An article in the Journal of Periodontology, May 2010 issue addresses the issue of “risk factors” in diagnosing and treating periodontal disease in 2010. The authors, Kenneth S. Kornman and Donald Clem discuss how periodontal disease is treated differently today, than in the past.
“…If one considers emerging evidence linking chronic inflammation to multiple systemic conditions, including cardiovascular events, Alzheimer’s disease, and diabetes, then pain and disfigurement of uncontrolled periodontitis have far-reaching systemic effects encompassing not only natural dentition, localized soft tissues and bone, but other diseases that may degrade the quality of living and may threaten life itself.
Over recent decades, the inflammatory process itself, as measured by the blood mediators, such as high-sensitivity C-reactive protein, has been identified as a primary modifier of many chronic diseases, including periodontitis. Clinicians recognize that systemic levels of inflammatory mediators in individual patients may result from genetic variations or from modifiable factors, such as diet, body fat, and unresolved chronic inflammation.
In 1968 the focus of periodontal therapy, and much of medicine, was on the current level of disease, with the assumption that most patients exhibited a clinical expression of disease resulting from a single common etiology. We argue that in 2010 treatment planning and patient monitoring must consider a complex web of factors beyond the current level of disease to include assessing risk factors predictive of future disease progression and of prognosis with treatment. Explicit evaluation of risk factors allows the clinician to modify treatment and therefore risk…. For example, if a patient with severe periodontitis is a smoker, we cannot ignore this risk factor whether we choose to treat the patient with or without the use of implants or regenerative technologies.
What has changed since 1968? First, treatment decisions are now based on not only tooth-level evaluations of past destruction, but also patient-level assessments of risk factors for disease progression. These may include concomitant systemic disease; conditions such as HIV, cancer chemotherapy, and organ transplant, which immunocompromise; pharmaceutical agents; menopausal issues; nutritional status; tobacco use; unresolved stress; and various genetic influences. Second, achievement of good treatment outcomes has become potentially more critical. Although not definitively proven, it seems very likely that proper periodontal care targeting elimination of inflammation will contribute to a decreased incidence of other chronic diseases. Given current knowledge, it is reasonable to conclude that failure to maintain the periodontium in a state of low to no inflammation in certain patients will increase the likelihood of loss of teeth, implants and dental dysfunction, and potentially increase the risk for systemic diseases.
One thing that has not changed in 40 years of managing these patients; dentistry for the long-term stability of patients who are in need of periodontal and restorative reconstruction requires a team approach to care in which restorative dentists and periodontists work together to achieve long-term health and well being for the patients they serve.”
Dr. Mark J. Weingarden
www.pittsburghimplantsandperio.com