So I do the pre and post natal care and I used to work a lot with the hospitals to to get people to understand that their periodontal and they just their oral health changes in pregnancy and so I do see a lot of these patients and so when it's marked on my chart, I just thought that maybe there here is an indication of me to think a little bit deeper about what is their periodontal status, like you know, just from my perspective, can you give me a little bit of an idea of what systemic conditions do we need to look out for, notoriously linked to an end game of periodontal disease?

Speaker 2:

actually the list is not that simple. It could be, it could be a big one, but the literature is still debating. We are still debating in the literature about the conditions, the system conditions, the chronic diseases that might be intimately related to periodontal disease. You know, at the end of the day, periodontal disease is only affecting the gums, so we might say, or many might say, that it is a very small area. How come that it might affect our systemic health? However, when we talk about the, the details of periodontal disease and the mechanism by which the periodontal disease establishes itself and by which the destruction occurs, we are talking about the inflammatory process and the immune system, and a long-lasting inflammatory response in our body would end up increasing the systemic markers of inflammation, and this is how the mechanism of the relation between periodontal disease and systemic conditions is established. So we can talk about any systemic condition that involves a pro inflammatory mechanism. Starting from there, we can start talking about the plausibility and the possibility of a potential relation between periodontal disease and that condition. For instance, some of the conditions that have been linked to periodontal disease are cardiovascular diseases you mentioned dermatoid arthritis, adverse pregnancy outcomes in terms of low birth weight or preterm birth diabetic complications.

Speaker 2:

However, I might need to open the parenthesis here and emphasize on the fact that having periodontal disease will not lead to the establishment of these diseases. Having these diseases will not lead to the establishment of periodontal disease. However, if both conditions are present and if you don't take care of both conditions, we might end up having a higher risk. I'm not saying an event. I need to weigh my words here. We are talking about a higher risk of having a complication in periodontal disease or in the system condition, because maybe five, ten years ago, the debate was was very, very hard in terms of cardiovascular diseases and the American Heart Association published a statement saying that you need to pay attention. We are not talking about an increased risk of microinfarction if you have gum disease. We know that. We need to establish that. We need to make it clear that having gum disease will not lead to microinfarction, but it might be one of the multiple small factors that, at the end of the day, would increase my risk to have that disease or to have the microinfarction. I'm sorry, so it is.

Speaker 1:

It is the relationship that that can be visible in those patients who don't take care of themselves, and usually these are the patients who are at a higher risk, whether it is periodontally or systemically thank you for clarifying, because we going about a way of just being able to expand just the ideas of trying to the disease sooner, and it's because our limitations are based on a lot of patients just wanting to get what is broken fixed. We often really do have these limitations of you. Don't look for a past, a point any longer. I'll tell you. You know just from my own experiences that when you, when you do that first examination, you see that patient for the first time, a lot has changed because you know the criteria and the environment says changed, and patients become very, almost impatient if you do not really just get to what they need done and so it's almost as though that they almost feel as though.

Speaker 1:

You know, I'm here for the filling. I don't want to talk about my bleeding gums and it's. You know, my bleeding gums have been a problem, it's just part of my life and I'm here for my filling. So I am aware that this conversation is difficult to to get going, but I also am aware that it needs to happen if we are going to improve on anything. Now, what is there that can be done for a patient? So when we send them off to the periodontist, what really can, can happen for them.

Speaker 2:

Well, it's difficult to answer it because it depends on the patient themselves from the beginning and actually it also depends on their relation with their general practitioner or their dental hygienists. If the, if the relation is well established and the patient knows that the general practitioner is sending them to the periodontist because they need that care, I think they will be, they will be on board, they will, they will be part of that relationship where they will invest in taking more care of their periodontal health and gum health. So I think it is it is more the relationship between the general practitioner and the patient that should be worked on. So the relationship that will take place later on between the or be established between the periodontist and the patient would be beneficial for the patient because usually, as periodontists, we receive the patient to do that part of periodontal care or gum care. We do our, we do our treatment, our non-surgical treatment, our surgeries, and then we send the patient back to their general practitioner. The patient will not continue following us, even for the long-term follow-up visits. So but however, patients would would benefit a lot from their visits to the periodontist because periodontists would look or would be able to find any other details that the general practitioner did not find or the patient did not mention to the general practitioner, especially in terms of history of treatment sometimes, or history of family history of periodontal disease. These are usually the main points that will trigger us to do our further detailed examination. So my point, my advice to to my students, is always to ask some key questions about the family history of periodontal disease and you've just mentioned it as well about the history of loss of teeth. If they have lost any tooth, what was the cause of that loss? Was it because of decay? Was it broken, or was it because the tooth was moving and the dentist has to take it away? So these key questions would help a lot in identifying patients who are at a higher risk and then the periodontist sometime will create a certain dynamic where the patient would be more involved in their treatment.

Speaker 2:

For instance, I myself I don't treat my patients from the first visit. I only do a consultation visit patients. They don't like that, so they came there to be treated. They were referred by their dentist, so in for them. I should know what I need to do and I start. I should start doing it from the first appointment, but what I do actually is I only do a consultation visit where I teach the patients about the disease, about the mechanism of the disease, regardless of their educational level, and then I show them the areas where they need to pay more attention in terms of cleaning, and then we establish the treatment plan and the number of appointments needed and we put a time schedule for them. This way I find it more productive in terms of patient complaints.

Speaker 1:

I think that we all know that periodontal disease is quite difficult to fix and when we reach that point of referring over to the periodontist, to be honest with you, we've done it for 20 years and each periodontist that we refer to requires just a baseline of information from the dentist in that referral letter. And over the years you'll find that certain periodontists some just want a baseline of what they're wanting from the patient, just so that they can do a full consultation, re-examination and really just the criteria of where they're standing in their level of disease. They want to know what you have been able to get from your data and then do a comparative analysis with their data when they base it on that first examination. So you get to learn what each periodontist in each office requires of you from a dentist. Now, from your perspective, what is the best referral that you will get from a dentist? What information does it have in that referral that helps you get to the next point in that first consultation you're having with that patient?

Speaker 2:

It is always very helpful if I can have a detailed history of the patient in terms of bone loss radiography and if the dentist is used to do periodontal screening. Many of my referring dentists now they do their dental screening and once they have a patient that has few periodontal pockets, they won't send the patient for you along with their intraoral x-rays. So this is very helpful because we can identify the progression of the disease. We can identify the degree of attachment loss and bone loss that has happened in addition to the recession that is ongoing. Some of my referring dentists also tell me that, okay, we have this gentleman or this lady. They are having dental recession.

Speaker 2:

That has been stable for the last five years. However, during the last few months, we've seen an increase in the recession of one or two millimeters. This is I can't get a more helpful information regarding the progression of disease. This would tell me that I need to intervene now. But if they send me the patient telling me that they have a recession but we have no any information, I would then start dealing with the patient as if they have not been seen at all by any other colleague, because I need to establish a history of the problem. So radiography, I would say, and any traces or any, any, any details about the history of probing depth, would be very helpful.

Speaker 1:

I remember you saying something about the link between periodontal health and natural birth and that there's a recommendation of now women not doing an elective cesarean and going back to natural birth. Can you expand on that a little bit, just for our audience's benefit?

Speaker 2:

Well, actually I'm not an expert in that field, but I've learned a lot about it during the last few years through documentaries and discussions with my colleagues, as well as the birth of my own daughters.

Speaker 2:

So I know that in many countries now elective cesarean section is not anymore covered by the social security system because we know that natural delivery is better for the future health of the individual. The establishment of the microbiome would be different if the infant is delivered through the natural pathway or through cesarean section. Some of the microorganisms cannot be acquired unless the individual has passed through the natural pathway and this has been linked to a certain risk of developing certain conditions such as obesity, irritable bowel disease and disease. So many gynecologists now they recommend the natural pathway delivery because of all that, in addition to the fact that it is better for the mother herself. I think this is a personal opinion. This has nothing to do with any science or any scientific data. For me, I always believe that anything natural should be followed. But if there is no direct relationship between the natural delivery or adperimental disease, except maybe for the establishment of the microbiome, I would think also that the microbiome formation is different between natural delivery pathway and cesarean section in terms of the risk of periodontal disease.

Speaker 1:

Listen, I think it's an evolving discussion and I appreciate that there's still a lot of research that needs to be done and just really the fact that the biome just changes Even the way we think about it. We know that there will be a different biome for each delivery technique. I wanted to know what's your thoughts on? Where is the future of periodontology?

Speaker 2:

Well, actually, I think it would not change that much during the next few decades. Periodontology, as we said in the beginning, is not related to our civilization. It is a disease that is there. It was there and I think it will be there, because it is based on our relation to the microbiome. However, we will be facing more and more problems because of the fact that we are having more patience with more teeth for longer periods of time. Life expectancy is getting better across the world, regardless of the economic level of the country or medicine is getting better. Our lives are getting better, maybe at different levels or at different percentages, but we are all getting better lives now, so life expectancy is improving.

Speaker 2:

Extracting teeth is not as famous as before. We are trying our best now to save teeth. We are trying more and more to save more teeth, so we are having more patience with more teeth for longer periods of time, which means that periodontal treatment and periodontal care needs to be there for longer periods of time. But I think that our approach should be different, because research is telling us now that we can keep teeth even if they have lost some bone, even if they have periodontal disease. We can save more and more teeth. So I think the future of periodontics would change in terms of doing more periodontal treatment, getting back to our classics, rather than extracting teeth and placing implants, because we know now that any implant that we place would face a problem at a certain point if we don't take good care of it. I'm not saying that we will stop placing implants or implant treatment.

Speaker 1:

So I want to thank you for being able to give us the time today. I congratulate you on what you've been able to contribute to for dental just for periodontal health. I really do commend you on what you've been able to provide in terms of information, not only to the scientific community but to patients at large. I think that your academic capacity is really appreciated and I'm really looking forward to what your future contributions are going to be like. I wish you well for the year. Thank you for being on.

Speaker 2:

Thank you, thank you very much, thank you very much for having me here with you, and I wish you a very excellent festive season and a very fruitful and productive and positive year ahead.

Speaker 1:

We have covered starting up and how to turn your vision into a business, and in our future episodes we look at leadership. We look at multi-practice success. I'm grateful for you and I would love to hear your ideas. What questions do you need answered? Please drop me a mail at behindasmile2atchillailcom. I look forward to hearing from you and remember you are heard, you are seen and on this platform, you are invited. Let's make it happen together.