- Periodontitis is an inflammatory disease and each individual produces a unique immune-inflammatory response profile to bacterial challenge. Inflammation is an essential homeostatic response but prolonged or excessive inflammation leads to tissue damage or disease.
- Plaque drives the inflammatory process but there may be more to the story as plaque control doesn’t always limit the disease. Susceptibility may be independent of plaque.
- The mouth should not be viewed in isolation from the rest of the body.
- The association between dental and systemic health was suggested as early as the 1876.
- Periodontitis has a significant impact on the life of an individual and may cause psychological disability, social disability, physical disability and a sense of regret (O’Dowd 2010).
- Possible mechanisms linking periodontitis and cardiovascular disease – direct effect of oral bacteria affecting carotid arteries and other blood vessels, inflammatory response in the periodontal tissues resulting in systemic inflammatory responses, genetic susceptibility and shared risk factors.
- Diabetes – adults with poorly controlled type 2 diabetes had a threefold increased risk of periodontitis compared with adults without diabetes (Tsai 2002). Successful periodontal treatment is associated with an approximate 0.4% reduction in HbA1C level – a clinical equivalent to adding a second drug to a pharmacological regime for diabetics (Simpson 2010).
- Mechanisms by which periodontitis and diabetes may be related – entry of periodontal bacteria into the circulation, type 2 diabetes is preceded by systemic inflammation resulting in reduced beta cell function and insulin resistance, AGE-RAGE interactions and oxidative stress-mediated pathways provide plausible mechanistic links.
- A study that interviewed physicians, diabetes specialists and diabetes nurses found that there is generally little/no knowledge about the links between periodontitis and diabetes. Some if the medical professionals expressed real surprise and some gave a defensive response when this was discussed (Bissett 2013). Patients welcome the opportunity to discuss general health in dental practice and dentists enjoyed giving this advice – the main barrier was time (Wright 2014).
- There is a potential broader role for the dental team in wider healthcare management.
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