Misleading the Public

Implants.jpg 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.



  1. Lynne Slim

    The AAP and EFP are special interest groups and it’s in their best interest to exaggerate these links. We need to call them out and they need to make this correction on their website and report it to their members and to the public at large. Will they do it? I seriously doubt it. Their last statement about “strong epidemiological evidence” concerning the perio/ASVD link was yet another misleading statement/exaggeration.


  2. Muller

    Thanks, Lynne, for the clarification. I doubt it too because even if officers of AAP/EFP are rather cautious in their official statements, the message conveyed to practioners and even undergraduate students is the desired one. Few practitioners read the original papers but see commercial ads where misleading information is shamelessly spread.


  3. Ruediger Osswald

    Thanks you for this very true statement.

    60 Years ago dentist tried to explain periodontal desease by bad function. You still find a lot of literature abaout this in medline. Seeing, that bad function (functional overload, we call it malfunktion) could not explain every aspect of the desease, they trew the idea away and focussed on bakteria. Dentists like unilateral relationships.

    Now, that they see, that bakterial infection cannot explain every aspect of the desease, the focus is laied thy on genetics, diabetes, smoking and on every thing, that is modern enough in the moment.

    Peridodontitis is what wie call a “big desease”. Like in every “big desease” there are many factors, that take infuence and have to be considered. And the most ignored/overlooked factor of all is malfunction, what means overload of the structures. When you see, that the teeth of the upper and lower jaw only meet within a maximum of 5 minutes per day without any pressure, that you realize easely, what functional overload may lead to: the combination of fuctional overload and inflamation is the Supergau for the perododental structures. Like any other structure in the body, longtime overload leads to inflamation or at least prevents from healing.

    Sorry for my bad English, I’m German. I hope anyway, even if you dont’ agree, that you understood at least, what I mean.

    Dr. Dr. Rüdiger Osswald, Munich, Germany


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