As dental professionals, one of the first things we review with our patients is their health history. Many patients are honest and will advise you up-front of all their currents conditions and diagnoses, as well as a give you a current medication list, including supplements. However, there are patients who tell you something like, “Nothing has changed that has to do with my teeth.” We know any change in medications or medical conditions can affect everything else in our bodies. But how do we convince our patients we need to know this info, without confrontation?
I like to begin the conversation with medication, and let them know about 400 of the top prescribed medications have a side effect of xerostomia. This is a great way to break the ice and assure patients we have knowledge, as well as showing them the conditions and treatments they may be dealing with, really do affect their oral cavity. While on the subject of xerostomia, many conditions and diseases can have dry mouth as a side effect; Sjogren’s syndrome, sarcoidosis, amyloidosis, and Rheumatoid Arthritis, to name a few. Just mentioning some of these conditions with patients who exhibit symptoms of xerostomia, or if they tell you their mouth feels dry, can open the door for you to uncover issues, and help your patients to better deal with their oral irritations.1
To help patients understand how their oral conditions can play a role in their overall health and to encourage them to disclose this information to us, as we are health care professionals, we need to understand what will be the best information to share with them. The following list may help in discussing why a patient needs to treat and maintain conditions such as periodontitis and gingivitis. Five of the chronic diseases on this list have been linked to periodontal disease. As dental professionals, we owe it to our patients, and ourselves, to have some basic knowledge of these links so we can discuss treatment plans which will help our patients live the best, healthiest lives possible.
In 2005, the National Center for Health Statistics listed the top 5 causes of death per year in the United States:
- Heart Disease: 652,091 deaths
- Cancer: 559,312 deaths
- Stroke/Cardiovascular Disease: 143,579 deaths
- Chronic Lower Respiratory Disease: 130,933 deaths
- Accidental Deaths: 117,809 deaths
- Diabetes: 75,119 deaths
If a patient has already disclosed having one of these diseases, such as diabetes, we can then discuss the known relationship between the disease and factors such as uncontrolled oral inflammation, and how that can affect their control over the disease. People with diabetes are more likely to develop periodontal disease, which can increase blood sugar and create other complications in the control of the diabetic condition.4
Other conditions patients may disclose to us are heart disease and pulmonary issues such as COPD. Both of these, along with other diseases, have been shown, according to the American Academy of Periodontology, to have strong links to periodontal disease. The Academy states that good oral health habits along with regular dental care can help with the effects of periodontitis with these health issues.
One group of people which may benefit significantly from dental advice is the geriatric population. Statistics show about 33% of senior adults who still have natural teeth, have untreated dental caries, and about 56% have untreated periodontitis.2
Another group we need to be concerned with is women and pregnancy. The ideal situation would be to discuss dental health with a female before she becomes pregnant and keep her home care and routine dental care going, before and throughout, the pregnancy. This will not always be the case. As a society, we know things such as alcohol, smoking, and drug abuse can adversely affect pregnancy. But we need to help educate our patients on the factors of the mouth that can also negatively affect pregnancy.
It has been shown that preterm birth and the associated morbidity is the leading prenatal problem in the United States. Studies show subclinical infections are one of the causes of preterm labor. More recent information seems to also link these subclinical infections to other neonatal issues such as cerebral palsy, respiratory distress, periventricular leukomalacia, bronchopulmonary dysplasia, and necrotizing enterocolitis.3
Hopefully, this information can help you open the lines of communication with your patients so you can better assist them in their overall health. We are experts at dental issues, and we are always striving to help our patients have the healthiest smiles possible. We are constantly studying and taking CE courses to be the best for our patients. Keeping up on the changes in the medical field and how the oral cavity can be affected, as well as be affected by the conditions and treatments of the rest of our body, is imperative to provide better outcomes for our patients.
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- Bartels, C.L. The Oral Cancer Foundation: Xerostomia. Retrieved from https://oralcancerfoundation.org/complications/xerostomia/
- Sjogren, P., Nilsson, E., Forsell, M., Johansson, O., Hoogstraate, J. (2008). A systemic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. Journal of the American Geriatrics Society. Nov 2008; 56(11), 2124-2130. Retrieved from https://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.01926.x
- Gibbs, R.S. (2017). The relationship between infection and adverse pregnancy outcomes: an overview. Obstetrics and Gynecology. Nov 2017; 6(1), 153-163. Retrieved from https://onlinelibrary.wiley.com/doi/10.1902/annals.2001.6.1.153
- New reports confirm perio-systemic connection and outline clinical recommendations. American Academy of Periodontology. Retrieved from https://www.perio.org/consumer/EFP_AAP_Workshop_Proceedings