Are dentists interested in the oral-systemic disease connection?
Dec. 6, 2013
A study looked at dentists and the oral-systemic connection.(1) Dentists in the USA see an increasing number of patients with systemic conditions. These patients are challenging to treat when the relationship between oral and systemic disease is not well understood. The dominance of professional isolation exacerbates the problem due to the difficulty in finding expert advice or peer support. This study intended to: identify whether dentists discuss the oral-systemic connection and what aspects they discuss; understand perceptions of dentists and attitudes toward the connection; and to determine what information dentists need to treat patients with systemic conditions.(1)
The methods used for the study were to retrieve 14,576 messages posted to the Internet Dental Forum from April 2008 to May 2009.(1) Using natural language processing and human classification, the researchers identified substantive phrases and keywords and used them to retrieve 141 messages on the oral-systemic connection. They conducted coding and thematic analysis to identify recurring themes on the topic.
What was found is that dentists discuss a variety of topics on oral diseases and systemic health, with the association between periodontal and systemic diseases, the effect of dental materials or procedures on general health, and the impact of oral-systemic connection on practice behaviors as the leading topics. They also disseminate and share research findings on oral and systemic health with colleagues online. However, dentists are very cautious about the nature of the oral-systemic connection that may not be causal. Nonetheless, they embrace the positive association as a motivating point for patients in practice. When treating patients with systemic conditions, dentists ask about the cause of less common dental diseases potentially in relation to medical conditions in one-third of the cases and in half of the cases seek clinical guidelines and evidence-based interventions on treating dental diseases with established association with systemic conditions. The conclusions are that dentists’ unmet information needs call for more research into the association between less studied dental conditions and systemic diseases, and more actionable clinical guidelines for well-researched disease connections. To improve dissemination and foster behavioral change, it is imperative to understand what information clinicians need and in which situations. Leveraging peer influence via social media could be a useful strategy to achieve the goal.
American College of Cardiology Along these lines, new guidelines issued November 13, 2013, by the American Heart Association (AHA) and the American College of Cardiology (ACC) that specify new risk factors for using cholesterol-lowering statin medicines.(2) Experts estimate that if followed in practice, the recommendations could increase the number of patients on statin therapy by more than two-fold. Specifically, the guidelines recommend to more broadly assess a patient’s risk for cardiovascular diseases and prescribe moderate- or high-intensity statin therapy to patients with either cardiovascular disease, an LDL level of 190 mg/dL or higher, patients with type 2 diabetes who are between 40 and 75 years of age, and patients with an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75 years of age. The new guidelines recommend staying on statin therapy irrespective of LDL cholesterol levels, eliminating a need for frequent blood testing.
American Heart Association The new guideline recommends moderate- or high-intensity statin therapy for these four groups: patients who have cardiovascular disease; patients with an LDL, or “bad” cholesterol level of 190 mg/dL or higher; patients with type 2 diabetes who are between 40 and 75 years of age; and patients with an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75 years of age (the report provides formulas for calculating 10-year risk).
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The full text of the report, “2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults,” will be published in future print issues of the of the Journal of the American College of Cardiology and the American Heart Association’s journal Circulation. It is also accessible on the ACC website(3) and AHA website(4).
