While all of us eagerly await the promised monthly comments on eleven themes which have been identified by J Perio’s Editor-in-Chief Dr. Kenneth S. Kornman and colleagues Drs. Paul B. Robertson and Ray C. Williams, your humble blogger will just go ahead sharing with my readers own thoughts which came to my mind when reading the extensive reading list on the Literature That Shaped Modern Periodontology. As the responsible teacher of Perio at The Arctic University of Norway, I feel obliged to put the list somewhat into perspective, in particular since Kornman et al. focus on just highly cited papers (which may frequently represent mainstream) and further consensus papers of importance as suggested by various U.S. postgraduate program directors. And especially as a highly esteemed colleague representing another subject here has put the list on fronter as if it was the best since the invention of chocolate ice cream. Since, for undergraduates, the list inevitably will causes if anything but shock and awe, there is apparent need for some moderation.
4. Periodontitis and Other Systemic Diseases Interact – in Both Directions
First, I want to make sure that I am no heretic. Interaction between periodontal disease and systemic health is, of course, an old story which has only been revived about 25 years ago, undoubtedly to some success for larger parts of our profession. For instance, even before 1990 or so it was well known that diabetes mellitus is associated with considerable periodontal morbidity. On the other hand, when having a look at clinical studies back in the 1970s and 1980s, one frequently reads that periodontitis patients “otherwise healthy” had been enrolled in the trials. After having realized in the meantime that periodontitis is associated with whatever chronic disease or condition is considered, be it lung cancer at one extreme or erectile dysfunction at the other, one can only come to the conclusion that the topic, which gets so much attention nowadays, had in the old days completely been ignored (as had been the effect of smoking on periodontal health). That “bad dentistry” may have, in certain cases, even fatal consequences is, on the other hand, not a new idea but had led, in particular in the United States and later, for instance, in Germany to what was sometimes vilified “Gnathology”, which should not be mistaken just as “occlusal ideology” but rather striving for proper biological function of fixed and removable restorations.
During the last couple of days I have had an email exchange with a colleague about the recent supplements in both EFP’s Journal of Clinical Periodontology and AAP’s Journal of Periodontology where a number of review articles had been published on the relationship between periodontitis and systemic diseases. The papers had been formulated and discussed during a November 11-14, 2012 workshop which had been organized by both organizations in Segovia, Spain. While the update of our current knowledge and opinion is welcome, of course, the effort bringing together the usual suspects (but not so many critical minds) from the United States and Europe was mainly directed in publishing a so-called Manifesto which largely simplified the complex information into easy to digest statements with which politics can be made. I have reported on certain aspects on this blog before.
My colleague last night wondered why the international community has not gained support to get the money to conduct an RCT intervention trial to determine if periodontal treatment will reduce cardiovascular events, calling for an international trial with each country providing funds to support the trial expense. Well, JCP editor Maurizio Tonetti, together with Thomas van Dyke, had actually called for “well-designed intervention trials on the impact of periodontal treatment on prevention of ACVD [artherosclerotic cardiovascular disease] hard clinical outcomes,” see here [pdf].