There is a growing body of science in oral-systemic medicine. Dental hygienists have an opportunity to integrate new clinical protocols that include the application of such emerging information and research. The challenge is to base patient services on credible resources in the field.
Take the following true/false quiz as a fun way to test your oral-systemic insight.
1. True or False. There are clinical studies that collectively show a significant association of periodontitis with cardiovascular disease (CVD) and cerebrovascular disease (stroke).
2. True or False. Periodontal disease is now considered a major risk factor for CVD.
3. True or False. Some current research is focusing on the heat shock protein 60 (HSP60) as a new signaling sign of systemic inflammation.
4. True or False. Full-mouth probing and documentation is a familiar assessment process that hygienists can use to quantify the risk of systemic heart issues related to periodotnal infection.
5. True or False. I want to learn more, but there is yet a peer-reviewed quarterly publication that is dedicated to the oral-systemic medicine arena.
Answers:
1. True. As we know, local bacteria and periodontal infections stimulate cascading oral events, which result in an inflammatory response. Then chronic inflammation plays a role in the destruction of alveolar bone and connective tissues. A variety of inflammation markers have been associated with arteriosclerosis (pre-cursor to CVD) and ischemic stroke. Studies suggest that chronic periodontitis, or the response of the patient (host) to those chronic infections, may play a role in the pathogenesis of coronary heart disease and ischemic stroke.
2. False. Studies are showing that periodontal disease and plaque related heart diseases have common risk factors i.e. smoking, diabetes, and elevated levels of serum CRP etc. However, to date, chronic periodontitis cannot be demonstrated a direct cause of CVD. Chronic periodontitis exposes the body's defense to inflammatory events and mediators, and such constant attacks is proofing to be an important risk factor in the fight against cardiovascular disease.
3. True. Many clinicians have been reading in the research about the systemic inflammation marker marker -c-reactive protein (CRP). CRP is a protein produced by the liver in response to infection and if detected in blood serum, above the normal range then it is an indication of significant vascular inflammation. Such levels can be a prelude to future cardiovascular events. Patients with severe periodontitis, who have been tested, have been shown to elevate serum CRP levels. Now, some researchers are also turning to HSP60 as an inflammatory marker. Preliminary studies show that HSP60 may be used as an independent marker of risk. Future research may show that it the testing of HSP60 and other mediators like CRP, should be part of the prevention and management of periodontal diseases.
4. True. By taking into account the probing depths of the deepest periodontal lesions and their total number per patient, the practitioner can gather a quick overview of the surface area of the infected sites and such degree of potential permeability of the connective tissue. This can provide a relative risk factor for the patient for the release of inflammatory mediators. Since the research is developing which suggests that periodontal infections may predispose certain patients to an increase risk for arteriosclerosis- adhering to a full-mouth probing schedule may have the potential to save your patients life.
5. False. PennWell Corporation published a new peer-reviewed editorial concept called Grand Rounds in Oral-Systemic Medicine.™ Grand Round will not limit its circulation to dentist and hygienists, but it is including a group of 10,000 physicians and nurses. The new magazine will bring members of the dental and medical communities together to learn and create positive protocols and changes supporting the oral-systemic link. Casey Hein, BSRDH, MBA, and Charles M. Cobb, DDS, PhD, are the editors. For additional information, go to www.thesystemiclink.com.
References: All questions and answers can from the February 2006 (first edition) of the Grand Rounds in Oral-Systemic Medicine.
