A simple but effective oral hygiene routine is all it takesUncategorised
Posted by: The Probe 7th July 2020
Periodontal disease remains a major public health concern around the world. It has been estimated to affect up to 50% of the global population,[i] making it the most common chronic inflammatory disease in humans.[ii] As dental professionals, you know that periodontal disease can lead to several oral health problems, including tooth mobility and loss. Even more than this, gingival infections can contribute to the development of and exacerbate existing systemic health conditions. In fact, periodontal disease has been associated with at least half of the top 10 causes of death worldwide.[iii]
Getting the right messages out to the right patients is therefore crucial if we are to effectively help them reduce the risks. They need clear, honest and evidence-based advice that enables them to demystify the often conflicting or misleading information that can be found online and in the national media. Having built up a rapport with their patients and gained their trust, the dental team is ideally placed to steer patients in the right direction.
Epidemiological studies have shown that diabetes is a major risk factor for periodontitis.[iv] There is even evidence to suggest that patients with diabetes are two to three times more likely to develop periodontitis than non-diabetics.[v] This seems to be especially applicable where glycaemic control is poor, when diabetes increases the risk of periodontitis.[vi] One of the possible mechanisms by which diabetes drives change in the periodontal tissue is an alteration in its immunoinflammatory response. [vii] Confirming the bi-directional relationship, treatment of periodontitis has been associated with improvement of the diabetic condition.[viii]
Poor oral health has been associated with an increased risk of developing cardiovascular disease (CVD).[ix] One study[x] found that lower levels of tooth brushing could be associated with increased concentrations of C-reactive protein and fibrinogen. Both of these are linked to coronary arterial plaque formation, though C-reactive protein may be involved with the inflammatory response in atherosclerotic lesions and consequent cardiac events.[xi]
Both direct and indirect mechanisms have been considered to explain the link between periodontal disease and CVD. These include oral bacteria accessing the vessel wall through the blood stream, as well as periodontitis increasing the risk factors for CVD like high cholesterol and blood pressure. While evidence exists to fulfil most of the criteria that show a cause-effect relationship,[xii] more research is needed to confirm this due to common risk factors between the two diseases making the relationship difficult to determine.[xiii]
A 2018 study[xiv] found a 24% increased cancer risk among patients with severe periodontitis. The highest increase in risk was found for lung cancer and then colorectal cancer. This supported the outcomes of a previous study ten years earlier, which also suggested a correlation between periodontal disease and cancer[xv] – though more in-depth research is still needed.
Applying to practice
Of course, correlation doesn’t equal cause, and where evidence is lacking to ensure a causal relationship, some caution should be applied to the literature. Aside from sample size and format of each study, the variations in definition of periodontal disease can also make direct comparison of research difficult. However, there is definitely enough evidence to show that maintaining oral health helps to maintain systemic health and general wellbeing.
This can be used in practice in two ways. Firstly, patient education is crucial if they are to appreciate how their oral hygiene habits might affect their systemic health. Providing reliable information backed by science will not only give your patients the resources they need, but it will also enhance your place as a trustworthy authority on the topic. You might give out leaflets or guide patients to websites that are designed by professionals to deliver the right information in a simplified way that patients understand.
Secondly, the entire dental can help patients improve their oral health routine in order to optimise their health. Any patients identified to have gingivitis or the beginnings of periodontitis should be encouraged to visit the practice more regularly, as recommended by their dental professional.
Routine check-up, review or hygiene appointments should include an assessment of and instruction on brushing and interdental cleaning techniques. This must also cover the products that patients are using, which should be analysed on a regular basis to ensure they remain suitable and effective for the patient’s current or developing periodontal condition. Curasept ADS Perio – available from J&S Davis – offers targeted treatment of periodontal issues, providing all the bacteria fighting benefits of chlorhexidine while minimising the adverse side effects associated with similar products, such as discolouration and taste disturbance. Containing PVP-VA and hyaluronic acid, it also protects the oral cavity from further bacterial colonisation and supports wound healing and repair.
Managing a global problem
Oral health is understandably not always at the top of patient’s priorities – especially when faced with such challenges as presented this year. However, it’s important to remind them that a simple yet effective oral hygiene routine will help to reduce their risk of serious systemic health conditions now, and in the future.
Author: Steve Brown Director of Sales and Marketing J&S Davis Ltd
[i] FDI World Dental Foundation. Global Periodontal Health Project. Periodontal health and Disease. A practical guide to reduce the global burden of periodontal disease. 2018 https://www.fdiworlddental.org/sites/default/files/media/resources/gphp-2018-toolkit-en.pdf [Accessed April 2020]
[ii] European Federation of Periodontology. Dossier on Periodontal Disease. https://www.bsperio.org.uk/publications/downloads/88_105951_gum-disease-facts-and-figures.pdf [Accessed April 2020]
[iii] World Health Organization. Fact Sheets. Detail. The top 10 causes of death. May 2018. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death [Accessed April 2020]
[v]Cheung S, Hsu WC, King GL, Genco RJ. Periodontal disease – Its impact on diabetes and glycemic control. Joslin Diabetes Centre. 2010. https://aadi.joslin.org/en/Education%20Materials/99.PeriodontalDisease-ItsImpactOnDiabetesAndGlycemicControl-EN.pdf [Accessed March 2018]
[vi] Casanova L, Hughes FJ, Preshaw PM. Diabetes and periodontal disease. BDJ Team 1, 15007 (2015). https://doi.org/10.1038/bdjteam.2015.7
[viii] Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, Taylor R. Periodontitis and diabetes: a two-way relationship. Diabetologia (2012) 55: 21. https://doi.org/10.1007/s00125-011-2342-y
[ix] Dhadse P, Gattani D, Mishra R. The link between periodontal disease and cardiovascular disease: How far we have come in last two decades ?. J Indian Soc Periodontol. 2010;14(3):148–154. doi:10.4103/0972-124X.75908
[x] de Oliveira C, Watt R, Hamer M. Toothbrushing, inflammation, and risk of cardiovascular disease: Results from Scottish Health Survey. BMJ 2010;340:c2451.
[xi] Deepa D, Chandni G, Abhishek G. Assessment of high-sensitivity C-reactive protein values in chronic periodontitis patients with and without cardiovascular disease: A cross-sectional study. Journal of Clinical and Preventive Cardiology, 2016; 5(4); 108-112 DOI: 10.4103/2250-3528.192677
[xii] Trevisan M, Dorn J. The relationship between periodontal disease (pd) and cardiovascular disease (cvd). Mediterr J Hematol Infect Dis. 2010;2(3):e2010030. Published 2010 Oct 1. doi:10.4084/MJHID.2010.030
[xiv] Michaud DS, Lu J, Peacock-Villada AY, Barber JB, Joshu CE, Prizment AE, Beck JD, Offenbacher S, Platz EA. Periodontal Disease Assessed Using Clinical Dental Measurements and Cancer Risk in the ARIC Study, JNCI: Journal of the National Cancer Institute. August 2018; 110(8); 843–854 doi.org/10.1093/jnci/djx278
[xv] Michaud DS, Liu Y, Meyer M, Giovannucci E, Joshipura K. Periodontal disease, tooth lossm and cancer risk in male health professionals: a prospective cohort study. The Lancet, Oncology. June 2008; 9(6); 550-558 doi.org/10.1016/S1470-2045(08)70106-2
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