In the year 2000, the US Surgeon General stated that ‘you cannot have good general health without good oral health.
There is now a considerable body of evidence linking periodontal disease with systemic diseases. There is a direct relationship between diabetes mellitus and levels periodontal disease, whilst heart disease, rheumatoid arthritis, renal disease and Alzheimer’s have also been implicated.
More teeth are lost from periodontal disease than caries.
Periodontal disease is the most widespread disease known to mankind.
Forty percent (yes 40%) of all medicolegal claims in the UK relate to failure to diagnose and treat periodontal disease, a higher claim rate per head of population than the USA.
You cannot make accurate impressions for crown and bridgework for patients whose gingivae bleed.
Implants will fail earlier than predicted if patients have poor plaque control.
We, as dental professionals, have an important role not only for our patients but also to educate our medical colleagues, some of whom have very limited knowledge of our skills and how we can work together, for example with the care of diabetics.
Before embarking on giving advice to a patient, there are several principles to consider first.
- Will the patient understand the advice we give?
- Will the patient understand the technical words we might use and our language?
- Will the patient be able to follow our advice easily?
- What ways do we have of reinforcing that advice?
- Has the patient fully understood what we have said?
- Will the patient remember what has been said?
- Will the patient be able to follow our advice even if they do remember correctly?
- How can we check on patient compliance?
Please teach patients that plaque is the villain of the peace, because periodontal disease is not a classic infection, as for example meningococcal meningitis. Periodontal disease does not fulfil Koch’s Postulates for an infection. Instead, it is described as a hypersentivity reaction to the antigens in plaque, the long term retention of which leads to an inflammatory reaction in the gingivae and progressive bone loss with varying degrees of individual susceptibility. Periodontal disease is not caused by a single bacterial species. This host response is modified by genetic predisposition, smoking, diet, plaque microflora, and personal plaque control.
It follows that the most important message you can give to any patient is that their daily effective plaque control is the key determinant in whether their periodontal disease can be controlled (Peace, 2011). And, you are there for them, at the regular intervals each specific case requires, to monitor and measure, advise, scale, ultrasonically remove radicular biofilm, surgery etc. It is a team effort between dental professionals and each patient.
You should also share with patients the results of their Basic Periodontal Examination (BPE) and pocket charting scores as an educational tool to improve oral health.