In a previous post, I have expressed considerable concern about an assumed advertorial in our leading periodontal journal, JCP. Quintessence Publishing was about to launch their fourth installment of “3D” animated, short (each 15-17 min) movies all called Cell-to-Cell Communication, “Oral Health and General Health – The Links between Periodontitis, Atherosclerosis, and Diabetes.” Previous movies have been offered for purchase by QuintPub for a remarkable amount of around $100. Luckily, the new one can now be found on the EFP homepage and accessed by members and non-members for free.
Again, motile bacteria are patrolling, in pairs, periodontal tissues when it is not clear which kind of compartment is actually shown. I had compared respective creatures in a previous Cell-to-Cell Communication movie with those featured in The Matrix franchise of 1999-2003, see here.
The new Quintessence movie which is authored by S. Jepsen, M. Sanz, B. Stadlinger and H. Terheyden lists all kinds of inflammatory cells, mediators, receptors, structures and small molecules such as glucose as “Main Cast (in Order of Appearance)” and “Also Starring.” Is it possible that QuintPub actually hopes the movie could be nominated for the next Academy Awards in the category Best Documentary short subject?
At no point, the movie mentions long established risk factors for atherosclerosis and diabetes. While the overall description of pathogenic mechanisms of either condition may be factual, the movie suggests that periodontal bacteria which have entered the blood stream can cause these two major global health problems and even killers. Respective claims are generally based on published in-vitro observations, though. In Chapter 4, the narrator from the off claims,
The successful treatment of periodontitis may […] contribute to improve health not only in the oral cavity but throughout the body. For example, some studies have shown that the extent of endothelial dysfunction, which is the initial step in atherogenesis, can be positively influenced in a clinically measurable way. Many studies have also shown an improvement in average blood glucose level with lowered HbA1c values following successful [sic] periodontal therapy and even some suggest improvement in lipid profiles overall improving the control of diabetes. The two effects have in common that they reduce the concentration of inflammatory mediators in the blood. This is an important step in breaking the self-perpetuating cycle of inflammation in the body.
To me it is not clear which “two effects” are meant here. As regards improvement of “lipid profiles” seen in some studies; well, the respective meta-analysis in the systematic review by D’Aiuto et al. (2013) reports non-significant overall effects. A recent Cochrane review by Simpson et al. (2015) has reported that periodontal treatment in diabetics, apparently a true challenge, has a tiny but significant mean effect on HbA1c levels, about -0.29%. It has yet to be determined whether successful periodontal treatment actually makes a difference.
Thus, the movie’s main purpose appears to promote once again a popular message: periodontists may improve health in general (or may prevent serious diseases). Although recent large, multicenter, intervention studies have failed to show any effect of periodontal treatment on the marker of diabetic control or undesired pregnancy outcomes; and NIDCR funding had been terminated after a large pilot study had not yielded the expected reduction of cardiovascular incidents, the movie perpetuates mainstream beliefs and distracts by mixing hardly convincing claims with some indisputable facts and by fascinating, at least for some , visualization of “the invisible.”
The movie is the “expert version” for professionals (and maybe supposed for dental education as well). Another version for the public still awaits release. Likely that QuintPub will market the two versions on a DVD later in spring.
 Apart from having apparently long been inspired by popular scientific movie franchise The Matrix by the Wachowskis, it becomes clear that several Hollywood productions may have heavily influenced the creators of the movie on General Health. The eerie “ambient” soundtrack starting with the sounds of irregular heartbeat inevitably recalls Ridley Scott’s horror classic Alien of 1979. There, heart sounds were rather subliminal, though. After having asked the main question, Can periodontitis or other inflammatory processes in the oral cavity contribute to the development of cardiovascular diseases and systemic conditions such as artherosclerosis or diabetes or negatively influence their course?, one sees bacteria covered mucosal cells which apparently indicate pocket epithelium. Big things have small beginnings, one may think, as Mr. Dryden in David Lean’s Lawrence of Arabia of 1962 uttered in response to Gen. Murrays assessment of the Arab revolt in WWI as “storm in a tea cup.”
27 February 2016 @ 4:50 pm.
Last modified February 27, 2016.