Discussing the Link Between Periodontal Disease and Overall Health

Tuesday, June 4, 2013

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In November 2012 the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) held a joint meeting to review the literature connecting periodontal disease with other health problems including diabetes, heart disease and adverse pregnancy outcomes. The meeting produced a joint statement from the AAP and the EFP that not only established the solid connections between oral health and overall health, but also included clinical recommendations.

As a follow up, Dentalcompare spoke with AAP member and director of the Buffalo Periodontal Disease Research Center Dr. Robert Genco about the joint AAP/EFP workshop which he took part in. Dr. Genco offered his thoughts on the state of research into periodontal disease and its connections to other health issues, as well as what both the AAP and the EFP hope will come from the reports they produced.

DC: Was there a goal going into the joint AAP/EFP workshop? 

RG: The main goal was to bring together the top experts from around the world to review the literature on the relationship of periodontal disease to systemic conditions with an in depth focus on diabetes, atherosclerotic disease and adverse pregnancy outcomes.

DC: What were some of the challenges to working with your European colleagues?

RG: The North Americans and Europeans have a positive history of working together, but this was the first time we’ve officially convened. We have great respect for each other’s expertise and perspectives, and through careful planning we achieved great success that ultimately advanced the field of periodontology 

DC: What is the biggest advantage to working with the EFP on this project?

RG: The biggest advantage for the AAP in working with the EFP was to engage both groups in a critical discussion of the state of the science and clinical relevance of oral systemic connections. Periodontal disease has no borders; it is a global disease that required a cross-border analysis and discussion.

DC: Were there any surprises at this workshop in terms of the results of the research being reviewed?

Dr. Robert Genco

Dr. Robert Genco

RG: I was thrilled that we developed clinical recommendations for physicians, dentists, and patients which provide greater specificity and guidance. For example, clinical recommendations were developed for cardiovascular disease, diabetes and adverse pregnancy outcomes.

For patients with a history of cardiovascular disease, dental professionals should discuss other risk factors including hypertension, obesity, and tobacco use as well as treating periodontitis according to the American Heart Association guidelines for elective procedures. For patient with diabetes, practitioners should conduct a comprehensive periodontal evaluation as part of the ongoing diabetes management regimen. For expectant women, dental professionals should perform periodontal therapy, however they should adhere to general obstetric guidelines that suggest elective procedures should be avoided during the first trimester.

DC: Are there major differences between the American and European populations in terms of incidence or clinical approach to periodontal diseases?

RG: There are major differences in prevalence and incidence of certain diseases such as diabetes, cardiovascular disease, and adverse pregnancy outcomes among subpopulations in America and Europe.  There are also well described differences in prevalence of periodontal disease among certain races and ethnic groups in both America and Europe. However, the workshop focused on the relationship of periodontal disease to systemic conditions.

DC: What is the most important point being made by the joint research statement from the AAP and the EFP?

RG: The most important point to remember is there is strong evidence to support the role of periodontal disease in diseases including diabetes, cardiovascular disease and adverse pregnancy outcomes. Second, co-management of patients by medical and dental health care professionals is likely to yield better results in oral and overall health.

DC: What is the biggest challenge moving forward following the release of this statement?

RG: The biggest challenge going forward is to determine to what extent prevention or treatment of periodontal disease will change the course of any of these systemic conditions. Another challenge is educating medical and dental professionals to look at the whole health of the patient, not just one part of the body.

DC: Do the different health care models in the US and Europe have an impact on how the AAP/EFP clinical recommendations can/will be implemented?

RG: Given the different healthcare delivery structures, I expect the clinical recommendations to be implemented as appropriate for the particular country or context. It is up to each medical and dental professional to take an active role in treating the overall health of the patient.

DC: What is the next step for this cross-Atlantic collaboration?

RG: The next step in this collaboration is outreach to health care providers, third party payers, and the public to inform them of these associations.

DC: How do you continue to get the word out to the general public, and educate clinicians of all disciplines on the oral systemic link?

RG: There are many approaches to outreach including newsletters, electronic media, social media, editorials, follow-up conferences, continuing education courses, and the mass media for the patients, but we need each dental professional to take the time to explain the correlation to their patients, educate their supporting staff, and begin to implement the clinical recommendations into their practice.

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