Garth Griffiths, DDS  Periodontist, VA Medical Center, Dallas

Garth Griffiths, DDS

VA Medical Center, Dallas

Dr Griffiths presented information on the periodontal systemic connection of cardiovascular disease, respiratory disease, diabetes mellitus, osteoporosis and adverse pregnancy outcomes. A good medical history can provide valuable information but blood tests may be more accurate. One HbA1c report may be more reliable than reported blood sugar recollections from a patient with diabetes.

Bacteremias may occur during daily activities such as tooth brushing, chewing, etc. The incidence and magnitude of the bacteremia is directly proportional to the degree of oral inflammation and infection. The risk of a bacteremia in a healthy patient is low. Periodontal procedures with risk include: oral prophylaxis, scaling and root planning, surgery, implant placement, dental extraction. The American Heart Association 2007 Guidelines are currently being updated.

Prevention of bacteremias include: maintain optimal oral health, regular professional care (4-6 month cleanings), brushing with electric toothbrush (removes more plaque) and floss!!

Patient with diabetes can experience xerostomia, burning mouth, periodontal abscesses, dental caries, and candidiasis. Often patients are afraid to brush well due to bleeding and need extra encouragement to do so.

Some patients experience gingival disease in puberty and pregnancy due to hormone changes. Contraceptives can also produce issues but generally symptoms decrease after the first 3 months.

Specific medications also contribute to gingival overgrowth: anticonvulsants, calcium channel blockers and immunosuppressants. Generally issues arise with calcium channel blockers in patients that have poor oral hygiene and respond to improved hygiene. Immunosuppressants can cause issues even with good oral hygiene and are more difficult.

When interpreting clinical studies be sure to assess the strength of the data to determine the significance of the findings. Often studies show an association but do not address significant or clear outcomes.