It has long been clear that the decades-long hype about what is called the Perio-Systemic connection is mainly PR. Recently, a comment writer in the AAP open forum used “self-esteem” as justifaction for exaggerating the issue. I have to admit that I was appalled. After all, we are part of the medical profession. Not exaggerating but putting into perspective the ever emerging “strong” evidence for minor and, most probably, clinically irrelevant effects of periodontal diseases on systemic health is an obligation of a serious member of our profession.
A colleague had sent me yesterday an ad by a company which markets zirconia oxide dental implants (see a more readable pdf here). The company’s circular reasoning seems to be that the risks for some life threatening diseases such as stroke, myocardial infarction, pneumonia etc. may be reduced by extracting periodontitis-affected teeth and replacing them with zirconia implants. While the patient who is not mentioned here is taken for a fool, there seems to be implicit complicity with the dentist who is suggested to use this kind of reasoning in his or her sales conversations.
Most of the alleged risks in the graph are exaggerated. All numbers are rounded up to the next integer. They are also based anyway on old case-control and cohort studies completely disregarding new and disillusioning intervention trials. They mix-up the direction in case of diabetes. Diabetes is mainly a risk factor for periodontitis and not vice versa. The associations between periodontitis and lung cancer and colorectal cancer, Alzheimer’s and erectile dysfunction, all of which can be found when browsing the literature, are not mentioned, either because the company doesn’t know or shies at complete hyperbolism.
Who should be held accountable? Well, our main organizations, AAP and EFP, have tiredlessly tooted the horn for years with each intervention study not being able to confirm what was a desired result followed by another workshop reviewing the literature once again. What has resulted was accumulating evidence for small effects. Not worth to be even considered by our medical colleagues.
Ads like the one discussed here are unethical, and colleagues should be wary not to follow the company’s suggestions. There is no evidence that extracting periodontitis affected teeth and replacing them by implants would reduce the risk for serious medical conditions. Proper treatment of periodontitis has important beneficial effects. In all likelihood, prevention of stroke, myocardial infarction, or low birth weight babies is not included.
17 March 2014 @ 10:45 am.
Last modified March 17, 2014.