In a Nutshell

The November 2012 EFP and AAP workshop on systemic health and how it is affected by periodontal disease has resulted in the joint publication of a couple of valuable systematic reviews in both Journal of Clinical Periodontology and Journal of Periodontology. I have expressed my strong opinion here on this blog that, in essence, there was not so much new or surprising. That there is strong evidence for minor effects of periodontitis on, say, cardiovascular disease and that diabetes mellitus is affected by periodontal disease while it is a risk factor for gum disease itself has been known for decades. That, what organizers had claimed,  there is now a need for intervention studies to show that the risk for cardiovascular events may be reduced, has been questioned on this blog and elsewhere.

I have criticized the workshop’s Manifesto, a press release which reduced the somewhat difficult to digest information to a message for the public (and I include here in particular most of the dental profession whose members may not be able or willing to read through the pages of documents, be it but systematic reviews let alone the original cohort studies). I have also suggested a brief example (based on a gut feeling of a possible risk ratio) in which the most relevant ethical problem of not treating huge cohorts for periodontal disease was mentioned while probably a great number of patients with periodontitis had to be treated successfully (number needed to treat) in order to prevent a single cardiovascular event (if the effect was causal) which renders the whole exercise probably irrelevant.

Well, this is unfortunately not the end of the story. The EFP website has linked to a youtube video of 2:27 min in which most trivial and highly questionable statements are given by our “thought leaders”.

“These days, even the most laid back professional may not find the time to digest anything but the most concise messages. We’ve taken that into account and skimmed the fat from our earlier 7-minute short documentary ‘The Vital Connections’. ” (The Vital Connections is not better, by the way.)

Apart from most trivial information, for instance that the oral cavity is a part of our body, colonized by millions [sic] of bacteria, and toothbrushing may lead to bacteremia, highly unsubstantiated claims are uttered as well. Professor Niklaus P. Lang further summarizes,

“Patients may realize that the mouth is an organ that cannot [sic] be neglected and that needs some priority. And with very simple methods prevention can be pursued with a high degree of success and by doing that they also minimize or reduce the risk for systemic diseases such as myocardial infarction or stroke.” (My emphasis.)

Lang does not mention that smoking cessation, a healthy diet and physical activity have been shown to reduce the risk. Nobody has shown what he actually claims. Since myocardial infarction and stroke are serious diseases, such an unsubstantiated message is dangerous, in particular for the public and busy dental practitioners.

There are growing numbers of dentists who are strongly committed to emerging true evidence. My task as university teacher is to convey the message to undergraduates that grandiose expert opinion, wishful or analogy thinking do not constitute any evidence and have to be disregarded in decision making. I take pride in that they are used to question my opinion, too. Continuing education of dental practitioners includes principles of evidence based medicine with the aim to debunk statements such as Lang’s. And, strong evidence for minor effects is mainly minor effects.

Since 13 August 2013, the video has been clicked 757 times.

13 February 2013 @ 4:27 pm.

Last modified 19 December, 2013.


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