The state of the oral-systemic connection

By Richard H. Nagelberg, DDSSo where are we with the various oral-systemic connections at this point in time? Much has been studied and written, some of which is supportive and some not so supportive of the relationship between periodontal disease and a variety of systemic diseases and conditions. At this point, the consensus in the dental and medical professions is that there is a link. The strength of these associations is currently the focus of considerable research.The bi-directional relationship between periodontal disease and diabetes mellitus is the strongest. It is recognized by the American Diabetes Association and is an area in which dental providers should be well versed. Knowledge of a diabetic individual’s level of blood sugar control significantly impacts perio treatment decisions, treatment outcomes, risk assessment, and prognosis. Research indicates that controlling perio disease in our diabetic patients may improve glycemic control. This is critical since diabetic complications are directly related to how well controlled they are. Diabetic complications are life changing and life threatening. Among the most common complications are retinopathy, neuropathy, and nephropathy. Approximately 65% of diabetic individuals die from cardiovascular diseases. The increased risk of a future heart attack or stroke among patients with gum disease is generally accepted in the dental and medical communities. The exact mechanism of the link between these diseases is not certain at this point; however, the inflammatory response seems likely from research. The same inflammatory mediators, including C-reactive protein are common denominators. Direct effects of oral bacteria on blood vessels may also play a role. Research has not consistently shown the strength of the link between perio disease and adverse pregnancy events to date. Some aspects have been irrefutably determined; however, most notably oral-utero transmission of bacteria. Further research will likely determine the contribution of perio diseases to the rate of preterm, low birth weight babies. Recently, some studies have concluded that a link exists between gum disease and rheumatoid arthritis (RA). One recent study conducted by two MDs and a PhD (Smolik I, et al. Compendium. May 2009; 30(4):188-197) concludes that the perio pathogen P. gingivalis plays an integral role in the series of events that culminates in the autoimmune joint destruction typically seen in patients with RA. The authors state that if further research affirms their findings, the elimination of P. gingivalis may prevent the onset of RA. If so, this would be one of the biggest breakthroughs ever. The common thread between perio diseases and the systemic conditions discussed above appears to be the body’s inflammatory response. In fact, the same inflammatory mediators are common to all. Going forward, greater awareness of the oral contribution to the total inflammatory burden and the effect on whole body health will be crucial.As dental providers, the need to address perio disease in a comprehensive manner has never been more important. Even without bulletproof evidence of the oral-systemic connections at this point, research is quite compelling. Treating every patient, every time he or she is under our care, with any level of perio disease will ensure we are treating people, not oral cavities ... and in the end that is what it is all about. © 2009 Richard H. Nagelberg, DDS