Periodontal Disease and Systemic Diseases: Is the Association Real?
There has been much publicity about the role of periodontal disease in various disease processes, some of it confusing. Associations have been observed between active periodontal disease and poor diabetic control, more pre-term and low birth-weight babies, as well as increased cardiovascular events such as stroke, MI and atheromas. Because of the opportunities for nurses to improve their patients’ health, understanding the best evidence on this connection is important.
Key questions are: While there is an association, is there a cause-effect relationship? Can controlling periodontal disease with good oral hygiene measures (such as effective brushing and flossing) in addition to dental treatment such as cleanings, improve the course of the associated systemic disease?
Current research supports the following conclusions:
- Diabetes. This is the clearest causal association: Patients with periodontal disease have poor diabetic control -- and patients with poor diabetic control tend to have serious periodontal disease. Further, it has been shown that treating periodontal disease results in better diabetic control.
- Cardiovascular disease. No definitive conclusions can be drawn on whether treating periodontal disease will improve cardiovascular outcomes although surrogate markers show improvement. Definitive research is yet to be done.
- Pregnancy. There is evidence that periodontal treatment prior to or very early in pregnancy shows an effect in reducing problems of pre-term and low birth-weight babies. Periodontal interventions during pregnancy have not yet been shown to be effective overall.
So what can nurses do? While any systemic infection is a stressor, periodontal disease is particularly insidious because it is hidden, painless and long-standing. Tucked away in the mouth, in the gingival crevices, particularly around back teeth, it Is not readily apparent.
The best marker for active periodontal disease is bleeding. Ask patients if their gums bleed when they brush. But since many patients with periodontal disease avoid brushing their gums, a better test is to wipe the gingiva with gauze and note any bleeding. If there is bleeding, a referral to a dentist is in order, especially if they have any of the diseases shown to be associated with periodontal disease or are planning to get pregnant.