Prevent, Identify Periodontal Disease for Overall Patient Health

The significance of oral health and hygiene often is overlooked until an issue arises. Research has established that oral health is critical to general health and well-being.

Poor oral health and hygiene may lead to infections and pain, which may result in eating and speaking problems and affect over-all quality of life, including self-esteem and social interactions, according to the CDC.¹

The 3 most common oral conditions affecting overall health and quality of life are cavities, severe periodontal disease, and severe tooth loss (meaning having 8 or fewer teeth), according to the CDC.¹ Recent statistics show that an estimated 26% of adults in the United States have untreated tooth decay; approximately 46% of all US adults 30 years or older exhibit signs of periodontal disease, with 9% having severe periodontal disease.² Moreover, about 68% of adults 65 years or older experience some degree of periodontal disease.²

Periodontal diseases are common but largely preventable and treatable if detected early. They may present with varying degrees of severity and are primarily the result of infections and inflammation of the bones that support and surround teeth, as well as the gums.³ Gingivitis is the early stage of periodontal disease, affecting only the gums, and is characterized by gingival bleeding, redness, and swelling.³ The most common cause of gingivitis is poor oral hygiene, which promotes the accumulation of plaque.³ By contrast, periodontitis, the most severe form of periodontal disease, is characterized by gingival inflammation, accompanied by loss of supportive connective tissues around the teeth. Comparable to gingivitis, periodontal disease is most often caused by poor oral hygiene.³ Certain chronic conditions and/or factors augment the risk for periodontal disease, including diabe-tes, genetic factors, having a compromised immune system, and poor oral hygiene.⁴ Moreover, use of tobacco products is an important risk factor for development of periodontal disease. In advanced stages, periodontal disease can lead to bleeding and sore gums, painful chew-ing problems, and tooth extraction and/or loss.⁴ Hormonal changes during pregnancy, metabolic diseases, and the use of certain medications such as antihypertensive agents and immunosuppressants may also affect the gums.

News and Clinical Studies

Investigators at Tufts University School of Dental Medicine in Boston, Massachusetts, discovered that targeting Fusobacterium nucleatum, which often thrives in periodontal disease, could slow development of Alzheimer disease (AD). However, more research is warranted.⁵ Although the correlation between AD and periodontal disease is not new, the association with this bacterium is. Investigators indicated that this is the first study to discover that F nucleatum can produce systemic inflammation and even infiltrate nervous system tissues, exacerbating the signs and symptoms of AD.⁵

In a recent publication, the American Heart Association indicated that more than 100 diseases can show symptoms in the oral cavity.⁶ For example, periodontal disease commonly occurs in those with diabetes; cases tend to be more severe, particularly in individuals with poorly controlled diabetes and those with higher HbA1c values, and diabetes related complications are exacerbated and increased.^6,7

Research results indicate that the presence of periodontal disease has been correlated with several cardiovascular diseases, including carotid atherosclerosis, hypertension, and myocardial infarction.^8-10 A 2020 systematic review indicates that periodontitis may boost the risk of developing rheumatoid arthritis.¹¹

Finally, research suggests connections between periodontitis and respiratory diseases such as asthma, chronic obstructive pulmonary disease, and pneumonia, probably because of inflammatory processes and aspiration of microorganisms from the periodontal pocket.¹²

Pharmacists can help to identify medical condi-tions and/or medications that contribute to or exacerbate oral health issues, making recommendations based on individual situations. They can also educate patients about and promote proper use of the various oral hygiene products, as well as expand awareness of the importance of oral health and its impact on overall health and well-being. During counseling, pharmacists should remind patients that routine oral health, including professional dental care, is essen-tial to maintaining good overall health. In general, the goals of oral hygiene are to decrease the incidence of halitosis and xerostomia; eliminate or thwart the formation and buildup of plaque and tartar; prevent dental caries, periodontal disease, and tooth loss; and reduce dentin hypersensitivity.

Pharmacists can also remind patients about the recommended proper brushing and flossing technique from the American Dental Association (ADA) and other helpful tips about oral health, such as the following:

• Brush teeth at least twice daily with a soft-bristled brush. The shape and size of the brush should allow accessibility to all areas of the mouth.
• Floss after brushing.
• Limit consumption of sugary beverages and snacks.
• Replace the toothbrush every 3 or 4 months, or sooner if the bristles are frayed. A worn tooth-brush does not clean teeth properly.
• Use an ADA-accepted fluoride toothpaste (see https://www.mouthhealthy.org/en/ada-seal-products).
• Visit a dentist at least twice a year.

For more information, visit the ADA’s Mouth Healthy website (https://www.mouthhealthy.org/en/az-topics/b/brushing-your-teeth).

References

1. Oral health fast facts. CDC. January 25, 2021. Accessed September 1, 2022. https://www.cdc.gov/oralhealth/fast-facts/index.html

2. Adult oral health. CDC. December 22, 2020. Accessed September 1, 2022. https://www.cdc.gov/oralhealth/basics/adult-oral-health/index.html

3. Gingivitis and periodontitis: overview. In: InformedHealth.org [Internet]. Institute for Quality and Efficiency in Health Care. Updated February 27, 2020. Accessed September 18, 2022. https://www.ncbi.nlm.nih.gov/books/NBK279593/

4. Oral health conditions. CDC. April 6, 2022. Accessed September 1, 2022. https://www.cdc.gov/oralhealth/conditions/index.html

5. Wu H, Qiu W, Zhu X, et al. The periodontal pathogen Fusobacteri-um nucleatum exacerbates Alzheimer’s pathogenesis via specific pathways. Front Aging Neurosci. 2022;14:912709. doi:10.3389/fnagi.2022.912709

6. Armas GC. Health conditions a dentist might find that have nothing to do with your teeth. American Heart Association. August 11, 2022. Accessed September 2, 2022. https://www.heart.org/en/news/2022/08/11/health-conditions-a-dentist-might-find-that-have-nothing-to-do-with-your-teeth

7. Cao R, Li Q, Wu Q, Yao M, Chen Y, Zhou H. Effect of non-surgical periodontal therapy on glycemic control of type 2 diabetes mel-litus: a systematic review and Bayesian network meta-analysis. BMC Oral Health. 2019;19(1):176. doi:10.1186/s12903-019-0829-y

8. Xu S, Song M, Xiong Y, Liu X, He Y, Qin Z. The association between periodontal disease and the risk of myocardial infarction: a pooled analysis of observational studies. BMC Cardiovasc Disord.2017;17(1):50. doi:10.1186/s12872-017-0480-y

9. Martin-Cabezas R, Seelam N, Petit C, et al. Association between periodontitis and arterial hypertension: a systematic review and meta-analysis. Am Heart J. 2016;180:98-112. doi:10.1016/j.ahj.2016.07.018

10. Zeng XT, Leng WD, Lam YY, et al. Periodontal disease and carotid atherosclerosis: a meta-analysis of 17,330 participants. Int J Cardiol.2016;203:1044-1051. doi:10.1016/j.ijcard.2015.11.092

11. Qiao Y, Wang Z, Li Y, Han Y, Zhou Y, Cao X. Rheumatoid arthritis risk in periodontitis patients: a systematic review and me-ta-analysis. Joint Bone Spine. 2020;87(6):556-564. doi:10.1016/j.jbspin.2020.04.024

12. Gomes-Filho IS, Cruz SSD, Trindade SC, et al. Periodontitis and respiratory diseases: a systematic review with meta-analysis. Oral Dis. 2020;26(2):439-446. doi:10.1111/odi.13228

About the Author

Yvette C. Terrie, BSpharM, Rph, is a consulting pharmacist and medical writer in Haymarket, Virginia.