What Can We Say To Our Patients?

By Richard H. Nagelberg, DDS

What can we tell our patients about the mouth-body connection at this point in time? A vast amount of information has now been established regarding the associations between the mouth and body. The minutiae of the processes involved in periodontal disease, diabetes, atherosclerosis, insulin resistance, cardiovascular disease, etc., are mind-boggling. Dental professionals speak a different language than the general public. We can use terms such as cytokines, lipopolysaccharides, endothelium, bacteremia, and endotoxemia, or we can use the myriad abbreviations — PMNs, TLRs, HbA1c, MMPs, or SRP — only when speaking with other dental professionals. These terms and abbreviations have no meaning to those outside our profession. We can explain the oral-systemic associations in broad strokes since complete appreciation of the links requires a detailed understanding of immunology, physiology, microbiology, and pathology, among other ologies. This does not mean we have to dumb it down for the public; rather, we must convey the current state of knowledge with accurate and appropriate explanations tailored for our audience.

We can say that there are associations between the mouth and body; this is not in dispute. We cannot tell our diabetic patients that controlling their hyperglycemia will eliminate their periodontal disease. We can say that optimal periodontal treatment results can be achieved by controlling blood sugar levels, which is associated with enhanced healing. We can also say that the more generalized or severe the level of periodontal disease, the more likely it is to adversely affect their diabetes.

We can also tell patients that we can positively identify the specific bacterial cause of their periodontal disease just by getting a saliva sample. That is truly revolutionary, as is the importance of that information to treatment planning and the results we obtain.

We can definitively tell our patients that if their family has a history of periodontal disease, their likelihood of getting it is elevated. This is powerful information since these patients have a greater need to keep bacterial counts as low as possible. Probiotics, a power brush, and a tongue cleaner, among other devices, will help level the playing field for these patients. We can tell our patients that if they have a family history of heart disease, their need to prevent or control periodontal disease is critical, as is the need to stop smoking, eat a healthful diet, and get off the couch. These are all risk elements, and it is vital to control as many as possible.

We cannot currently tell patients that getting their periodontal disease under control will prevent a heart attack or stroke. We can tell them that research indicates that the total amount of inflammation in the body from all sources — including periodontal disease, an ingrown toenail, or anything in between — increases the risk for heart problems. We can accurately say the bugs that cause gum disease may be involved in the development of plaques in blood vessels. It is not proven yet, but studies have shown this relationship. If we communicate in a manner consistent with research findings, we are acting ethically.

We cannot tell our patients that periodontal disease is definitely associated with rheumatoid arthritis (RA). We can say that research appears to show a relationship between certain bacteria that are associated with periodontal disease and RA. We can ethically recommend salivary testing for those bacteria. We cannot say that bacterial reduction will provide any improvement in RA; however, reduction in Pg will certainly be beneficial due to its high toxicity, whether or not it makes any difference in the patient’s joint disease.

We can say that the mouth is unique due to the type of connection it has to the outside world. This connection functions in many different ways, including food and beverage intake, medication intake, respiration, speech, interpersonal contact, and so on. Not everything is positive with this mouth-as-a-portal-to-the-outside-world arrangement, since bacteria and other microbes come from the outside world.

We encounter situations every day in which we use our clinical judgment to make recommendations to patients and provide explanations involving virtually every aspect of dentistry. The mouth is just another part of the body, connected to the rest of it, as are all the other organ systems and virtually every cell. It is a mistake to think the mouth is separate from the body. We just need to choose our words with care and accuracy.

Richard Nagelberg, DDS, has practiced general dentistry in suburban Philadelphia for more than 30 years. He is a speaker, advisory board member, consultant, and key opinion leader for several dental companies and organizations, and lecturer on a variety of topics centered on understanding the impact dental professionals have beyond the oral cavity. Contact him at [email protected].