By JoAnn Gurenlian, RDH, MS, PhD, AAFAAOM, FADHA
February 2, 2023
A joint workshop was held between the European Federation of Periodontology (EFP) and the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) to explore the implications of dentists and family doctors between periodontal and systemic diseases and the role of these professionals in collaborating and managing these diseases and promoting healthy lifestyles. The consensus report presents the conclusions of a Focused Workshop held in Madrid, Spain in July 2022.
The report summarized that there is evidence that patients with periodontitis exhibit significant sub-clinical atherosclerosis, and there is a positive association between periodontitis and coronary heart disease and stroke. Oral health professionals (OHPs) should advise their patients with periodontitis that their risk for cardiovascular diseases (CVDs) is higher. They should actively screen for cardiovascular risk factors and advise the patient on adequate preventive measures and advise patients to consult with their family physicians to discuss active lifestyle measures.
Further, providing periodontal therapy is safe regarding cardiovascular risk. Nonsurgical periodontal therapy should be provided in several 30–45-minute sessions to minimize the spike of acute systemic inflammation. Surgical periodontal and implant therapy should be provided paying attention to hypertension considerations and patients in treatment with anti-platelet and anti-coagulant medications. Family physicians should evaluate patients for CVD and signs of periodontitis and recommend a periodontal evaluation where appropriate.
Diabetes and periodontitis are highly prevalent conditions that have a bidirectional relationship. Complications of diabetes in relation to periodontitis are retinopathy, nephropathy, neuropathic foot ulceration, CVDs, and mortality. The focus group recommended there is a need to raise awareness among family doctors, general dentists, other health professionals, patients, and health authorities of the importance of periodontitis to diabetes control and the impact of hyperglycemia upon periodontitis. Family doctors and OHPs should maintain collaborative management and communication, and there should be written communication between the two teams.
OHPs should inform patients with prediabetes they are at risk of periodontitis and its impact on glycemic control and complications. These patients should then receive a full periodontal chart and radiographs and recording of bleeding on probing. Primary prevention of periodontitis should be performed. If gingivitis is diagnosed, primary prevention strategies for periodontitis should be performed and regular visits to the family physician to maintain optimal control of diabetes should be emphasized. If periodontitis is diagnosed, the OHP should treat the patient according to the recent EFP treatment guidelines and then inform the family doctor of the diagnosis of periodontitis.
Likewise, family practitioners should advise patients with prediabetes and diabetes that hyperglycemia increases their risk of periodontitis and potential tooth loss, periodontal treatment can improve glycemic control, and regular oral health assessments and periodontal care should be tailored to their individual needs. Patients should be referred to OHPs for regular oral health assessments.
Lastly, the report recapped that periodontitis and COPD, asthma, obstructive sleep apnea (OSA), and community-acquired pneumonia have epidemiological associations and comorbidities. The focus group recommended family doctors refer patients with these respiratory diseases or at risk of these conditions to OHPs for an oral/periodontal health examination. For patients who are smokers, smoking cessation is recommended and promoted in both dental care and family practice settings. Education in adequate oral hygiene habits for patients with COPD is essential as is oral health education of the effects of use of corticosteroids in patients with asthma. Weight loss, dry mouth considerations, caring for OSA appliances, and possible orthodontic evaluation may be necessary recommendations and discussions among both family doctors and OHPs in patients with OSA. Use of antiseptic mouth rinses, such as cetylpyridium chloride, may be considered for patients with a history of COVID-19.
To read the full paper, first issued in March 2023, access it here.
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This article summarizes the consensus report “Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe)” as published online by the Journal of Clinical Periodontology, March 3023. (https://onlinelibrary.wiley.com/doi/10.1111/jcpe.13807)
JoAnn Gurenlian, RDH, MS, PhD, AAFAAOM, FADHA, is the ADHA Director of Education, Research & Advocacy, professor emerita in the Department of Dental Hygiene at ISU, and former president of the American Dental Hygienists’ Association 1990-1991.
