New Reports Confirm Perio-Systemic Connection and Outline Clinical Recommendations
The American Academy of Periodontology (AAP), in collaboration with the European Federation of Periodontology (EFP), recently published a series of consensus reports that analyze the scientific evidence linking periodontal disease, specifically periodontitis, to other systemic diseases, including diabetes, cardiovascular disease and adverse pregnancy outcomes. The consensus reports, which appear in both the Journal of Periodontology and the Journal of Clinical Periodontology, also outline clinical recommendations for dental professionals to use when treating patients at risk for, or presenting with, certain medical conditions.
Specifically, the consensus reports conclude:
There is strong epidemiologic evidence that periodontitis provides an increased risk for future cardiovascular disease. Dental professionals should discuss other risk factors for cardiovascular disease with their patients, including hypertension, obesity, and tobacco use. The treatment of periodontitis in patients with a history of cardiovascular disease should follow the American Heart Association guidelines for elective procedures.
There is an independent association between moderate to severe periodontitis and an increased risk for the development or progression of diabetes. Periodontal interventions may provide beneficial effects on diabetes outcomes in some patients, so regular comprehensive periodontal evaluations should be part of an ongoing diabetes management program.
While some studies suggest a modest association between maternal periodontitis and adverse pregnancy outcomes, there is currently insufficient evidence that periodontal therapy can be recommended as a means to improve pregnancy outcomes. Periodontal therapy is considered safe in pregnant women and can result in improved periodontal health, but dental professionals are urged to adhere to general obstetric guidelines that suggest elective procedures should be avoided in the first trimester.
- Evidence suggests a relationship between periodontitis and other systemic diseases, including chronic obstructive pulmonary disease, pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome and cancer. However, additional studies are needed to better understand these associations.
The consensus reports also identified recommendations for future research, such as well-designed interventional studies and randomized clinical trials, to enhance understanding of the impact of periodontitis and periodontal treatment on overall health. The complete consensus reports are freely available online.
The consensus reports were developed at a joint workshop held in Segovia, Spain in November 2012. More than 70 international experts met to conduct an intense review of the available evidence supporting the association between periodontitis and other systemic diseases.
“These consensus reports confirm that periodontitis is related to other conditions, especially diabetes, cardiovascular disease and adverse pregnancy outcomes. Since we know that nearly half of U.S. adults have periodontitis, it is imperative that patients are made aware of their increased risk for systemic disease,” said Robert Genco, DDS, PhD, co-chair of the EFP-AAP 2012 Workshop Organizing Committee and Distinguished Professor at The State University of New York at Buffalo. “The AAP’s collaboration with the EFP provides the ability to promote the importance of periodontal health in maintaining overall health on a widespread scale.”
According to Nancy L. Newhouse, DDS, MS, President of the American Academy of Periodontology and an Assistant Clinical Professor at the University of Missouri – Kansas City School of Dentistry, “The AAP was honored to be part of this milestone event. Both the AAP and the EFP understand the importance of synthesizing the current literature to provide helpful information to dental professionals. Periodontists, and all dental professionals, share a responsibility in managing the periodontal health of our patients. These findings only help us be more effective.”
The EFP and AAP joint workshop on the perio-systemic link was supported by an educational grant from Colgate-Palmolive. “This initiative in dental care is crucial in the overall challenge to improve general health,” said Foti Panagakos, DMD, PhD, Global Director, Scientific Affairs, Colgate-Palmolive Co. “There is a strong association between periodontal disease and conditions affecting many of the body’s other systems. Colgate-Palmolive is proud to support this campaign and help raise awareness of the importance of healthy gums as a fundamental element to patients’ quality of life.”