The American Academy of Periodontology (AAP), in collaboration with the European Federation of Periodontology (EFP), has published a series of consensus reports that analyze the scientific evidence linking periodontitis to other systemic diseases, including diabetes, cardiovascular disease, and adverse pregnancy outcomes (Journal of Periodontology, April 2013, Vol. 84:4-s).
The reports also outline clinical recommendations for dental professionals to use when treating patients at risk for, or presenting with, certain medical conditions.
The reports were developed at a joint workshop held in Segovia, Spain, in November 2012, where more than 70 international experts met to review the available evidence supporting the association between periodontitis and other systemic diseases. The workshop was supported by an educational grant from Colgate-Palmolive.
Here are some of their key conclusions:
There is strong epidemiologic evidence that periodontitis provides an increased risk for future cardiovascular disease. Dental professionals should discuss other risk factors for cardiovascular disease with their patients, including hypertension, obesity, and tobacco use. The treatment of periodontitis in patients with a history of cardiovascular disease should follow the American Heart Association guidelines for elective procedures.
There is an independent association between moderate to severe periodontitis and an increased risk for the development or progression of diabetes. Periodontal interventions may provide beneficial effects on diabetes outcomes in some patients, so regular comprehensive periodontal evaluations should be part of an ongoing diabetes management program.
While some studies suggest a modest association between maternal periodontitis and adverse pregnancy outcomes, there is currently insufficient evidence that periodontal therapy can be recommended as a means to improve pregnancy outcomes. Periodontal therapy is considered safe in pregnant women and can result in improved periodontal health, but dental professionals are urged to adhere to general obstetric guidelines that suggest elective procedures should be avoided in the first trimester.
Evidence suggests a relationship between periodontitis and other systemic diseases, including chronic obstructive pulmonary disease, pneumonia, chronic kidney disease, rheumatoid arthritis, cognitive impairment, obesity, metabolic syndrome, and cancer. However, additional studies are needed to better understand these associations.
The consensus reports also identified recommendations for future research, such as well-designed interventional studies and randomized clinical trials, to enhance understanding of the impact of periodontitis and periodontal treatment on overall health.
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