The notion that problems in the mouth cause diseases elsewhere in the body makes sense but has been difficult to prove, explains the Harvard Heart Letter. Scientists are exploring several mechanisms that may connect the two processes. In people with periodontitis (erosion of tissue and bone that support the teeth), chewing and toothbrushing release bacteria into the bloodstream. Several species of bacteria that cause periodontitis have been found in the atherosclerotic plaque in arteries in the heart and elsewhere. This plaque can lead to heart attack.

Oral bacteria could also harm blood vessels or cause blood clots by releasing toxins that resemble proteins found in artery walls or the bloodstream. The immune system’s response to these toxins could harm vessel walls or make blood clot more easily. It is also possible that inflammation in the mouth revs up inflammation throughout the body, including in the arteries, where it can lead to heart attack and stroke.

Although we sill have a lot to learn about whether, and how, periodontitis and other oral problems are linked to heart disease, the Harvard Heart Letter notes that it still makes good sense to take care of your teeth. Brush and floss every day, and see your dentist at least twice a year for regular cleanings and oral exams. This will pay off for your oral health and just may benefit your heart as well.

Health

As reported in the journal Cancer Epidemiology, Biomarkers, and Prevention, the study included 266 patients with cancers of the head or neck treated between 1999 and 2005, and 207 control subjects.

Periodontitis was determined by alveolar bone loss seen on x-rays, Dr. Mine Tezal, from The State University of New York, Buffalo, and colleagues note. Alveolar bone is the ridge of bone that surrounds the roots of the teeth, holding them in place. Loss of this bone is typically seen with severe periodontal disease.

With each millimeter of alveolar bone loss, the risk of head and neck cancer increased more than 4-fold, the report indicates. (One millimeter is about the size of the head of a pin.) The link was seen even in subjects who had never used tobacco and alcohol.

“Confirmatory studies … are needed,” Dr. Tezal said in a statement.

Source: (Reuters Health)

According to Samuel Low, DDS, MS, Associate Dean and professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology, the discrepancy between the prevalence of gum disease and the lack of treatment can likely be blamed on a lack of understanding of the effect periodontal disease can have on overall health. “Patients do not always seek the periodontal care they require because they are not aware of the long-term and potentially dangerous implications of untreated gum disease,” says Dr. Low. “Unfortunately, there are a variety of myths surrounding periodontal disease and its repercussions.”

In order to help distinguish between fact and fallacy regarding periodontal disease, the AAP has identified and addressed below some common misconceptions about oral health.

1. Bleeding gums are not that big of a deal.
   Red, swollen and bleeding gums are an important sign of periodontal disease. If you notice bleeding while brushing or flossing, or when eating certain foods, you should schedule a visit with your dental professional to be evaluated for periodontal disease. Studies have shown that in addition to tooth loss, gum disease may contribute to the progression of other diseases, including heart disease and diabetes, so it is important that you begin treating periodontal disease as soon as possible.
2. You don’t need to floss every day.
   Routine oral care, which includes brushing after every meal and before bedtime, and flossing at least once a day, is the best way to prevent gum disease. However, a recent survey estimates that only 13.5 percent of Americans floss each day. It is vital that you keep up with your daily oral care, and see a dental professional for a thorough check-up twice a year. If gum disease is diagnosed, a consultation with a periodontist, a dentist who specializes in treating periodontal disease, may be beneficial.
3. A visit to the periodontist will be scary.
   Periodontists are gum disease experts. They have received three or more years of specialized training following dental school centered on the diagnosis, treatment and prevention of periodontal disease. Periodontists are equipped with the latest treatments and technologies, using innovative tools such as digital radiography, ultrasound technology, biomarker measurement and laser therapy to help make your visit more comfortable.
4. A tooth lost to gum disease is a tooth lost forever.
   Gum disease is a major cause of tooth loss in adults. However, in addition to treating gum disease, periodontists are also experts in placing dental implants – a convenient and comfortable way to permanently replace missing teeth. A dental implant is an artificial tooth root that is placed into the jaw to hold a replacement tooth. Studies have shown that dental implants have a 98 percent success rate, and with proper care, allow you to speak, eat and smile with confidence. In fact, a survey conducted by the American Academy of Periodontology found that over 70 percent of respondents reported being “pleased” or “extremely satisfied” with the results of their dental implants.
5. Poor oral hygiene is the only way to develop gum disease.
   Forgoing good oral hygiene can certainly contribute to the progression of gum disease, but there are a variety of other factors that can also impact your risk. For instance, tobacco use has been shown to greatly increase your chance of developing gum disease. Stress, poor diet, and even genetics, can also play a role in the health of your gums. To determine your risk of developing gum disease, the AAP offers a free online risk assessment test.

For more information on common myths surrounding periodontal disease, or to speak with an AAP spokesperson, please contact the AAP’s Public Relations Office at 312-573-3242 or meg@perio.org.

About the American Academy of Periodontology

The American Academy of Periodontology (AAP) is the professional organization for periodontists – specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has

The study examined periodontal health in 64 pairs of identical and 53 pairs of fraternal twins. The study found that between 48 and 59 percent of the differences in measures of periodontal disease, such as attachment loss and probing depth, could be attributed to genetics. When correlating eight different clinical measures for periodontal disease among the two types of twins, all eight measures were statistically significant in the identical twins, while only two measures were significantly greater than zero in the fraternal twins.

“Periodontal disease is multifactorial, meaning that susceptibility involves genetic and environmental factors,” explained John C. Gunsolley, D.D.S., M.S., one of the authors of the study. “The basic question of what portion of periodontal disease risk among individuals is genetic versus environmental is important because it may lead to a better understanding of disease susceptibility. Identification of people at high risk for periodontal disease before they even display symptoms may provide new avenues for treatment.”

Gunsolley cautions that there are likely a number of genes that play a role in susceptibility, and these may differ in different races and ethnic groups. “I hope future studies will determine the genetic determinates underlying the risk for periodontal disease,” he said.

A consensus paper on the relationship between heart disease and gum disease was recently published concurrently in the online versions of two leading publications, the American Journal of Cardiology (AJC), a publication circulated to 30,000 cardiologists, and the Journal of Periodontology (JOP), the official publication of the American Academy or Periodontology (AAP). Developed in concert by cardiologists, the physicians specialized in treating diseases of the heart, and periodontists, the dentists with advanced training in the treatment and prevention of periodontal disease, the paper contains clinical recommendations for both medical and dental professionals to use in managing patients living with, or who are at risk for, either disease. As a result of the paper, cardiologists may now examine a patient’s mouth, and periodontists may begin asking questions about heart health and family history of heart disease.

The clinical recommendations were developed at a meeting held earlier this year of top opinion-leaders in both cardiology and periodontology. In addition to the clinical recommendations, the consensus paper summarizes the scientific evidence that links periodontal disease and cardiovascular disease and explains the underlying biologic and inflammatory mechanisms that may be the basis for the connection.

According to Kenneth Kornman, DDS, PhD, Editor of the Journal of Periodontology and a co-author of the consensus report, the cooperation between the cardiology and periodontal communities is an important first step in helping patients reduce their risk of these associated diseases. “Inflammation is a major risk factor for heart disease, and periodontal disease may increase the inflammation level throughout the body. Since several studies have shown that patients with periodontal disease have an increased risk for cardiovascular disease, we felt it was important to develop clinical recommendations for our respective specialties. Therefore, you will now see cardiologists and periodontists joining forces to help our patients.”

For patients, this may mean receiving some unconventional advice from their periodontist or cardiologist. The clinical recommendations outlined in the consensus paper advise that periodontists not only inform their patients of the increased risk of cardiovascular disease associated with periodontal disease, but also assess their risk for future cardiovascular disease and guide them to be evaluated for the major risk factors. The paper also recommends that physicians managing patients with cardiovascular disease evaluate the mouth for the basic signs of periodontal disease such as significant tooth loss, visual signs of oral inflammation, and receding gums.

While additional research will help identify the precise relationship between periodontal disease and cardiovascular disease, recent emphasis has been placed on the role of inflammation – the body’s reaction to fight off infection, guard against injury or shield against irritation. While inflammation initially intends to have a protective effect, untreated chronic inflammation can lead to dysfunction of the affected tissues, and therefore to more severe health complications.

“Both periodontal disease and cardiovascular disease are inflammatory diseases, and inflammation is the common mechanism that connects them,” says Dr. David Cochran, DDS, PhD, President of the AAP and Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio. “The clinical recommendations included in the consensus paper will help periodontists and cardiologists control the inflammatory burden in the body as a result of gum disease or heart disease, thereby helping to reduce further disease progression, and ultimately to improve our patients’ overall health. That is our common goal.”

NOTE: A copy of The American Journal of Cardiology and Journal of Periodontology Editors’ Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease can be viewed online.

The study, led by Dr. Shiela Strauss, Associate Professor of Nursing and Co-Director of the Statistics and Data Management Core for NYU’s Colleges of Dentistry and Nursing, examined data from 2,923 adult participants in the 2003-2004 National Health and Nutrition Examination Survey who had not been diagnosed with diabetes. The survey, conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention, was designed to assess the health and nutritional status of adults and children in the United States.

Using guidelines established by the American Diabetes Association, Dr. Strauss determined that 93 percent of subjects who had periodontal disease, compared to 63 percent of those without the disease, were considered to be at high risk for diabetes and should be screened for diabetes. The guidelines recommend diabetes screening for people at least 45 years of age with a body mass index (a comparative measure of weight and height) of 25 or more, as well as for those under 45 years of age with a BMI of 25 or more who also have at least one additional diabetes risk factor. In Dr. Strauss’s study, two of those additional risk factors — high blood pressure and a first-degree relative (a parent or sibling) with diabetes — were reported in a significantly greater number of subjects with periodontal disease than in subjects without the disease. Dr. Strauss’s findings, published today in the online edition of the Journal of Public Health Dentistry, add to a growing body of evidence linking periodontal infections to an increased risk for diabetes.

Dr. Strauss also examined how often those with gum disease and a risk for diabetes visit a dentist, finding that three in five reported a dental visit in the past two years; half in the past year; and a third in the past six months.

“In light of these findings, the dental visit could be a useful opportunity to conduct an initial diabetes screening — an important first step in identifying those patients who need follow-up testing to diagnose the disease.”

“It’s been estimated that 5.7 million Americans with diabetes were undiagnosed in 2007,” Dr. Strauss added, “with the number expected to increase dramatically in coming years. The issue of undiagnosed diabetes is especially critical because early treatment and secondary prevention efforts may help to prevent or delay the long-term complications of diabetes that are responsible for reduced quality of life and increased levels of mortality among these patients. Thus, there is a critical need to increase opportunities for diabetes screening and early diabetes detection.”

Dr. Strauss said that dentists could screen patients for diabetes by evaluating them for risk factors such as being overweight; belonging to a high-risk ethnic group (African-American, Latino, Native American, Asian-American, or Pacific Islander); having high cholesterol; high blood pressure; a first-degree relative with diabetes; or gestational diabetes mellitus; or having given birth to a baby weighing more than nine pounds.

Alternatively, dentists could use a glucometer — a diagnostic instrument for measuring blood glucose — to analyze finger-stick blood samples, or use the glucometer to evaluate blood samples taken from pockets of inflammation in the gums.

“The oral blood sample would arguably be more acceptable to dentists because providers and patients anticipate oral intervention in the dental office,” Dr. Strauss noted. In an earlier study involving 46 subjects with periodontal disease published in June 2009 by the Journal of Periodontology, an NYU nursing-dental research team led by Dr. Strauss determined that the glucometer can provide reliable glucose-level readings for blood samples drawn from deep pockets of gum inflammation, and that those readings were highly correlated with glucometer readings for finger-stick blood samples.

Dr. Strauss’s coauthors on the study for the Journal of Public Health Dentistry include Ms. Alla Wheeler, Clinical Assistant Professor of Dental Hygiene; Dr. Stefanie Russell, a periodontist and Assistant Professor of Epidemiology & Health Promotion; and Dr. Robert Norman, Research Associate Professor of Epidemiology & Health Promotion, all of the NYU College of Dentistry; Dr. Luisa Borrell, an Associate Professor in the Department of Health Sciences at Lehman College of the City University of New York; and Dr. David Rindskopf, Distinguished Professor of Educational Psychology and Psychology at the City University of New York Graduate Center.

— ScienceDaily (Dec. 15, 2009)

The study examined periodontal health in 64 pairs of identical and 53 pairs of fraternal twins. The study found that between 48 and 59 percent of the differences in measures of periodontal disease, such as attachment loss and probing depth, could be attributed to genetics. When correlating eight different clinical measures for periodontal disease among the two types of twins, all eight measures were statistically significant in the identical twins, while only two measures were significantly greater than zero in the fraternal twins.

“Periodontal disease is multifactorial, meaning that susceptibility involves genetic and environmental factors,” explained John C. Gunsolley, D.D.S., M.S., one of the authors of the study. “The basic question of what portion of periodontal disease risk among individuals is genetic versus environmental is important because it may lead to a better understanding of disease susceptibility. Identification of people at high risk for periodontal disease before they even display symptoms may provide new avenues for treatment.”

Gunsolley cautions that there are likely a number of genes that play a role in susceptibility, and these may differ in different races and ethnic groups. “I hope future studies will determine the genetic determinates underlying the risk for periodontal disease,” he said.

The dental endoscope creates the opportunity for successful periodontal therapy and offers the dental hygienist a tool to aid in definitive scaling and root planing.

HUMANS have been cleaning each other’s teeth for at least 3,000 years. Instruments designed for cleaning teeth have been recovered from archeological sites in Greece, Egypt, and Turkey that predate Greek and Roman recorded history.
For all of these years, the basic techniques for subgingival root debridement have not changed. It is remarkable that given all the advances in science and medicine, dental hygienists are currently scaling root surfaces using essentially the same blind instrumentation techniques developed so long ago. Until recently, clinicians were not able to visualize the root surface in deep periodontal pockets during scaling and root planing. But now, the dental hygienist has the ability to see the root surface in real time and can effectively instrument subgingivally with vision.
This is possible with the development of an endoscope (made by DentalView Inc, Irvine, Calif) that is small enough to fit within the gingival sulcus, so the clinician can see the root surface and sulcus contents.^1,2 Clinicians can effectively remove all root deposits and biofilm in well-defined, selected sites with the aid of the dental endoscope.³ The unexpected result of cleaning a root surface well is that the gingiva will most often reattach to the root surface—effectively reducing pocket depth and inflammation. This decreases or eliminates the need for periodontal surgery³ in many periodontal pockets where access for the endoscope is feasible and skillful instrumentation can be completed. This procedure is called perioscopy.

The term perioscopy is derived from peri, meaning around, and scope, which means to see. Perioscopy is a definitive periodontal therapy that the dental hygienist can deliver in selected sites. The introduction of the dental endoscope has created a new paradigm for dental hygiene practice.

The Dental Endoscope
The dental hygienist is confronted daily with the uncomfortable realization that, despite strong instrumentation skills and an understanding of root anatomy, the question of whether residual root deposits are left behind within moderate to deep periodontal pockets remains. This uncertainty is well founded because complete removal of all root deposits in periodontal pockets deeper than about 4 mm is impossible with traditional scaling and root planning (SRP).^4-10With the dental endoscope, dental hygienists can now visually explore the gingival sulcus, providing the precise location of biofilm, root deposits, granulation tissue, caries, and root fractures.

The endoscope is about 1 meter in length and .99 mm in diameter. It is made up of 10,000 optical and 19 illumination elements. To maintain sterility, a disposable sterile sheath is placed around the endoscope for each patient use. The sheath has a lumen or opening for delivering water into the sulcus to clear blood, biofilm, and other debris from the field of view. The sheath is attached to an explorer-probe (Figure 1) used to guide the endoscope subgingivally. A soft tissue shield is attached to the explorer probe to aid in gently displacing the margin of the gingiva to one side so you can look directly into the sulcus. The image of the root and sulcus contents is projected on a flat screen monitor (Figure 2, page 16) with a magnification of 22x to 48x. The clinician is, therefore, observing the sulcus contents and subgingival root surface using indirect, highly magnified, illuminated vision.

Acquiring skills in instrumentation using the endoscope requires time and effort. Most clinicians are effectively scaling subgingivally with the endoscope within a few weeks and many periodontal pockets begin healing within a few months. Regardless of clinicians’ initial skill level and experience, once they begin to use the dental endoscope, their abilities in root instrumentation improve dramatically. This is obviously because clinicians can directly observe the effectiveness of instrumentation with visual confirmation of deposit removal. Approaches can be modified and new techniques or instruments adopted to successfully remove all visible root accretions.

Explorer probe of the dental endoscope.

The introduction of the dental endoscope has created a new paradigm for dental hygiene practice.

Steps for Successful Perioscopy Therapy
Detecting calculus and biofilms with the endoscope and developing instrumentation skills are both required to achieve a perioscopy clean root surface. This dual skill set is essential to effective perioscopy.

In the process of training hundreds of dental hygienists in perioscopy, it is evident that most dental hygienists can develop the skills necessary for image interpretation and instrumentation. The dentist needs to provide time and resources for the dental hygienist to reach this level of proficiency. It may take the clinician 1 to 2 additional months of using the dental endoscope 2 to 3 hours a week to achieve proficiency in perioscopy.

The best method of assessing the skills of the clinician in achieving the goal of a “perioscopy clean” root is evaluating the clinical result. If the clinician acquires these skill sets and achieves a perioscopy clean root, the effect will be significant healing of the periodontal lesion, probeable pocket depth reduction, and improvement in calibrated attachment level.

Achieving a Subgingival Calculus Index¹¹ of zero (SCI O) is the goal of subgingival instrumentation with the aid of the endoscope. An SCI O is defined as the absence of visible calculus based on indirect, magnified, illuminated vision of the subgingival root surface when viewed with the dental endoscope.¹¹ Using these techniques is an extension of traditional SRP.

Perioscopy is considered after traditional SRP has been completed. Attempting to use the dental endoscope during initial SRP is difficult and impractical. SRP alone and improved patient oral hygiene can resolve many periodontal lesions and are more quickly accomplished than perioscopy. Moreover, the use of the endoscope in moderately inflamed tissue makes viewing the root surface difficult due to hemorrhage and granulation tissue.

Perioscopy is considered when evaluating the patient’s response to initial SRP and oral hygiene instruction. This is usually the point in periodontal therapy where the dentist examines the patient after nonsurgical periodontal therapy and elects to treat nonresponsive sites with periodontal surgery. Perioscopy is an alternative, noninvasive, definitive therapy that serves as a substitute for periodontal surgery in carefully selected sites. It is, therefore, a therapy to consider between SRP and periodontal surgery in the sequence of conventional periodontal therapy.¹¹

In a retrospective study¹¹ of 12 patients who had periodontal surgery treatment planned, the efficacy of perioscopy therapy was demonstrated. These patients had 626 periodontal pockets treated with perioscopy rather than periodontal surgery. These periodontal pockets, ranging from 5 mm to 10 mm in depth, were treated with perioscopy to achieve a perioscopy clean root surface (SCI O) and then the patients were provided periodontal maintenance procedures (PMP) every 3 months thereafter. Note that the perioscopy procedure is performed once, to a level of perioscopy clean, and then the patient is placed back on 3-month PMP. In this study, most periodontal pockets around single rooted teeth healed with significant reduction in probable pocket depth (PPD), an increase in calibrated attachment level (

CAL ), and the elimination of bleeding upon probing. The pocket depths continue to be maintained in the 2 mm-3 mm range after more than 3 years of 3-month PMP alone.¹¹ The following observations were made from this clinical trial.
1. Significantly more reduction in PPD can be achieved with perioscopy in addition to that achieved with traditional SRP (2.25 mm mean over traditional SRP in all sites).
2. Significant gain in CAL.
3. Continuing reduction in PPD may continue up to 12 months while in PMP.
4. Results were maintained for more than 36 months.
5. Furcations, maxillary bicuspids, and distals of second molars did not generally respond as well.
6. No antibiotics or other drugs were required to facilitate healing.
These observations are significant to p<.0001.¹¹

The guidelines for site selection and sequence of perioscopy therapy within periodontal therapy are based on retrospective surgical candidate and prospective multicenter maintenance¹¹ patient clinical trials.

Single rooted teeth respond well to perioscopy therapy. The response of pocket closure is predictable for these teeth if there is access for visualization and instrumentation. With most anterior teeth, this access is present with over-contoured restorations and root proximity as the major exceptions.

The data from retrospective studies and clinical experience reveal that molars with furcation involvement and maxillary bicuspids do not respond as well. There is a beneficial effect of perioscopy in these sites but the response is not as pronounced or as predictable as that observed around single rooted teeth. This lack of nearly complete resolution of pocket depth in furcation and maxillary first bicuspid sites is related to the clinician’s inability to thoroughly visualize and/or instrument these root surfaces.

The limitations of perioscopy in these sites may also be related in part to the current absence of effective scaling instruments for these sites. An example of a specific site that may respond unpredictably is the distal of second molars where access for vision and instrumentation is difficult because of root morphology, deep pocket depth, and firm, resilient gingival tissues. As some of these sites may not even respond predictably to surgical therapy, or the patient may not be a surgical candidate, the clinician may decide to perform perioscopy in these areas to gain some additional reduction in pocket depth and increased attachment level over that achievable by SRP and local delivery therapies.

The clinician will occasionally visualize root accretions that cannot be completely instrumented due to root morphology, inadequate access, or limitations of instruments available to the clinician for root preparation. These sites may respond more predictably to surgical intervention. Surgical access for debridement, pocket reduction, and regeneration procedures are appropriate where perioscopy cannot be performed.

Sequence of Appointments
Periodontal therapy begins with helping patients improve daily oral self-care and educating them about their specific disease processes. Education and oral selfcare instructions are provided at the first appointment and positive reinforcement/instruction continues at each subsequent appointment.

The dentist can use the endoscope as a diagnostic tool in selecting sites that may be treated with perioscopy and sites that may be more effectively treated with periodontal surgery. Reevaluating the root surface is mandatory after perioscopy if the pocket does not reduce significantly within 3 to 6 months. Additional perioscopy may be required if residual calculus is noted.

References
1. Stambaugh RV, Myers GC, Watanabe J, Lass, C, Stambaugh KA. Visualization of subgingival root surfaces with the dental endoscope. J Dent Res. 2000;79(special issue):abstract 3656.
2. Stambaugh RV, Myers G, Ebling W, Beckman B, Stambaugh KA. Endoscope visualization of the subgingival dental sulcus and tooth root surface. J Periodontol. 2002;73:374-382.
3. Stambaugh RV, Myers GC, Watenabe J, Lass C, Stambaugh KA. Clinical response to scaling and root planing aided by the dental endoscope. J Dent Res. 2000;79(special issue):abstract 2762.
4. Nagy RJ, Otomo-Corgel J, Stambaugh RV. The effectiveness of scaling and root planing with curettes designed for deep calculus. J Periodontol. 1992;63:954-959.
5. Stambaugh RV, Dragoo M, Smith DM, Carasali L. The limits of subgingival scaling. Int J Periodontics Restorative Dent. 1981;1(5):31-41.
6. Kepic TJ, O’Leary TJ, Kafrawy AH. Total calculus removal: an attainable objective? J Periodontol. 1990;61:16-20.
7. Stambaugh RV, McMullin KA. Effectiveness of long term, non-surgical maintenance in deep periodontal pockets. J Dent Res (special issue). 1988;67:272.
8. Buchannan SA, Robertson PB. Calculus removal by scaling/root planning with and without surgical access. J Periodontol. 1987;58:159-163.
9. Fleischer HC, Mellonig JT, Brayer WK, Gray JL, Barnett JD. Scaling and root planing efficacy in multirooted teeth. J Periodontol. 1989;60:402-409.
10.

Sherman PR, Hutchens LH, Jewson LG, Moriarty JM, Greco GW, McFall WT Jr. The effectiveness ofsubgingival scaling and root planing. I. Clinical detection of residual calculus. J Periodontol. 1990;61:3-8.
11. Stambaugh RV. A clinician’s three year experience with perioscopy. Compendium of Continuing Education in Dentistry. 2002;23:1061-1070.

Roger V. Stambaugh, DMD, MS, MSEd, FACD, specializes in periodontics and dental implants in his private practice in Burlington,Wash,and Santa Monica,Calif. He is also a member of Dentalview Inc’s Scientific Advisory Board.

The new IDF oral health clinical guideline supports what research has already suggested: that management of periodontal disease—which affects the gums and other supporting tissues around the teeth—can help reduce the risk of developing diabetes and can also help people with diabetes control their blood sugar levels. Studies have suggested there is a two-way relationship between diabetes and periodontal disease, and the IDF guideline outlines helpful guidance for health professionals who treat people living with and at risk for diabetes.

The IDF guideline contains clinical recommendations on periodontal care, written in collaboration with the World Dental Federation (FDI), that encourage health professionals to conduct annual inquiries for symptoms of periodontal disease such as swollen or red gums, or bleeding during tooth brushing; and to educate their patients with diabetes about the implications of the condition on oral health, and especially periodontal health.

“Everyone should maintain healthy teeth and gums to avoid periodontal disease, but people with diabetes should pay extra attention,” said Samuel Low, DDS, MS, Associate Dean and professor of periodontology at the University of Florida College of Dentistry, and President of the American Academy of Periodontology (AAP). “Periodontal disease triggers the body’s inflammatory response which can affect insulin sensitivity and ultimately lead to unhealthy blood sugar levels. Establishing routine periodontal care is one way to help keep diabetes under control.”

In addition to helping increase awareness about the importance of oral care for people with diabetes, Dr. Low believes the guideline presents more opportunities for medicine and dentistry to work together. “I know that these clinical recommendations will be helpful for those professionals who work with and treat people with diabetes. I also encourage the medical and dental communities to work together to provide the best possible care for our patients.”

• Download the IDF Guideline on Oral Health for People with Diabetes (pdf, 616KB)