Page 50 - Dental Practice Vol 17 No.5_

periodontic section

EMBRACING AN ORAL SYSTEMIC PRACTICE

KERRY LEPICEK

Table 1: Risk Factors

Health and Family History mounting evidence that bacteria in the mouth affects our oral and
overall health. Many of our clients are pre-diabetic and present
clinically with active gingivitis or rapidly progressing periodontal
disease.
Medication and Biofilm accumulation
Pathogens involved in the progression of periodontal disease
and decay enter the blood stream directly triggering the inflam-
matory response that is leading to remote systemic issues.
Diabetes and High Blood Pressure Research is continually being released highlighting the impact of
oral pathogens in pregnancy, diabetes, cardiovascular disease,
various types of cancers and Alzheimer's to name a few.
Sleep Apnea Dental professionals have an opportunity and responsibility to
tackle the root cause of inflammation, pathogenic bacterial load,
lifestyle, poor oral self-care and many more factors that con-
tribute to gingivitis, periodontal and implant diseases. The
Smoking and Alcohol Use
hygiene department is extremely valuable to the practice. The
dentist and hygienist need to collaborate to form a periodontal
diagnosis, create client goals and a treatment plan. The AAP
High levels of Pathogenic Bacteria (American Academy of Periodontology) staging, and grading
highlights the importance of these risk factors in disease progres-
sion, diabetes, smoking, medical, family, and dental history. It is
a tool to start the oral systemic conversation with your clients and
Dental professionals are frontline oral health advocates. Oral Systemic medical practitioners.
education must be included in our standard of care. We repeat treat- Using AAP classifications, we have to remember our clients
ments and/or therapies and yet, our clients continue to have active can fit into many categories such as periodontitis as a direct man-
infection. Yes, change is challenging however, it's time we talked about ifestation of systemic diseases or non-biofilm induced gingivitis.
addressing the root cause(s): 1. bacteria, 2. the host response and 3. We need to educate physicians that clients with diabetes or car-
diagnosed or undiagnosed systemic health conditions. All of these diovascular disease should be referred to their dental profession-
increase the progression of dental infections and the potential for rapid al. Furthermore, when we see clients with active gingivitis, peri-
periodontal tissue breakdown. Reevaluating our protocols, reviewing odontitis, implantitis, or halitosis we also need to recommend
our client’s medical, pharmacological, and family history as well as their they see their physicians for an evaluation. It is through continu-
home care routines can give us clues. al effort we will break down the barriers and educate the medical
When I'm performing an assessment and observe generalized active community about how we can all work together to help our
disease, I ask my client three things: when was their last medical exam, clients.
have they had a recent blood work-up and is there anything their physi- Type 2 diabetes (T2D) is prevalent in society. Individuals with
cian was “watching”. A thorough assessment should also include med- T2D who have severe periodontal disease have 3.2 times greater
ical and family history, reviewing risk factors (Table 1), complete peri- mortality risk compared with individuals with mild periodontitis.
odontal charting, indices and current radiographs to evaluate bone lev- The good news is that periodontal therapy has been shown to
els and disease activity. If you have an incomplete assessment it will improve glycemic control in type 2 diabetics. We have the poten-
compromise care and your results. Consider taking blood pressure tial and ability to make a significant difference in the oral and sys-
annually and every visit if they have risk factors. We often see clients temic health of our diabetic clients. Consider the use of screening
more than their physician, and we can screen for undiagnosed high tools to identify diabetes in clients at high risk and to encourage
blood pressure. them to go for an assessment with their medical doctor.
Our clients are overwhelmed by information about the oral systemic Drs. Bradley Bale and Amy Doneen’s article - “High risk peri-
link in the news or on Facebook but they don't always hear it from us. odontal pathogens contribute to the pathogenesis of atheroscle-
Let’s make 2021 the time for us to become the professional source of this rosis” is really shocking the medical community. They are
information. encouraging the medical community to pair up and work with
3.5 billion people worldwide are affected by untreated dental caries, dental offices to eliminate all signs of infection and inflammation
severe periodontitis, and edentulism. There are numerous studies and in the whole body because specific high risk periodontal

50 Dental Practice // May-June 2021 // Vol 17 No 5