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Periodontal disease: more than an oral health concern

Periodontal disease: more than an oral health concern

Described as a global burden, severe periodontitis has been reported to be the sixth most prevalent medical condition in the world.[1]


In the UK, periodontitis affects about half of all adults with up to 15% estimated to have the condition severely.[2] These shocking statistics echo the findings of the 2009 Adult Dental Health Survey, which reported that, although this generation has a better outlook than their predecessors, there are still many people whose oral health and function does not meet the best possible standards.[3]


Periodontal disease is a particular area of concern because it can cause serious oral health problems and when left untreated, and can result in tooth loss as well as deterioration of both gingiva and bone. Ominously the potential effects and implications of periodontal disease may also extend beyond oral health and recent research has established that periodontal infection is a probable risk factor for various systemic diseases, including pulmonary disease.[4]


Furthermore, periodontal disease has the capability of changing the chemical composition of the blood and glucose levels as well as interfering with the body's inflammatory system and thereby increasing the risk of diabetes, rheumatoid arthritis,[5] respiratory[6] and cardiovascular diseases.[7],[8]


As we know, tobacco use, stress and obesity may be significant risk factors in the development and progression of periodontal disease. However people with other general health conditions also have an increased risk of developing the condition. Evidence has consistently revealed that diabetes is a risk factor for the prevalence of gingivitis and periodontitis[9] and a five-year follow-up, population-based study in Taiwan[10] has also indicated that patients with osteoporosis might have an increased chance of developing periodontitis.


Over the last few decades the concept of a genetic vulnerability to periodontal disease has also been investigated.[1] Since the completion of the Human Genome Project (HGP)[2], researchers have found evidence to suggest that a key element of whether individuals develop periodontitis appears to be controlled by the way they interact with environmental agents including biofilm. These researchers also believe that periodontal disease could be categorised more effectively using pathobiology-based grouping as well as the clinical presentation of the disease, rather than the current clinical only classifications of ‘chronic’ and ‘aggressive’.[3]


A new system for categorising periodontitis based on the molecular profiling of gingival tissues has therefore been devised, which could enable earlier diagnosis and more personalised treatment. It is hoped that patients found to be highly susceptible to severe periodontitis may be considered for assertive therapy even if that person only show indicators. This would then prevent aggressive progression, bone and tooth loss.


Helping patients to understand the threat of periodontal disease not only with regard to oral health but also in relation to other potential health risks is vital. Of course treatment for periodontal disease depends upon each individual case, but every patient must appreciate the importance of practicing good oral hygiene. Employing an improved oral health care regime may be enough to kerb further development of the disease in some patients, although professional scaling and debridement is commonly required to remove plaque, calculus and biofilm from the teeth and roots.


For some patients it is necessary to include on-going periodontal therapy with medication to keep infection under control and to heal periodontal pockets. Nevertheless, in aggressive cases it may be necessary to perform flap surgery to clean the area thoroughly and suture periodontal pockets. Some of these patients may also require bone grafting to promote new growth or tissue regeneration to cover any exposed tooth roots.


In many cases a general dentist, therapist or hygienist can treat patients with periodontal disease successfully. However, in complex or unresponsive cases the skills of a specialist periodontist may be needed. By creating a good working relationship with a reliable referral practice, such as London Smile Clinic, your patients can benefit from specialist clinical skills in a wide spectrum of dentistry. With a wealth of experience in oral and maxillo-facial surgery, Dr. Hatem Algraffee, specialist periodontist at London Smile Clinic


[1] N.J. Kassebaum, E. Bernabé, M. Dahiya, B. Bhandari, C.J.L. Murray, W. Marcenes.  Global Burden of Untreated Caries: A Systematic Review and Metaregression J DENT RES, May 2015; vol. 94, 5: pp. 650-658, first published on March 4, 2015

[3] 2009 Adult Dental Health Survey (ADHS) http://www.hscic.gov.uk/catalogue/PUB01086/adul-dent-heal-surv-summ-them-exec-2009-rep2.pdf

[4] Scannapieco FA, Papandonatos GD, Dunford RG. Associations between oral conditions and respiratory disease in a national sample survey population. Ann Periodontol 1998;3:251-256.

[5] American Academy of Periodontology. http://www.perio.org/consumer/risk-factors

[6] Association between respiratory disease in hospitalized patients and periodontal disease: a cross-sectional study. Sharma, N., Shamsuddin, H. J. Periodontol. August 2011. pp1155-1160. Available at: http://www.pharmaden.net/pdf/articles/2.pdf

[7] Machado AC, Quirino MR, Nascimento LF. Relation between chronic periodontal disease and plasmatic levels of triglycerides, total cholesterol and fractions. Brazilian oral research, 2005, 19(4):284–9.

[8] Genco RJ et al. Overview of risk factors for periodontal disease and implications for diabetes and cardiovascular disease. Compendium of continuing education in dentistry, 2001, 22(2 Spec. No.):21–3.

[9] Mealey BL, Oates TW. Diabetes mellitus and periodontal diseases. J Periodontol. 2006;77:1289-1303.

[10] Population-Based 5-Year Follow-Up Study in Taiwan of Osteoporosis and Risk of Periodontitis
Wei-Pin Chang, Wei-Chiao Chang, Mei-Shin Wu, Jei-Tsung Pai, Yuh-Cherng Guo Ku-Chung Chen, Mu-En Liu, Wen-Ta Chiu, and Kuo-Sheng Hung

4 Research, Science and Therapy Committee of the American Academy of Periodontology. Informational paper: implications of genetic technology for the management of periodontal diseases. J Periodontol. 2005 May;76(5):850-7.   

5 Schafer AS, Jepsen S, Loos BG. Periodontal genetics: a decade of genetic association studies mandates better study designs. J Clin Periodontol. 2011 Feb;38(2):103-7.

[2] National Human Genome Research Institute (NHGRI), National Institute of Health US. www.genome.gov

[3] Gingival Tissue Transcriptomes Identify Phenotypically Distinct Classes of Periodontitis. Panos N, Papapanou M, Kebschull R.T, Demmer B, Grün  P, Guarnieri P, Pavlidis P (University of British Columbia, Vancouver, BC, Canada) March 2014. http://jdr.sagepub.com/content/early/2014/03/17/0022034514527288  [Accessed 25th March 2015] 


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