Periodontal Disease and Overall Health: A Clinician's Guide

48 Periodontal Disease and Overall Health: A Clinician's Guidebacterial products found in the mouth couldenter the bloodstream and could in some waybe harmful to the body as a whole. 29 It wasnot until the last decade of the twentieth centurythat dentistry and medicine started againto consider the relationship of oral diseases,such as periodontal disease, as a contributorto risk factors for certain systemic diseases.Oral-Systemic Relationship RevisitedThe late 1980s saw an increasing numberof publications implicating an associationbetween periodontopathogenic bacteria andcertain systemic conditions such as coronaryartery disease, stroke, and preterm/low birthweight babies. Such insinuations had alsobeen made early in the twentieth century, butthis time reports were judged with a moremeasured response. 30 According to Barnett 30this response was a result of several factors:(a) greater analytical and statistical knowledge,and a better understanding of the con -strains of epidemiological research in “estab -lishing disease causalty”; (b) increased aware -ness of the etiology and pathogenesis of oraldiseases; (c) increased awareness of theetiology and pathogenesis of associated systemicdiseases; (d) modern advances in thetreatment of oral conditions; (e) realizationthat bacteria could in some way be implicatedin the development of diseases that asyet have an undetermined etiology.In 1989, Mattila and coworkers 31 inFinland conducted a case-control study on100 patients who had suffered an acute myocardialinfarction. They compared these patientsto 102 control subjects selected fromthe community. A full dental examinationwas performed on all of the subjects studied.Additionally, a dental index was computed.This index computed the sum of scores fromthe number of missing teeth, carious lesions,peri-apical lesions, probing depths, and thepresence or absence of pericoronitis. It wasfound that dental health was significantlyworse in patients with a history of acutemyocardial infarction than in control subjects.This association remained valid evenafter adjustment for age, social class, smoking,serum lipid concentrations, and the presenceof diabetes. It was mainly this studythat renewed the interest of physicians anddentists in the relationship of oral to systemicdisease.In retrospect, it is now clear that theadvent of reports by Mattila and colleagues—followed soon thereafter by DeStefano etal. 32 and Offenbacher et al. 33 —was the beginningof a new era of understanding theimpact of oral health and disease on overallhealth and disease. 25,30 By 1996, the term“periodontal medicine” would emerge asscientists and clinicians in dentistry andmedicine began to appreciate the tremendouseffect that oral disease can have on thebody. 34PERIODONTAL/ORAL DISEASEAS A RISK FACTOR FORSYSTEMIC DISEASEDespite many years of history demonstratingthe influence of oral status on generalhealth, recent decades have seen an acceleratedeffort for the prevention and managementof these conditions through groundbreakingadvances. Specifically, periodontitis,a chronic infectious and inflammatory diseaseof the gums and supporting tissues, hasbeen associated with systemic conditionssuch as coronary heart disease and stroke,higher risk for preterm, low-birth-weightbabies, and certain cancers. It has also beensuggested that it might pose threats to thosewith chronic disease, e.g., diabetes, respiratorydiseases, and osteoporosis. 35-38 Perio -dontal diseases are infections that are causedby micro-organisms that colonize the toothsurface at or below the gingival margin.These infections affect the gingival tissuesand can cause damage to the supportingconnective tissue and bone. Periodontal diseasecan be caused by specific bacteria (such