Role of Periodontal Therapy in Management of Common Complex Systemic Diseases and Conditions: An Update
The link between oral disease and systemic disease has been widely studied. Poor oral health has been associated with multiple systemic conditions such as atherosclerosis, diabetes mellitus, adverse pregnancy outcomes, and respiratory conditions. A recent study published in October 2018 in Periodontology 2000 aimed to examine the results of clinical trials to determine if treatment of periodontal disease improves systemic diseases and condition outcomes.1
Numerous systematic reviews have been written on the topic of the relationship between oral and systemic disease. In one such review published in 2010, the authors attempted to answer the question, “Does periodontal therapy reduce the risk for systemic disease?” That review concluded, “there was little evidence that periodontal therapy prevented or modified the progression of systemic disease”. The clinical trials used in the review had small sample sizes and limited duration of follow-up. Therefore, this prompted the current review, to reassess clinical trials published since 2010.
Clinical trials conducted since 2010 were limited. The authors found clinical trials that studied the effects of periodontal interventions to prevent the initiation or progression of systemic diseases for only four major conditions, they included adverse pregnancy outcomes, diabetes, pneumonia, and chronic obstructive pulmonary disease. The clinical trials included in this update showed evidence that periodontal intervention did indeed prevent and slow the progression of the disease for adverse pregnancy outcomes, diabetes, pneumonia, and COPD. No evidence was found in clinical trials to show periodontal intervention reduces the risk of cardiovascular disease.
Even with more current clinical trials, the authors note some shortcomings. There was a common lack of definition of systemic disease outcomes and periodontal disease leading to erroneous conclusions. Additionally, group sizes were again quite small, and the follow-up of study participants was found to be quite short, rarely spanning more than a year. These shortcomings are very limiting when trying to generalize findings for this update.
Ultimately, the authors summarize their findings by stating “this review describes the results from randomized controlled trials which suggest that periodontal intervention can reduce the risk for several common complex diseases and conditions, namely adverse pregnancy outcomes, diabetes, pneumonia, and chronic obstructive pulmonary disease. To date, no other common complex diseases and conditions have been shown to be influenced by these interventions. Caution is therefore warranted when ascribing efficacy for periodontal interventions to prevent other diseases. Additional well-designed and appropriately powered randomized controlled trials are required to support such claims.”
Were you aware there was little evidence to indicate periodontal intervention is effective in the prevention and control of cardiovascular disease? Would you like to see more well-designed trials to evaluate the long-term efficacy of periodontal interventions on other common complex diseases? Considering these findings, will you address periodontal disease differently when explaining the benefits of periodontal therapy to patients? If so, how will you change your explanation?
- Sabharwal A, Gomes-Filho IS, Stellrecht E, Scannapieco FA. Role of periodontal therapy in management of common complex systemic diseases and conditions: An update. Periodontol 2000. 2018;78(1):212‐226. doi:10.1111/prd.12226
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