Dental and Medical Providers Work Together in Treating Patients

by  Christine Taxin- Links2Success
August 19th, 2015

Synergistic effects of oral-systemic disease requires cooperative response by providers

More and more information is coming to light about the role of the mouth as it relates to systemic disease. While research is still unfolding, studies are showing that oral disease can both contribute to and/or be a sign of systemic disease. There has been a call to action recently for dental and medical providers to work together in treating patients, recognizing risk factors, and referring patients across specialties when necessary. However, the application of this practice is still in infancy. Many dental professionals are not aware of all the possible systemic issues influenced by oral disease. Similarly they are not always confident in recommending patients with oral disease to seek medical risk assessment for things like heart disease, diabetes or respiratory issues. On the other hand, many physicians still feel it is not within their specialty to treat issues in the oral cavity, and therefore do not consider checking for oral disease.

Research suggests the management of oral disease can reduce the risk for systemic disease and vice versa. Therefore there is a need for a comprehensive risk assessment that can be used across disciplines in order to make timely referrals. There is also great need for both types of providers to prioritize educating themselves and their teams about risks of the mouth and body.

Periodontal Disease: Why it matters

In short, Periodontal Disease (PD) is caused by bacteria festering below the gum line. Left untreated, the inner layer of the gum and bone pull away leaving pockets that collect food debris that leads to infection. In advanced stages the bacteria destroys more and more gum tissue and bone to the point that the tooth may become loose and eventually fall out.

Because the gums of patients with PD bleed, the open and inflamed tissue allows for toxins from the infection into the blood stream. The mouth becomes the literal gateway for the infection to pass through the rest of the body, leading to higher risk for a multitude of systemic issues like heart disease, stroke and diabetes. What has recently become known is that periodontal disease and systemic disease when coupled, compound effects one on another. If one of the diseases goes untreated it makes it more difficult to treat the other. This further demonstrates it is in the best interest of both the doctor and dentist to watch for early warning signs of disease typically outside of their respective practice.

The good news of this synergistic relationship, however, is if one (systemic or periodontal) disease is caught in its early stages it gives doctors and patients an early warning the other may not be far behind.

It is imperative for physicians to know the signs and symptoms of PD and assess patients accordingly. If risk factors are present then a referral should be made to a periodontist for treatment. By treating the disease of the mouth doctors can impact their success with the treatment of systemic disease. Unfortunately as many as 1/3 of the population did not visit the dentist last year[i], so physicians are essential to catching PD in its early stages.

Disease indicators include:

Risk factors to look for include:

Systemic disease: It matters too

According to Consumer Reports:

Gum disease and diabetes counteract with yin-yang synergy; because diabetes can affect circulation, it can restrict blood flow to the gums, making a person more susceptible to gum disease. Research suggests that treating periodontal disease can improve blood-sugar control. In fact some insurance companies already offer patients with diabetes extended coverage for periodontal treatments.

While recognizing periodontal issues are critical to physician’s work, systemic risk factors that could be catalyzed by, or lead to oral disease need to be assessed by dental teams regularly. Gathering a basic health history and taking a blood pressure reading may not be enough. The American Academy of Periodontology [iii] offers some insight into a more complex set of data points dental wellness teams need to assess in order to truly gauge their patient’s health and overall risk:

OSTEOPOROSIS

 

Researchers have suggested that a link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation.

 

RESPIRATORY DISEASE

 

Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease.

 

CANCER

 

Researchers found that men with gum disease were 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers.

 

DIABETES

 

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk. Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications

HEART DISEASE

 

Several studies have shown that periodontal disease is associated with heart disease. While a cause-and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of heart disease. Scientists believe that inflammation caused by periodontal disease may be responsible for the association. Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

 

STROKE

 

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

 

American Academy of Periodontology 1

While the list provided by the American Academy of Periodontology is exhaustive enough, the potential impact the health of the oral cavity has remains unknown.   There have also been reports of connection between PD and colon cancer, complications with orthopedic implants[iv], and premature or stillbirth [v],[vi].

[i] http://usatoday30.usatoday.com/news/health/2009-03-10-dental-skip_N.htm

[ii] …researchers found that the prevalence of periodontal disease among obese young adults (aged 18–34 years) was 76 percent higher than that among normal weight young adults. (http://www.jada-plus.com/content/134/7/826.3.short?related-urls=yes&legid=jada;134/7/826-b)

[iii] http://www.perio.org/consumer/other-diseases

[iv] http://www.oralsystemicevaluationcenter.com/oral-systemic-connection.htm

[v] http://www.perio.org/consumer/women.htm

vi http://www.hindawi.com/journals/jp/2010/293439/

References:

Dental and Medical Providers Work Together in Treating Patients. (2015, August 19). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/dental-and-medical-providers-work-together-in-treating-patients-26660.html

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