Dr. GOUNSIA AMIN
Introduction
The oral cavity is the intersection of medicine and dentistry and the window to an individual’s overall health. Hundreds of diseases and medications impact the oral cavity, and pathological problems in the mouth have a greater systemic impact than many providers believe. It is not clear whether there is actual causation or simply an association between periodontal disease and certain other systemic conditions, including atherosclerotic vascular disease, pulmonary disease, diabetes, pregnancy-related complications, osteoporosis, and kidney disease. Elderly adults are affected by many chronic diseases, including diabetes, hypertension, osteoarthritis, osteoporosis, cardiovascular disease and cerebrovascular disease. These older adults require special dental care and a better understanding of the complex interactions of oral disease and systemic chronic diseases that can complicate their treatment. Oral diseases are strongly associated with systemic diseases, and poor oral health can aggravate the impact of systemic diseases.
Diabetes has a true bidirectional relationship with periodontal disease, and there is strong evidence that treatment of one condition has a positive impact on another. A common feature of periodontal disease and these medical conditions is that they are chronic diseases that are time-consuming to develop and become clinically significant. Periodontal disease has been associated with numerous health problems, including cardiac disease and diabetes. Although some associations have been found between periodontitis and systemic conditions, finding direct causality remains elusive. Periodontal and systemic diseases share a number of common risk factors, including smoking and unhealthy eating. Primary prevention-treating the patient before the onset of symptoms, myocardial infarction, stroke, diabetes complications, or an important periodontal disease-is the challenge.
The complications associated with these conditions result in high morbidity and mortality and are incredibly expensive for the health care system. Unfortunately, lack of access to primary health and dental care prevents some patients from accessing the system until a negative event occurs. Despite the absence of clear evidence of causality and the direct impact of treatment, the impact of these chronic diseases on the population is well understood. Dentists, family physicians and all primary care providers need to increase collaboration and communication to maximize the benefits to patients.
Periodontitis and cardiovascular diseases
Patients with periodontal disease are also at greater risk for uncontrolled diabetes. According to the American Academy of Periodontology (AAP), severe periodontal disease can increase blood glucose levels and make them more difficult to control, increasing the risk of diabetic complications in patients with diabetes.
It’s a two-way relationship; patients with diabetes are more likely to develop periodontal disease, perhaps because of their increased susceptibility to infection. In fact, the relationship is so strong that American Academy of Periodontology (AAP), emphasizes in its patient resources that periodontal disease is often considered a complication of diabetes.
Periodontitis and obesity
Obesity is itself a risk factor for cardiovascular disease and diabetes, and is associated with multiple diseases and disorders of the airways. Obesity and other systemic inflammatory disorders, often exacerbated by stress or smoking and poor oral health care, can contribute to periodontal rupture and osteoclasts activity. The CDC states that severe obesity increases the risk of acute respiratory distress syndrome (ARDS), a major complication of COVID-19 that can intensify symptoms and interfere with the ability to provide care for seriously ill patients.
Periodontal diseases in a pediatric patient
Gingivitis is very common in children, occurring in about 70% of pediatric patients. Generalized periodontitis in prepubescent children, however, can be a manifestation of a systemic illness (for example, congenital or hematological). Directing a child with generalized periodontitis to a doctor can help determine if periodontitis is a manifestation of a systemic disease or not.
Whether periodontal symptoms are plaque-induced or systemic, early diagnosis and treatment are essential, although success in periodontal treatment can be inhibited by systemic disease. Delaying the treatment of periodontal disease in children to support differential diagnosis can increase the risk of bone loss.
Pregnancy-related complications
Women are particularly susceptible to developing gingival problems during pregnancy. In addition, periodontal disease in pregnant women may lead to adverse outcomes for both mother and infant, which has serious clinical and public health implications. Both scenarios have been extensively examined and call attention to pregnant women as an important and vulnerable population in relation to periodontal health. Recent data also indicate that there is an association between the presence of periodontal disease and oral dysbiosis associated with pregnancy. Although this oral dysbiosis and pathogenic periodontal bacteria are considered to be associated with adverse pregnancy outcomes, it is still not clear how an oral dysbiosis during pregnancy can modulate oral diseases and birth outcomes.
Alzheimer disease
The various bacterial, viral and other microbial pathogens associated with periodontal disease that may transfer into the blood and then into distal sites, such as the brain. Such microbial translocation would lead to local inflammation and build-up of the hallmark signs of Alzheimer disease, including beta-amyloid deposits, tau fragmentation and tangles, breakdown of host protective molecules (such as the apolipoproteins), and neuron toxicity. This process makes clear the importance of the oral-cerebral axis.
Preventive and non- invasive treatment
Preventive and non-invasive treatment, supportive periodontal treatment, and patient-specific maintenance plans are essential to maintaining oral health in older adults. Multiple coexisting changes, including xerostomy, altered scarring, altered bone physiology, altered microbioma, and decreased plaque control, can add complexity to periodontal management. Consideration must be given to the patient’s general health, the selected periodontal treatment plan, and the selected completed restorative procedures.
(Author is III – year post graduate student of oral medicine and radiology, Shree Bankey Bihari Dental College. Email id: [email protected])
