More news on the oral-systemic link

Maria Perno Goldie, RDH, MS, shares the latest information in research conducted between the link between oral disease and systemic disease.

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According to the American Dental Association (ADA), good oral health is not a luxury, but essential to overall health. In “Actions for Dental Health,” the ADA outlines how dentists can make a difference in community health.(1)

They have goals for reducing the amount of tooth decay in children and adults, and for getting low-income children into care. Reducing trips to the emergency room for oral care, and working with community health centers and Federally Qualified Health Centers (FQHCs) are a part of the plan. Nursing home care, Give Kids A Smile, expansion of community water fluoridation, improved utilization of the existing safety net, and referring consumers to the ADA’s consumer website launched in July 2012.(2)

There is a “Dental Divide” infographic available for download.(3) Click here to view the infographic. Read more about the report to Congress.(4)

We know there is a link between oral disease and systemic disease. One study showed the relationship between change in periodontal clinical and microbiological status and progression of carotid atherosclerosis in The Oral Infections and Vascular Disease Epidemiology Study.(5)

They found that improvement in clinical and microbial periodontal status was related to a decreased rate of carotid artery intima‐medial thickness (CCA‐IMT) progression at 3‐year average follow‐up. For an editorial on this study, and for another perspective, read this article.(6)

It states: Important questions regarding this association remain unanswered: What is the nature of the association? Does one disease influence the pathogenesis of the other? How might the association influence treatment strategies?(6)

Other researchers acknowledge that there are reported links between periodontal disease and cardiovascular risk, but they feel there is insufficient data, especially from populations with established coronary heart disease. Their study describes self-reported indicators of periodontal disease and associations with cardiovascular risk factors in a global stable coronary heart disease population.(7)

Self-reported indicators of periodontal disease were common in this chronic coronary heart disease population and were associated with an increasing socioeconomic and cardiovascular risk factor burden. However, they feel that causality between self-reported periodontal disease and cardiovascular risk and outcome needs further investigation.

Poor dental health has been shown to be an independent risk factor for mortality in patients with end-stage renal disease, according to results released at the 51st Congress of the European Renal Association–European Dialysis and Transplant Association.(8)

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Researchers at Columbia University Medical Center (CUMC) have devised a new system for classifying periodontal disease.(9) The system is based on the genetic signature of affected tissue, rather than on clinical signs and symptoms.(10) The new classification system may allow for earlier detection and more individualized treatment of severe periodontitis, before loss of teeth and supportive bone occurs.

One thing we do know, is that good oral hygiene can help improve oral health. Whether there is a causal link, or not, routine brushing, interdental cleaning, and visiting a dental hygienist and dentist regularly will help preserve health and teeth. There is no downside to having a healthy mouth, but many benefits. If male patients need convincing, explain that a Turkish study found that men with inflamed tissue caused by severe periodontal disease were three times more likely to suffer from erection problems!(11) We must do what we can to motivate our patients!

Editor’s Note: Special issue: Periodontitis and Systemic Diseases--Proceedings of a workshop jointly held by the European Federation of Periodontology and American Academy of Periodontology. Co-edited by Maurizio Tonetti and Kenneth S. Kornman. The workshop was funded by an unrestricted educational grant from Colgate-Palmolive to the European Federation of Periodontology and the American Academy of Periodontology. All manuscripts were fully peer reviewed.(12)

RELATED | Are dentists interested in the oral-systemic disease connection?

References
1. http://www.ada.org/~/media/ADA/Public%20Programs/Files/action_for_dental_health_goals.ashx.
2. http://www.mouthhealthy.org/en/.
3. http://www.ada.org/~/media/ADA/Public%20Programs/Files/ADA_Dental_Divide_in_America_Infographic.ashx.
4. http://www.ada.org/en/public-programs/action-for-dental-health/report-to-congress.
5. Desvarieux M, Demmer RT, Jacobs DR, et al. Changes in Clinical and Microbiological Periodontal Profiles Relate to Progression of Carotid Intima‐Media Thickness: The Oral Infections and Vascular Disease Epidemiology Study. J Am Heart Assoc., 1-10, 2013.
6. Van Dyke TE and Starr JR. Unraveling the Link Between Periodontitis and Cardiovascular Disease. J Am Heart Assoc. 2013; 2:e000657; originally published December 16, 2013.
7. Vedin O, Hagström E, Gallup D, et al. Periodontal disease in patients with chronic coronary heart disease: Prevalence and association with cardiovascular risk factors. European Journal of Preventive Cardiology 2047487314530660, first published on April 10, 2014 doi: 10.1177/2047487314530660.
8. http://www.renalandurologynews.com/poor-dental-health-boosts-mortality-risk-in-esrd/article/351557/.
9. Kebschull M, Demmer RT, Grün B. Gingival Tissue Transcriptomes Identify Distinct Periodontitis Phenotypes. JDR May 2014 vol. 93 no. 5 459-468.
10. http://www.dentistryiq.com/articles/2014/03/columbia-group-points-to-genetic-signature-for-classifying-periodontal-disease.html.
11. Eltas A, Oguz F, Uslu OM and Akdemir E. The effect of periodontal treatment in improving erectile dysfunction: a randomized controlled trial. J Clin Periodontol 2013; 40: 148–154. doi: 10.1111/jcpe.12039.
12. http://www.joponline.org/toc/jop/84/4-s.

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Maria Perno Goldie 2014c FoMaria Perno Goldie, RDH, MS, is the editorial director of RDH eVillage FOCUS.

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