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Where are we standing in our standard of periodontal treatment? How should we treat our patients?

23rd February 2015

In June, London is hosting the internationally renowned meeting for all the dental team (yes, not only for specialists in Periodontics) with an interest in Periodontology and implant dentistry, the EuroPerio 2015.

I’ve been following its planning since last autumn and seeing the promotional videos from fellow leading researchers and clinicians. I found one by Professor U. Van der Velden (ACTA, Holland). He was our (Jose and I) External and EFP (European Federation of Periodontology) Examiner at the end of our Specialist training in Goteborg back in 2002.

For those who want to see his video, here’s the link

When I reflect on what has been our carrier as a specialist Periodontist and how have we changed or adapted to the new scientific evidence emerging year after year, I feel very fulfilled to see confirmed our “clinical impressions” that there is much more into periodontitis then just dental plaque and its infectious potential. Even more, to specific bacterial findings in individual cases… I’ve been tremendously excited back in 2000 when the connection between periodontitis and “chronic inflammation” and the individual’s systemic health, namely cardiovascular diseases/stroke, diabetes/etc…  brought about immense and intense discussions. At that time however, there was indeed a lot of “data massaging”, meaning that many studies were being published using enormous existing databases which were not built to answer these specific questions, so many positive associations “popped-up”, which were great for tabloid headings, but lacked on scientific robustness.

This kind of research had to be stopped and indeed it phased out, but now, over more than a decade later, a significant body of more serious research has produced a trustworthy level of evidence. Indeed, theses associations seem to be there, we as Periodontists can no longer just focus on dental biofilms, no matter how its irrefutable and determinant role on the onset of gingival inflammation.

Here is a link where you can see what the “opinion makers” in our Specialty are saying!!

The patient’s lifestyle, from social behaviors (smoking/drinking/stress) to nutrition & quality of physical exercise, seems to play a far more important role. And we now know, we all start aging from the age of 30… and it’s all driven by inflammation (we see it being called inflammaging)!

Systemic inflammation is intensely influenced by all these factors. Look at inflammation as a double-edged knife; one hand we all thrive with a “bit of it” and really, all healing processes rely of inflammatory events, the ”players” are the same…. On the other hand, a long-standing and up-regulated inflammatory state creates mayhem and destruction in our body; it ages faster and it increases the susceptibility to chronic disease.  Given enough time and add  the effect of aggravating factors ( smoking/stress/plaque) , it may enhance the susceptibility to gum disease too and feed on to other inflammatory diseases in other parts of the body (joints, muscle, intake/effect of insulin on cells, allergy-related conditions, etc..)

At our Practice, we already dedicate some time to investigate our patient’s medical records and do our best to liaise with GP as/when needed, however it we may need to be more emphatic (we already are with smoking) and specific  recommendations, which can enhance our patient’s response to our golden-standard treatments.

Let’s do this!! If you want to keep inflammation low, here are some of our top recommendations:

  • Don’t smoke!
  • Supplement your diet with vitamin C, D and fiber, ideally through micronutrients (use a juicer to get all these goodies in…)..or eat at least 1 Kiwi/day.
  • Supplement Omega-3 fatty acids in your diet to protect your heart.
  • Watch for the intake of sugars (lower in particular fructose) and wrong fats.
  • Pay attention to the glycemic index and more even, the glycemic load of your food, especially if you are a pre-diabetic or a diabetic patient… or want to lose some weight wisely…. Here are some links for further information…
  • A balanced diet complemented by regular physical exercise (10-15 minutes aerobic daily sessions…it can be just a brisk walk!) complement each other beautifully in reducing the “inner fire”…

Lastly… something we hardly think or ask our patients. Social Isolation! Only recently I became aware of the real impact of  “social isolation” as a determinant of health. It’s not a usual topic to address at the dentist chair, you must agree! However, many well-designed studies (mostly US based) have demonstrated that social isolation has a tremendous effect on your health; it’s as bad as smoking 15 cigarettes/day, as dangerous as being an alcoholic, as harmful as never exercising and twice as dangerous as for your health as being obese. So…what are you waiting to meet up with friends and family and enjoy life in the full!

Watch this space…

Cristina Romao

Specialist Periodontist

The Perio Team

Carisbrooke Specialist Dental Centre