Periodontal disease has increasingly become a topic of discussion regarding how it impacts our overall health and other disease processes. As dental professionals, we discover and diagnose this disease by doing a periodontal exam looking for "pockets" and taking x-rays that show bone loss around the teeth. We find periodontal disease in patients who smoke or neglect their dental health. We then prescribe a treatment for the disease, and many times we will complete scaling and root planing along with seeing the patient for supportive therapy every 3 months to help maintain their periodontal health.
If they don't improve, we use antibiotics, antibacterial rinses, and maybe more "deep cleanings" along with other treatment modalities to help fight off the bacteria. And, if we beat the bacteria, we win! Sounds pretty straightforward, right? Wrong.
The science and our understanding of periodontal disease have evolved tremendously from a "bacterial infection" of the gums to a complex interaction between the bacteria and the host/host immune system, not only impacting gum health, but also overall health. With this in mind, we have to understand that it's not just the bacteria at work here, but also how the body responds to their presence.
As dental professionals, we have to start looking at periodontal disease differently in a sense that it is a marker or possible indication of something bigger. Did you know that vitamin D deficiency is very prevalent (40% of the patient population, on average) and has been shown to affect some patient populations by as much as 80%? Recent studies show that vitamin D deficiency can have a significant impact on periodontal disease and the host response. Vitamin D deficiency not only impacts patients' oral health, but also their overall health by increasing their risk for cardiovascular disease, osteoporosis, cancer, and several other chronic diseases.
Vitamin D is one of many vitamins that can have an impact on our patient’s periodontal health, as well as vitamins A, C, E, K, and B. Unfortunately for many patients, this is often overlooked by primary care physicians as well as dental professionals, especially when all we’re doing is trying to manage bacteria to help maintain the patient’s oral health.
The oral cavity truly is linked to everything else in the body, and many times it is a reflection of what is going on in the patient's overall health. Over the past year, as I've started to talk to and discuss vitamin and nutrient deficiency with my patients, I've been finding that many who come in with ongoing periodontal disease and gum inflammation are referred to their physicians for bloodwork, only to find they have low vitamin D levels. Did I just help that patient's overall health vs. prescribing more gum disease treatment? Yes.
With all of this mind, dental professionals can actually help their patients improve their overall health. So, next time you see a patient with periodontal issues, think "outside the mouth."
Jeff Lineberry, DDS, graduated in 2000 from the University of North Carolina School of Dentistry. He is a fellow in the Academy of General Dentistry and the International Congress of Oral Implantologists; an Accredited Member of the American Academy of Cosmetic Dentistry; and a Visiting Faculty, Online Moderator, and Contributing Author for Spear Education. His dental practice is in Mooresville, NC.