Game Changers in Dentistry: 2013 and Beyond

The Oral/Systemic Connection

Much research in the past 10-20 years has aimed to discover whether (and how) oral health is related to systemic conditions and outcomes, such as cardiovascular disease, diabetes, and premature birth. Frankly, I would be surprised if some of these connections did not exist; after all, I was taught that the head is usually connected to the body. The reasons that this "revelation" was so long in coming would make an interesting digression.

Suffice to say that enough credible evidence is now in place that we can see (through a glass, darkly) that there are real and important links between systemic and oral health. In most cases, the evidence shows correlations without causality: For example, does diabetes aggravate periodontal disease, or the other way around, or is there some third factor that causes both? Scientists are working hard to untangle the critical question of causation.

I can't leave this subject without mentioning the possible links between oral health and genetics -- surely the granddaddy of all systemic factors. It would be a boon to patients if the dentist knew in advance what to look for in the way of disease, abnormality, or response to treatment. One would hope that this clue would be something more useful than "bad teeth run in my family." The research effort is enormous, and the technology is well in hand. The problem, as I see it, is to connect the clean, clear-cut, quantitative genetic data with the very complicated business of clinical outcomes.

Even now, we know enough to start modifying diagnosis and treatment protocols according to oral/systemic factors. The link between periodontal disease and premature birth is reflected in the latest Health Resources and Services Administration guidelines for dental treatment during pregnancy.^[6] The American Academy of Periodontology and the American Diabetes Association have summarized comparable guidelines^[7] for treating diabetes. Perhaps most telling is the fact that at least 1 insurance company has introduced a policy that includes major incentives for expectant mothers to receive dental treatment to reduce the risk for preterm delivery.

Understanding how to treat patients with special medical needs is a near-term game changer for the practicing dentist. It won't be long before more dramatic findings will come on line in this area.