There are new studies being conducted to try and determine the causative relationship between systemic health and periodontal disease. We know there is a strong connection but which came first. Does periodontal disease create the environment for greater susceptibility to cardiovascular disease or does the prescience of cardiovascular disease create greater risk for periodontal breakdown? After monitoring the progress of periodontal disease in my practice over a prolonged period, I believe there is a symbiotic relationship. I have seen periodontal breakdown in a patient exacerbate and then finding out the patient had a heart attack with subsequent bypass surgery. After the patient returned for dental visits the periodontal disease reverted to a more stable controlled condition. I would have thought that the patient’s periodontal condition would have gotten worse because of the reduced hygiene while recovering from the prolonged hospital stay.
In February researchers reported that adults over the age of 55 who have a higher proportion of bacteria linked to active periodontal disease also tend to have thicker carotid arteries which are a strong predictor of stroke and heart attack. This study was conducted by the NIH and published in the journal “Circulation”. The studies lead author, Moise Desvarieux, MD, PHD, said “What was interesting was the specificity of the association. These same 4 bacteria were there, they were always there in the analysis with one exception.” The study of 657 adults had their oral bacteria and carotid thickness evaluated at the same time. So which came first, the oral bacteria or the carotid thickness? There is now a study being conducted by the National Institute of Dental and Craniofacial Research under Dr, Desvarieux to follow the progression of which indicator shows up first, the carotid thickness or the 4 bacteria linked to periodontal disease.
Also in February there was a report in the “Journal of Oral and Maxillofacial Surgery” that the presence of third molars not fully impacted affected periodontal health. When these third molars were present the patient was 1.5 times more likely to have 5mm or greater periodontal pockets on the distal of second molars than those patients who did not have third molars.
An article in the January issue of “Diabetes Care” reported a link between patient mortality in type 2 diabetes and the severity of periodontal disease in that patient. The study involved 628 Pima Indians age 35 and older. The researchers used panoramic radiographs and examinations to determine the severity of periodontal disease. As the severity of the periodontal disease increased the mortality rate increased significantly. Type 3 diabetes patients with severe periodontal disease as defined in this study had a mortality rate 3.2 times greater than type 2 diabetes patients with no or mild to moderate periodontal disease combined! The researchers wrote “Periodontal disease is a strong predictor of mortality from ischemic heart disease and diabetic nephropathy.”
It is becoming more apparent that periodontal disease contributes to systemic problems. The causative bacteria in periodontal disease initiate, exacerbates or is an indicator of serious systemic problems. It is imperative that every dental office have a protocol for carefully evaluating and treating periodontal disease. If your dental office does not wish to treat this problem it is your obligation to refer the patient for the necessary treatment. I have been training dental offices since 1988 to recognize and treat periodontal disease. Every general dental practice has the ability to effectively recognize and treat periodontal disease non-surgically and refer those patients that need periodontal surgery. It is your obligation as health professionals to help your patients prolong their quality of life. Patients in your practice who ignore this problem and avoid treatment of active periodontal disease cannot be acceptable. For the sake of your patients make sure your practice makes eliminating periodontal disease a priority.
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