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The impact of Dental Hygiene Treatment on Systemic disease. Georgia Dental Hygienists’ Association 2011.
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“In the U.S., the fields of dentistry and medicine have traditionally been worlds apart. But in light of the growing evidence pointing to links between oral and whole body health, this separation of disciplines is slowly beginning to break down. The notion that dentists (and hygienists) care for only gums and teeth, while doctors look after everything else is being rethought.”
Sharon Guynup, Editorial director
Oral and Whole Body Health, 2006
The first-ever Surgeon General’s Report on Oral Health has called attention to this important connection and states, that if left untreated, poor oral health is a “silent X-factor promoting the onset of life-threatening diseases which are responsible for the deaths of millions of Americans each year.”
American Dental Hygienists’ Association
“Periodontal disease is a chronic inflammatory disease, and is linked to other serious health risks.”
“Plaque is a bacterial challenge to the body. It’s an infection. Patients don’t think of that”
JoAnn Gurenlian, RDH, PhD
Because of the abundance of current information on the “Oral –Systemic Connection”, Meta analysis and systemic reviews were primarily consulted for this presentation.
Consequently, a large amount of research was considered with the primary findings highlighted here.
Periodontal disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.
Periodontal disease is more prevalent, progresses more rapidly, and is often more severe in those with both type 1 and type 2 diabetes.
Periodontal disease has been named as the sixth complication of diabetes.
U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute of
Dental and Craniofacial Research, 2000.
Taylor GW, Burt BA, Becker MP, et al. Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus. J Periodontol. 1996;67(10 Suppl):1085-1093.
Also, periodontal disease in diabetic patients increases the severity of complications of diabetes such as kidney and heart disease.
Some of the mechanisms that explain the increased pathology seen in diabetic patients as a result of periodontal infection:
Diabetes and Periodontal Disease: Current ConceptsRobert Genco, DDS, PhD, Distinguished Professor, Oral Biology, School of Dental Medicine, State University of New York, Buffalo, New York
• Dry, burning mouth
• Gingival proliferation, gingivitis, periodontitis
• Abnormal wound healing
• Multiple carious lesions
• Candida infection – denture sore mouth, angular cheilitis, median rhomboid glossitis
• Periodontal abscesses
• Acetone breath
• Increased salivary viscosity
• Asymptomatic parotid gland swelling
Patients at the highest risk for respiratory infection (pneumonia and bronchitis) are institutionalized patients or medically compromised patients with or without respiratory disease who are unable to perform self-oralcare.
Also at risk are hospitalized elderly patients.
“There is good evidence that mechanical oral hygiene practices reduce the progression or occurrence of respiratory diseases in high-risk elderly people in nursing homes or hospitals. Mechanical oral hygiene practices may prevent the death of about one in 10 elderly residents of nursing homes from health care–associated pneumonia.”
This author evaluated 328 articles published from 1996 to 2007 which discussed the results of clinical studies linking oral hygiene to health care–associated pneumonia or respiratory tract infection in elderly people.
Rosenblum, R. “Oral hygiene can reduce the incidence of and death resulting from pneumonia and respiratory tract infection” J Am Dent Assoc 2010;141;1117-1118
Sjorgren P Nilsson E, Forsell M, Johansson O, Hoogstraate J. A systemic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes. J Am Geriatric Soc 2008; 56: 2124-2130
Coronary Heart Disease
A relationship between periodontal disease and atherosclerotic diseases, including heart disease and stroke, has been established.
Oe Y, Soejima H, Nakayama H, Fukunaga T, et al. Significant association between score of periodontal disease and coronary artery disease. Heart Vessels. 2009;24:103-107.7. Friedewald VE, Kornman KS, Beck JD, et al. The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. Am J Cardiol. 2009;104:59-68.
In a large 14 year study, patients with periodontal disease were 25% more likely to develop coronary heart disease (CHD) than their healthy counterparts.
DeStefano, F, Anda RF, Kahn HS, et al. Detna disease and risk of coronary heart disease and mortality.
BMJ. 1993; 306:688-691
Wu T, Trevisan M, Genco RJ, et al. Periodontal disease and risk of cerebrovascular disease: the first national
Health and nutrition examination survey and its follow-up study. Arch Intern Med. 2000; 160:2749-2755.
Model explaining the Oral inflammation-Systemic Disease Associations
eg. P gingivalis
Or their products
Low birth-weight infants
“Enough evidence exists to show there is an association between the presence of periodontitis and preterm delivery and low birthweight infants. However, the exact nature of that association is still unclear”
M. John Novak, BDS, LDS, PhD
A reverse association
Periodontal bone loss will progress more rapidly in patients with osteoporosis.
Medications taken by patients with osteoporosis should be considered before any operative procedures. Intravenous bisphosphonates create a greater risk for the patient than oral bisphosphonates.
Pancreatic and Breast Cancer
Dental professionals should stay current in their own research of emerging evidence on these subjects, and be prepared to pass pertinent information along to our patients.
Caries and Periodontal Disease
It is not only socially responsible, but fiscally prudent, to increase access to preventive services. Each year millions of productive hours are lost due to dental diseases.
Community Voices: HealthCare for the Underserved.2001. Poor Oral Health Is No Laughing Matter. Washington, DC: Community Voices: Health Care for the Underserved.
National Center for Health Statistics. 1996. Current estimates from the National Health Interview Survey,1996
“Early tooth loss caused by dental decay can result in failure to thrive, impaired speech development, absence from and inability to concentrate in school, and reduced self-esteem.”
Office of Disease Prevention and Health Promotion.
2000. Healthy People 2010. In Office of Disease
Prevention and Health Promotion
Dental caries rarely lead to death, but it is possible as in the 2007 Deamonte Driver case.
Deamonte did not have access to dental care. By the time he sought medical treatment, the bacteria from his abscess had traveled to his brain and he ultimately could not be saved.
His hospitalization cost approximately $250,000. An extraction would have cost less than $100.
Because of the overwhelming science supporting the “oral-systemic connection”, patients with these systemic and oral conditions should have access to dental hygiene services on a very routine basis.
The American Dental Hygienists’ Association and the Georgia Dental Hygienists’ Association advocate that the services of dental hygienists who are graduates from an accredited dental hygiene program can be fully utilized in all public and private practice settings to deliver preventive and therapeutic oral health care safely and effectively.
If improvement in the nation’s health care system is to occur, more equitable access to basic quality oral health care at affordable costs is necessary.
Licensed dental hygienists are educated and qualified to perform oral health care services.
Furthermore, dental hygienists serve as an efficient pipeline for identifying and sending on those who need the care of a dentist.