Health Care Professionals have been aware of the link between systemic disease (ie, heart attacks, strokes, diabetes, premature babies) and oral disease, the recent research now shows unequivocally that the dentist successfully treating periodontal disease should be receiving the majority of his/her patients as referrals from these same Heath Care Professionals (cardiologists, endocrinologists and OB/Gyn’s). They know that the blood that flows through the gums, also goes to the heart. It can carry bacteria to arterial plaques.
The Oral / Systemic Disease Connection came into prominence with the U.S. Surgeon General’s report in May of 2000: US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General-- Executive Summary, 2000.
“The terms oral health and general health should not be interpreted as separate entities. Oral health is integral to general health; this report provides important reminders that oral health means more than healthy teeth and that you cannot be healthy without oral health”.
Studies have demonstrated an association between periodontal diseases and diabetes, cardiovascular disease, stroke, and adverse pregnancy outcomes.
What is new?
While the statistical relationship has been well documented, it has remained until recently to demonstrate that the periodontal disease is a causal factor and not just a correlated bystander, and that in fact removing the periodontal disease reduces the risk of the systemic disease. The mouth, with its 500 different naturally occurring organisms, is only second to the intestines in the number of bacteria present. Periodontal disease allows these bacteria to enter the bloodstream and create problems. Secondly, periodontal disease is a main cause of inflammation in the human body. Inflammation has been demonstrated to have a number of negative effects on health. One of the most significant concerns to researchers is the effect of C-Reactive Protein.
C-Reactive Protein is the body’s response to inflammation. This is what has changed. The following research is noteworthy in that it documents the causal relationship and that treatment of periodontal disease reduces the risks of systemic diseases.
Heart Disease
American Medical News: Levels of C-reactive protein may be a stronger predictor of potential heart attack or stroke than cholesterol, according to a study published in the Nov. 14 New England Journal of Medicine.
The investigators found that levels of both cholesterol and C-reactive protein were indicative of potential heart attacks and strokes, although the latter was more so. Also, women with high levels of one didn't necessarily have high levels of the other.
UC Davis study identifies C-reactive protein as cause of blood clot formation. Jan. 25 print edition of the journal Circulation, a publication of the American Heart Association "The study provides further conclusive evidence that CRP, until now viewed as an 'innocent bystander' in the formation of heart disease, is in fact a key culprit that causes inflammation in the arteries, resulting in formation of clots and plaque that lead to heart attacks and strokes.
Treatment of Periodontal Disease significantly reduces CRP levels. ADA News April 4, 2004. Dr. Sara Grossi, SUNY Buffalo, senior author of the study, said. "Our results showed that in people who had elevated levels of CRP at baseline, removal of dental plaque bacteria by scaling or scaling combined with topical antibiotics produced a statistically significant reduction, bringing CRP levels close to the low-risk level."
Preterm, low birth weight babies
This trial indicates that performing SRP in pregnant women with periodontitis may reduce Pre term Birth in this population. Periodontal Disease and Preterm Birth: Results of a Pilot Intervention Study , Marjorie K. Jeffcoat, J Periodontol 2003;74:1214-1218.
Diabetes
Dr. Robert Genco, chairman of Oral Biology Department at SUNYAB, studies show that treating PI significantly reduced diabetic's blood sugar. Grossi et al. 1997. Treatment of periodontal disease in diabetics reduces glycated hemoglobin. J. Periodontal 68(8): 713-719.
Our “Centers for Dental Medicine” now offer free periodontal risk analysis for all Cariology patients, diabetics and pregnant women as a public service.
The problems with conventional Periodontal Treatment
Until recently, periodontal treatment has revolved around the mechanical removal of calculus and plaque from the teeth, assisted often by surgery to provide access to the calculus, remove the disease and pockets.
This was painful and all too often provided only a temporary cure, a few years later the disease had returned. This gave rise to the mantra in dentistry that periodontal disease could only be managed and not cured.
Putting periodontal disease into “remission”.
While periodontal disease was once thought to be caused by the accumulation of plaque and calculus and treated by mechanical means, it is now recognized that the cause of the disease is the proliferation of certain anaerobic bacteria in the presence of volatile sulfur compounds which are generated in the mouth each day, exacerbated by nutritional deficiencies, lifestyle (smoking) and systemic disease. “Bad breath” is the evidence that the sulfur compounds are at work.
The comprehensive treatment includes:
• Providing nutrients to support periodontal health and suppress inflammation
• Controlling the bacteria using a laser before and during active treatment
• Removing the irritants (Biofilm) and providing an environment for re-attachment using conventional scaling and root planning
• Laser Debridement of the diseased tissue and encouraging regeneration of new tissue
• Long term home care based upon daily irrigation with a Chlorine Dioxide preparation to control the bacteria and Volatile sulfur compounds
• Dealing with the lifestyle changes as necessary
This is normally offered as a comprehensive treatment with sheduled recare visits at 6 to 8 week intervals.
This process normally replaces periodontal surgery, and it has been reported that Scaling and root planning when accompanied by Laser Assisted therapy is more comfortable than scaling and root planning alone.