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BRUSSELS, Belgium: Close collaboration between general practitioners, periodontists and other oral health professionals is necessary for effective prevention, early detection and management of widespread systemic health conditions affecting millions of patients everywhere. This is one of the main conclusions of a new consensus report, which is the result of a joint workshop of the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe). The workshop’s aim was to define the potential role, on the one hand, of general practitioners in the early detection, screening and prevention of periodontal diseases and, on the other hand, of dental professionals in the early detection, screening and prevention of non-communicable diseases and consequently to develop adequate information for both groups.
The consensus report updates and improves scientific evidence supporting the conclusion that periodontal disease, in particular periodontitis or chronic inflammation of the gingivae, is independently associated with cardiovascular diseases (CVDs), diabetes mellitus and respiratory diseases such as chronic obstructive pulmonary disease, sleep apnoea or COVID-19 complications.
The paper builds on scientific reports from two previous workshops organised by the EFP. One workshop, with the International Diabetes Federation in 2017, explored links between periodontal disease and diabetes and the other, with the World Heart Federation in 2019, explored associations between periodontal disease and CVD. “Both reports suggested that family doctors have a pivotal role in the implications of the associations between conditions, since they treat most patients with diabetes or CVD after all,” said lead author Prof. David Herrera, chair of the EFP’s workshop committee and chair of the workshop.
“Our paper presents a critical update of the evidence supporting the association between periodontitis and very important systemic conditions, but our main objective was to understand the interpretation of this information by the family doctors, and the derived implications, developed to improve the management of our patients’ health,” explained Prof. Herrera.
The document advocates for general practitioners and oral healthcare professionals to work together in preventing, detecting and treating major systemic health issues, in exchanging information and mutually referring their patients, and in promoting healthy lifestyles among them. There is consensus in considering gingival health-related input as essential for general physicians to correctly manage their patients’ overall health.
For example, the report recommends that dental professionals and general practitioners implement effective strategies for the early detection of periodontal disease in primary healthcare centres and the early detection of CVD and diabetes in dental practices. General practitioners are encouraged to seek information about the periodontal health of their patients, and oral health professionals need to be aware of cardiovascular and metabolic risk factors.
Higher risk of CVD and diabetes
“When treating patients with periodontitis, oral health professionals should inform them that their risk of CVD is higher. Also, they are suggested to collect a careful history informing of reported CV risks factors including diabetes, obesity, hypertension, smoking, and to screen for other CV risk factors, as physical activity, excess of weight, blood pressure, or lipids or glucose management. If the patient presents obvious risk factors, they should be advised to consult with their family doctor and to adopt active lifestyle measures as weight loss, smoking cessation and physical activity,” advised co-author Prof. Lior Shapira, past EFP president and workshop co-chair.
“In the case of patients with diabetes or prediabetes, family doctors are invited to inform them of a higher risk of suffering from a gum disease, so they need to go to their dentist and screen their gums health. Besides, gum inflammation is a major risk factor to develop a metabolic disease such as diabetes. Importantly, at the dental practice we can screen periodontitis patients and identify those with diabetes or prediabetes who haven’t been previously diagnosed, which may save their lives. All in all, the main conclusion is that we, dental professionals, need to be in touch with our patients’ family physicians all the time,” Prof. Shapira added.
“The current split between dental health professionals on one side, and systemic disease professionals on the other makes no sense,” explained co-author Prof. Shlomo Vinker, president of WONCA Europe and workshop chair. “We should strive for great integration and better sharing of information. More collaboration on screening, prevention, and referrals would clearly benefit our patients and the public health.”
The EFP is currently preparing an outreach campaign based on the paper, targeting specific groups such as primary care providers, dental patients, policymakers, family physicians, dentists, periodontists and dental hygienists.
The consensus report, titled “Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe)”, was published online on 19 March 2023 in the Journal of Clinical Periodontology, ahead of inclusion in an issue.