For many years, the worse scenario from periodontal disease was loss of teeth. In the past 18 years or so, attention has focused on systemic effects of periodontal disease and the impact of periodontal inflammation elsewhere in the body. However, new emerging research is clearly showing a link between the extent and severity of periodontal disease as a risk factor for many systemic diseases. The two conditions most frequently cited for which periodontal disease is a significant risk factor are coronary heart diseases and adverse pregnancy outcomes. However, despite publicity and early education by dental team staff, many patients are still ignorant of the serious health risks, such as heart disease, associated with poor oral care practices.
This article will look at the latest research news around heart disease and adverse pregnancy outcomes and the link to periodontal disease, plus the urgent need to get patients adhering to more thorough, daily oral care regimes.
Coronary heart disease
A recent systematic review identified 15 studies, which have explored whether periodontal disease is a risk for CHD. Whilst these studies were of different design, the analysis concluded the prevalence and incidence of CHD are significantly increased in patients with periodontal disease.
Many putative mechanisms have been suggested to explain the risk. Mechanism includes periodontal disease inducing an increase in white blood cells, fibrinogen and C-reactive protein (CRP). Plaque has also been shown to induce platelet aggregation and pathogens derived from bacterial plaque have been found in aortic and heart endothelial cells. Inflammation arising from periodontal disease can cause hyperlipidemia and also change the nature of cholesterol, making it more likely to be involved in atheroma formation.
A conclusive argument on whether periodontal disease is a significant risk for CHD would arise from interventional studies. Such studies would be designed to investigate the impact of periodontal treatment in reducing the incidence of CHD or further coronary events in high-risk patients. Currently, surrogate markers for CHD have only been utilised to investigate the effect of periodontal therapy. Periodontal intervention and radical treatment, such as a dental clearance, does reduce levels of CRP. However, only small numbers of patients have been recruited into these studies, the follow-up period was short and it has not been established whether reductions in CRP produces a cardioprotective effect.
More recent intervention studies have shown non-surgical periodontal treatment does have a significant effect on endothelial function and the ability of blood vessels to recover from temporary occlusion. Such changes, which last for six months post-treatment, can have a beneficial effect on reducing athrogenesis.
By contrast, further studies from the United States have shown only a minimal benefit of non-surgical periodontal therapy in reducing the risks of further coronary events. However the authors of this study comment there findings may be compounded by the obsessed nature of many of their patients. Overall, there is mounting evidence the extent and severity of periodontal disease is a risk for CHD.
Adverse pregnancy outcomes
Several studies have shown the extent and severity of periodontal disease is a risk factor for an adverse pregnancy outcome. These studies have been recently reviewed and 18 showed periodontal disease was a significant risk, with seven showing no association. Six interventional studies have been completed evaluating the effect of periodontal intervention on reducing the risk of an adverse pregnancy outcome. Four of these trials show such an intervention reduces the prevalence of pre-term low birth weight babies, and one study showed such intervention can reduce the risk by as much as 50 per cent. By contrast two of these studies showed no benefit from such periodontal intervention. Further interventional studies are required to confirm the benefits of periodontal treatment during pregnancy.
Evidence to date suggests during pregnancy clear advice and intervention should be given to prevent and treat any periodontal problem.
Getting patients to understand
The latest research regarding heart disease and adverse pregnancy outcomes is a real cause of growing concern, with children as young as 13 showing signs of gum disease.
For the majority of the population, mechanical methods of plaque removal are the mainstay of their oral health regimen. Most rely upon a toothbrush, either manual or powered, to clean their teeth. However, evidence from the last UK Adult Health Survey revealed over 70 per cent of participants had visible plaque or calculus present on their teeth at the time of inspection. This last survey also showed 74 per cent of adults spend on average 40 seconds brushing their teeth. When the data is combined, the results confirmed those who brushed twice a day left plaque on 69 per cent of their tooth surfaces, whereas those who brushed less than once a day had plaque remaining on 87 per cent of tooth surfaces. It is unlikely there will be a wholesale change in the level of plaque control and oral hygiene.
With people’s brushing regimes not very effective at plaque removal, using an alcohol free mouthwash, together with brushing, needs to be followed as a regime twice daily; it can help to sustain and maintain the health of the periodontal tissues. Using a proven, antiseptic mouthwash, preferably alcohol-free, can reduce plaque levels by a further 50 per cent.
The reason I say alcohol-free mouthwashes, such as Dentyl, is they provide the same oral care benefits (plaque and gingivitis control) as alcohol based mouthwashes, but without the need for ethanol (alcohol).
In a recent discussion paper, Dr Wermer and myself found a clear link between the use of alcohol containing mouthwash and various health risks such as adverse effects on oral structures and functions. These included burning mouth, drying of the oral mucosa, softening effects on composite filling materials and mucosa pain, and worsening any damage caused by tobacco from cigarette smoking. There is also an associated health risk between alcohol rich mouthwashes and the ingredient danger to oral cancer but that area warrants a separate discussion article in its own right.
For now, the message is clear: we have an urgent need to encourage the UK public into more thorough oral care regimes at home; brushing and using an alcohol free mouthwash, twice daily, plus interdental cleaning/flossing each day.
Dentyl facts
Alcohol-Free Dentyl, the proven two phase mouthwash is a powerful and clinically proven mouthwash that kills 99.9 per cent oral bacteria, and removes plaque and food debris from the mouth. Unlike other mouthwashes, Dentyl contains the special antibacterial ingredient - cetylpyridinium chloride.
Dentyl’s power is harnessed in a smooth action, efficiently removing bacterial layers from a solid surface (teeth, tongue and so on); it does not sting, burn or dry the mouth. Developed by dental experts, the entire Dentyl mouthwash range has a distinctive, smart working action. The advanced formula consists of two stages, a water-based phase incorporating CPC and an oil-based solution with natural essential oils, that has to be shaken well before use.
This shaking action combines the two mouthwash stages and creates a dynamic cationic solution. The negatively charged bacteria and debris adhere to the positively charged mouthwash solution and when it is rinsed out you can even see what has been removed. Bacteria, together with the food debris and other deposits on the teeth, are all visible as small, brightly coloured masses you can see in the sink, proving that as a mouthwash, it really works.
References available on request.
For more information on Dentyl visit www.dentylph.com