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April 2009 | Dental Products Report Help them make the connection Putting the oral-systemic link into perspective for your patients and educating them about what it means to their overall health can lead to increased treatment acceptance. The set-up  Photo: UpperCut Images/Getty Images “The emerging body of clinical evidence supports the connection between oral and systemic diseases. In this article, Dr. Kassolis gives us a practical perspective that can be used in evaluating our periodontal patients. With the experience of a seasoned clinician, he guides us from the times where periodontitis was considered a simple infection to the current, evidenced-based clinical evaluation. Dr. Kassolis presents sample scripts that can help us guide our patients toward better health.” —Dr. Peter O. Cabrera, Team Lead We have come full circle in our knowledge of the relationship between periodontal disease and systemic conditions. In the first third or so of the 20th century pyorrhea was thought to be a disease simply caused by infection in the gums, and the only practical treatment was surgical removal of the “diseased gums” or the offending teeth. Patients presented with various systemic conditions that were related to and a consequence of the presence of the “diseased gums,” but that was not discussed nor realized. Although patients with such conditions presented with gum infections, in actuality the primary cause was “rooted” in bacterial contamination of the dental apparatus. These patients often died as a result of misdiagnosis, particularly in the early 1900s. Even if a relationship was made between the systemic conditions and the dental disease, the means of treatment were not available at the time. Now we know better Today’s knowledge allows us to diagnose periodontal disease, define its cause as a bacterial infection and treat it appropriately. It is true there is no cure, but as with diabetes, control is available and predictable. We also know periodontitis is not only a disease of the gums or teeth but a disease that has systemic ramifications. From the early 1970s to the early 1990s a school of thought prevailed that periodontitis was a disease of the gums and had little, if any, effect systemically. Now we know certain systemic conditions not only are affected by periodontitis or gingivitis, but dental disease also has the potential to influence systemic conditions as well; diabetes alters periodontitis progression and vice versa. We recently discovered periodontitis has an influence on systemic conditions far greater than we first realized. We know there is a relationship between periodontitis and low birthweight babies, chronic coronary disease and certain cancers. As more research is reported, we’ll see a greater link between periodontal disease and other systemic conditions—and that’s something you need to discuss with your patients. Talking to your patients How do we approach the ever-flowing new knowledge and incorporate it into our protocol for treatment and present it to our patients? As dental therapists we must diagnose a condition, present the proper treatment to cure or control the condition, and then set in motion the means of completing the necessary treatment. We must explain the consequences of completing treatment and of no treatment. There must be dialogue on the systemic aspects of the condition both short- and long-term. Patients generally are aware that any infectious disease can lead to systemic conditions. The important factor in a discussion with patients is the added significance of a systemic component, which gives credence to and supports their decision to move forward with treatment. The idea of having “infection” contaminating their body appears to aid in the justification to progress with treatment. Because a potential systemic complication to periodontal disease appears to be a long-term negative side effect of an oral disease process, the primary concern for patients is generally more oriented toward their immediate concerns of losing their teeth or compromising their smile. Patients have changed over the years as a result of total access to the media and the Internet. Anyone can type in a few words in a search engine and bring up any dental-related subject he or she wants to identify. Many years ago patients did not hear of “gum” disease with the urgency or the repetitiveness they hear today. Back then, patients were referred to a periodontist when their mouth was at a more involved stage of periodontal activity. Today, because of the public’s and the profession’s increased awareness of periodontal disease, that emphasis has changed for the better. CONTINUED ON NEXT PAGE
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