Source: J Clin Periodontol. 2009 Jul;36 Suppl 10:15-9.       PerioFrogz Issue No.: 1109

Overview:

This article provides an update on research efforts aimed at determining if periodontal treatment reduces the incidence of cardiovascular disease.

Summary of research:

• Interventional trials conducted by various researchers were reviewed in this article
• Interventional studies are designed to determine causality by providing treatment and observing changes in the disease under investigation

Results and Conclusions

• Intensive perio treatment reduces systemic inflammation and improvement in endothelial dysfunction in healthy subjects
• Evidence indicates that severe, generalized periodontitis causes systemic inflammation and endothelial dysfunction
• Periodontal disease prevention and treatment may contribute to prevention of atherosclerosis by reducing chronic inflammation and improving endothelial function.

Key take-aways:

Interventional studies determine the impact of periodontal treatment on various systemic conditions and diseases. Previous research has determined that periodontal diseases contribute to the total inflammatory burden in the body. This review article concludes that research to date indicates that treating periodontal disease may reduce the occurrence of atherosclerosis, thereby reducing the incidence of cardiovascular events such as heart attack and stroke. If further studies affirm these conclusions, the prevention and treatment of periodontitis will have effects beyond the oral cavity.

Implementation Strategies:

One of the biggest challenges we have as clinicians is communicating the urgency of treating periodontal disease to the patient without sounding like an alarmist. Try this approach and let me know how it works.

“John, as I normally do, I will be checking your gum tissues to be sure they are healthy. Before I do that, I wanted to share some important health information with you. I am sure you have heard that chronic inflammation is a major risk for heart disease, diabetes, rheumatoid arthritis, stroke and Alzheimers disease. Many people do not realize that periodontal disease is a preventable chronic inflammatory disease. So today I am going to take a very careful look to be sure you do not show signs of chronic inflammation.”

This dialog assumes health but at the same time conveys a very clear message. Periodontal disease is a very serious chronic inflammatory condition that is easily treatable. Favorable treatment outcomes benefit the patient by reducing their overall inflammation, thereby improving their level of health risk.

As clinicians we must remind ourselves that the clinical signs we see may not be a true reflection of the bacterial invasion. For example, we diagnose gingivitis and treat it as such. There is improvement, but the next time you see the patient the condition has returned. This is a very common occurrence for the dental hygienist.

To overcome the obstacles inherent in using only a subjective diagnosis, you may want to consider DNA testing. Knowing the specific pathogens that are present will assist the clinician in selecting the best treatment paths and maintenance schedule. This is especially critical for those patients who have risk factors like, heart disease, diabetes, tobacco use and previous history of periodontal disease.