Australian Dental Perspectives

For several years now, the evidence supporting links between oral health and systemic health has been steadily growing.

In February, a study published in Circulation, the Journal of the American Heart Association, provided new evidence that gum disease may lead to stroke or cardiovascular disease. The study, of 657 people with no history of stroke or heart attack found that subjects with more bacteria that cause periodontal disease had thicker carotid arteries.¹

In October 2004, Professor Laurie Walsh, Head of School and Professor of Dental Science at the University of Queensland, presented the PDF with an overview of periodontal health and its impacts on general health. The presentation reinforced to the PDF not only the large numbers of people at risk but the dramatic impact that simple measures such as brushing, flossing and rinsing can have on the overall wellbeing of patients.

Commenting on these issues, Professor Walsh described the weight of published evidence as far too strong for health professionals to ignore.

"Studies into the relationships between oral health and general health make it clear that oral health professionals have an important role in identifying periodontal infections which may impact on a patient's systemic health, and then following through with preventive measures or treatments that may reduce these adverse health outcomes," he said.

"A study conducted at the University of Queensland by Annetta Tsang and others, which looked at associations between maternal periodontal health and prematurity of newborns in Brisbane, provides an excellent example of this. When all known risk factors were excluded, the study found that preterm mothers had significantly higher levels of calculus and plaque, and were less regular users of dental floss or antibacterial mouthrinses than controls who had full term births," he added.

While Professor Walsh supported oral health professionals becoming more involved in the prevention and management of these systemic health issues, both he and the other members of the PDF concurred that there are broader structural and ideological issues to be addressed in order for this to happen.

"The first of these issues is that of much closer collaboration between oral health and the various other fields of health care, particularly medicine," he commented.

"At present, we don't see a great deal of patient referral between medical professionals and dentists. If, for example, women in the early stages of pregnancy and other patients at risk of cardiovascular disease, diabetes and pulmonary infections were routinely referred to a dentist for a comprehensive oral health examination, the opportunity for dentists to diagnose and manage periodontal issues that may negatively impact their health would be greatly enhanced."

"The second issue that needs to be addressed is ensuring that all Australians have access to this type of oral health service. While providing this level of care is possible in the private sector, the limited funding and resources dedicated to public dental health means that resources may be concentrated on providing emergency treatment, rather than preventive care.

"Finally, this is also an issue for all oral health professionals to address when considering their needs for continuing professional education to help them change their way of thinking to adopt a more preventive approach with a total body focus," he concluded.

In light of the issues identified and the time and money required to address them, the PDF concluded that patient education about the links between periodontal health and overall health, including the importance of daily brushing, flossing and rinsing as part of the solution, represents the most viable response at this time.

Reference

1. Desvarieux M, Demmer RT, Rundek T, Boden-Albala B, Jacobs DR Jr, Sacco RL, Papapanou PN. Periodontal Microbiota and Carotid Intima-Media Thickness: The Oral Infections and Vascular Disease Epidemiology Study (INVEST). Circulation. 2005;111:576-582.