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Periodontal specialist Professor David Herrerra outlines the importance of periodontal health

In the first of an exclusive new series created together with GSK, Professor David Herrerra highlights the importance of periodontal health in a Q&A session with Dental Review editor, Derek Pearson.

Q: Periodontal disease has been highlighted in recent days. Poor perio has been linked to Alzheimer’s disease, low birth weight, heart disease, diabetes and even cancer. What proof is there, if any, that perio is causative? Or, is perio actually caused by a systemic disease demonstrating in the mouth? What I mean is – which comes first, conditions like diabetes or poor perio?

A: Periodontal diseases, and among them, periodontitis, are infectious conditions, caused by bacteria located under the gingival tissues (gums), which trigger a local inflammatory response that can result in the progressive destruction of the periodontal tissues and, if left untreated, in tooth loss.

Bacteria present in the subgingival are able to access the systemic circulation, causing bacteraemia (presence of living bacteria in the blood). This will induce, together with local inflammatory response, a state of systemic inflammation in patients with periodontitis.

Based on this, periodontitis has been associated with an increased risk of suffering different systemic conditions: up to 54 have been evaluated so far. However, among them, there are a group of conditions which have demonstrated to present strong evidence to support the association.

It cannot be said that there is causality in the association, but evidence clearly supports that periodontitis is an independent risk factor for cardiovascular diseases and diabetes. In some studies, with prospective design, it was clear that the putative risk (periodontitis) was there before the studied condition (diabetes or cardiovascular disease).

Q 2: Should dentists be looking at perio as a demonstration of systemic health, and if so what are the most common indicators?

A: Dentists need to understand that oral health is part of general health. General health is impossible without oral health. Therefore, suffering a relevant infection in the mouth (e.g. periodontitis) has relevant systemic implications, including bacteraemia, increased systemic inflammation, and higher risk of suffering important systemic conditions, such as diabetes or cardiovascular diseases.

Therefore, primary prevention, early detection and management and, then, secondary prevention of periodontitis, become critical not only for the problems in the mouth (which are already very relevant), but also as part of the overall health of our patients.

In addition, periodontitis is one of the chronic non-communicable conditions, and it shares relevant risk factor with other non-communicable conditions, including smoking, obesity, sedentarism... Dentists should be aware of the importance of controlling these common risk factors, based on their relevance for the oral disease, but also for controlling the risk of other systemic conditions.

Oral hygiene, including tooth brushing with a fluoride dentifrice, at least twice per day, during at least two minutes, and interdental brushing with dental floss or an interdental brush, at least once per day, are the basis to prevent the formation of dental plaque and, as a consequence, the risk of suffering periodontal diseases or caries.

In addition, some dentifrices and mouth rinses include agents that have demonstrated efficacy in helping to control plaque and gingivitis. Routine check-ups with the dentist/periodontists - normally once per year – are crucial for maintaining periodontal health, and professional tooth cleaning may be necessary to eliminate plaque and calculus.

And finally, it is critical to control the risk factors: smoking, diabetes, obesity, and sedentarism etc.

Oral hygiene should be part of the healthy life style.

Author
Professor David Herrera is Professor of Periodontology, and Associated Dean for Clinics and Co-director European Federation of Periodontology Graduate Program in Periodontology at the University Complutense of Madrid