According to the American Academy of Periodontology, periodontal disease or gum disease is linked to systemic disease such as diabetes and heart disease, with new research linking it with other systemic diseases such as respiratory disease, osteoporosis and even cancer.  This makes it necessary for the treatment of periodontal disease to take on a multidisciplinary approach.

Here is an interview with Dr David Paquette, Curriculum Director from North Carolina Dental Assisting School in the United Statues, whose major research interests include the interplay between periodontal disease and systemic conditions, in particular cardiovascular disease, diabetes and obesity.

To what extent can the gums be a reflection of a patient’s pathology?

While systemic conditions like diabetes can lead to poorer gum health (periodontal disease), the presence of inflamed gum tissues is associated with poorer overall health. Patients with periodontal disease and diabetes have poorer glycaemic or blood sugar control.  Likewise patients with periodontal disease are at higher risk for developing atherosclerosis and cardiovascular disease.

Why is it important to take a multidisciplinary approach to periodontal disease?

A multidisciplinary approach is most effective in managing the patients oral and overall needs. Patients may present with complex medical conditions that need to be managed for the delivery of safe and effective periodontal care. The dentist and healthcare team can work together to help motivate the patient to adopt healthy behaviours and preventive strategies for improved oral and overall health.

To what extent is applying a multidisciplinary approach to treating patients with periodontal disease practical? Can it be made more practical?

Dentists need to be competent in collaborating with physicians, physician assistants, nurses, pharmacists and other health care providers. To better serve patients, dentists need to be part of the healthcare team in screening and referring patients at risk for medical conditions in addition to providing dental care. Conversely, physicians, nurses and other healthcare providers need to be comfortable in inquiring about patients’ dental health, oral function and behaviours in addition to screening for signs of overt oral disease.

Can a patient suffering from obesity, heart disease and/or diabetes help improve the condition of his gums just by switching to better lifestyle habits? What else needs to play a part to reverse this condition?

Unfortunately, bad health behaviours and choices seem to cluster in certain patients. Adopting a healthier lifestyle that includes a well-balanced diet, exercise, not smoking and personal oral hygiene can be effective in improving gum health and overall health. Seeking professional care and definitive periodontal care (e.g., scaling and root planing) would be needed to resolve the inflammation especially if there has been frank tissue breakdown as part of the disease process.

Please comment on the new research linking gum disease with other types of pathology such as cancer and osteoporosis.

There are early observational studies indicating that patients with inflammatory periodontal disease may be up to two times more likely to develop head and neck cancer or pancreatic cancer even after adjusting for other risk factors like smoking. Likewise, women with low bone density (diagnosed as osteopenia or osteoporosis) are two times more likely to have periodontal disease.

While the cause and effect relationship of heart disease is yet to be proven, there are several studies that show that heart disease is often exacerbated by oral infection. Please provide some examples of these studies and the types of heart disease examined in these studies.

Population studies indicate that there is a consistent and significant association between periodontal disease and future cardiovascular events (e.g., myocardial infarction or stroke) or subclinical atherosclerosis. The odds for periodontal disease and cardiovascular events or atherosclerosis is modest (30 percent to two-fold increase in risk), but this is magnified by the high prevalence of periodontal disease in populations (up to 50 percent of the population affected). Other studies have isolated periodontal bacteria in atherosclerotic vessels and have implicated periodontal bacteria in triggering inflammatory events and atherosclerotic changes in vessels.