A new expert report published in the journal Current Medical Research and Opinion examines the potential link between oral hygiene, associated gum disease and other systemic diseases involving inflammatory processes such as cardiovascular disease (CVD) and diabetes. The authors conclude that current evidence suggests periodontitis is associated with an increased risk for CVD and diabetes.1
Primary care practitioners are encouraged within the report to educate their patients about the importance of maintaining a healthy mouth for conferring potential public health benefits.
For the first time in the UK, a multidisciplinary group of experts in the fields of cardiology, endocrinology and periodontology reviewed the latest clinical evidence to examine the emerging evidence for an association between periodontitis and systemic conditions. In addition to finding a potential link between periodontitis and increased likelihood of CVD, the group found that periodontitis is also often more severe in subjects with diabetes mellitus, a group already at increased risk for cardiovascular events.
Dr Ray Williams, a leading periodontist in the US at the University of North Carolina School of Dentistry and lead author of the report, said: ‘There is an urgent need for dentists and physicians to work more closely together in understanding and improving patient health. The promotion of good oral health, as part of better overall health care should be seen as a natural extension of current healthy lifestyle messages around diet, exercise and the cessation of smoking, which are designed to help reduce the burden of CVD and diabetes.’
The infectious and inflammatory burden of chronic periodontitis is thought to have an important systemic impact on overall health. The exact reasons are unknown, but may be the result of oral bacteria entering the bloodstream and/or the systemic inflammatory reaction produced in response to the oral bacteria. Further research to determine the inflammatory pathophysiology of periodontitis, CVD and diabetes and the oral bacteria cascade, should identify potential links between the conditions.
Dr Margaret Kellett, Dean and Head of Periodontology at Leeds Dental Institute and one of the report’s authors commented, ‘The interaction of oral health and general health has been long recognised in the dental profession.
Through this consensus report both dental and medical literature has consolidated the need to further emphasise the necessity for dental and medical professionals to collaborate in both clinical care and research. The evidence base supports commissioning of targeted preventive dental care as part of the general health care plan for high risk medically compromised patient groups.’
Within the last decade periodontitis has attracted much interest as a potential risk factor not only for CVD and diabetes, but also for its association with adverse pregnancy outcomes, respiratory disease, kidney disease and certain cancers. The idea that oral infection and inflammation within the mouth can reach distant sites and organs in the body, or the ‘focal infection theory’, was a popular concept in the 1920s but interest waned.
Then in 1989, with compelling reports from Finland of the link between CVD and periodontitis, there has been a major effort to elucidate the relationship of oral health to general health The emerging position of periodontal disease in cardiovascular and metabolic disease research has been recognised by the World Heart Federation and by the American Diabetes Association congress committees as a topic for inclusion within recent and forthcoming international congress programmes.
On reading the new report Dr Tony Jenner, Deputy Chief Dental Officer for England commented ‘The Department of Health launched ‘Delivering Better Oral Health–An evidence based tool kit for prevention’ in September 20072. This document intended for use throughout dental care services aims to provide practical evidence-based guidance to help promote oral health and prevent oral disease. We welcome this new report and it reinforces the current drive for greater emphasis on prevention of ill-health and reduction of inequalities of health by the giving of advice and application of evidence-informed actions.
It is important that the whole dental team, as well as other healthcare workers, give consistent messages and that those messages are up to date and correct. This literature review does however identify a lack of prospective studies at this point in time linking periodontal disease with CVD and until such studies have taken place we should be cautious in attributing a causal effect’.
The new report, The Potential Impact of Periodontal Disease on General Health represents the first time that such a broad group of UK experts has convened to explore the growing body of research into this important area. The meeting was supported by an unconditional educational grant from Colgate-Palmolive.
1. Williams RC et al. The potential impact of periodontal disease on general health: A consensus view. Curr Med Res Opinion 2008; 24(6):1635-1643
2. Delivering Better Oral Health – An evidence-based toolkit for prevention, September 2007, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_078742