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“Simple interventions by oral health professionals can greatly improve overall health and reduce risks”

Prof. David Herrera, chair of the European Federation of Periodontology’s workshop committee. (Image: EFP)

It is increasingly recognised that general medical care and dental care should be more closely linked. To that end, the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe) have recently published a consensus report on the basis of a joint workshop aimed at establishing specific recommendations for dental professionals and general practitioners for improved prevention, detection and treatment of cardiovascular conditions, diabetes and respiratory diseases. In this interview, Prof. David Herrera, lead author and chair of the EFP’s workshop committee, speaks about how dental professionals can achieve more holistic care of their patients and about an upcoming campaign to further disseminate the report’s findings.

Prof. Herrera, what was the motivation for the workshop organised by the EFP and WONCA Europe? How did the collaboration among both organisations come into being?
The EFP has long experience in organising high-level scientific workshops, since the first Perio Workshop (then called European Workshop in Periodontology) back in 1993 in Switzerland. More recently, a new workshop format—focused workshops—was established by my predecessor Prof. Mariano Sanz. These are organised in collaboration with other relevant medical associations, with 15–25 scientists, and have focused on the association between periodontal and systemic diseases.

The first one was held in 2017, together with the International Diabetes Federation, and the consensus document was published in 2018 in our Journal of Clinical Periodontology and in Diabetes Research and Clinical Practice. The second one, in collaboration with the World Heart Federation, took place in 2019, and the consensus report was published in 2020 in both the Journal of Clinical Periodontology and Global Heart. In both workshops, endocrinologists and cardiologists strongly suggested a pivotal role to be played by general practitioners in the implications of the identified associations, since they take on most patients with diabetes or cardiovascular diseases.

In 2021, then EFP President Prof. Lior Shapira made collaboration with general practitioners a priority for his presidency. Contacts were established with the president of WONCA Europe, Prof. Shlomo Vinker, who was very positive from the very beginning in the development of the process.

How would you summarise the purpose of your workshop?
Our main aim was to discuss and prepare a consensus document, developing and agreeing on a set of recommendations on how general practitioners and oral health professionals could approach the systemic impact of periodontitis on cardiovascular diseases, diabetes and respiratory diseases. A team of nine periodontic experts and nine general medicine experts reviewed the latest evidence available on the associations between periodontitis and the mentioned chronic systemic conditions. For cardiovascular diseases and diabetes, the starting point for the discussions was the outcomes of the previously mentioned workshops. For respiratory diseases, a purposely written systematic review was presented, including the evaluation of the associations of periodontitis with chronic obstructive pulmonary disease, asthma, community-acquired pneumonia, obstructive sleep apnoea and COVID-19.

Although specific conclusions were made depending on the evidence of association for the various conditions, the overall conclusion is that oral health professionals and general medical practitioners should collaborate in managing non-communicable diseases (NCDs) and in implementing strategies for the early detection of periodontitis in primary care centres and of cardiovascular diseases or diabetes in dental settings. General medical practitioners should be informed about periodontal diseases and their consequences, and oral health professionals should be informed about the relevance of NCDs and the associated risk factors.

“A very important conclusion of the consensus report is that general practitioners and oral health professionals should work together”

What are some of the most important risk factors that dental professionals should regularly check in their patients?
This information is explained in detail in the consensus report, and it may be too difficult to condense in a few words. However, I can give some examples for each of the groups of diseases covered in the focused workshop.

Oral health professionals should inform patients with periodontitis that their risk of cardiovascular diseases, such as myocardial infarction and stroke, is higher. Hence, oral health professionals should take action by collecting a careful history to assess for cardiovascular disease risk factors (diabetes, obesity, smoking, hypertension, hyperlipidaemia and hyperglycaemia) and by screening for cardiovascular risk factors, including physical activity, excess weight, blood pressure, and lipid and glucose management.

Oral health professionals should try to identify patients with undiagnosed prediabetes and diabetes either by referring the patient to a general doctor or by screening on-site using validated questionnaires or questionnaires and HbA1C point-of-care tests.

For patients with respiratory diseases, recommendations on risk factor control can and should be implemented in both dental care settings and primary care centres: for chronic obstructive pulmonary disease patients, smoking cessation must be promoted in all smokers, and for obstructive sleep apnoea patients, strategies for weight loss and healthy lifestyles should be recommended.

How could general practitioners and dental professionals make sure that their patients will actually receive the appropriate care if they identify any risk factors?
A very important conclusion of the consensus report is that general practitioners and oral health professionals should work together, first, in preventing, detecting and treating major systemic diseases; second, in exchanging information and mutually referring their patients; and third, in promoting healthy lifestyles among them. Being able to implement these three ambitious actions represents a huge challenge, but the publication of this report and the communication campaign we will run later this year are important stones in paving the way for a successful collaboration that will ultimately benefit patients.

For example, it is recommended to periodontists and family physicians to implement effective strategies for early detection of periodontal disease in primary healthcare centres and of cardiovascular diseases and diabetes in dental practices. General practitioners are encouraged to seek information about the periodontal health of their patients and oral health professionals about the cardiovascular and metabolic risk factors.

What would you advise dental professionals who want to treat their patients more holistically but are lacking appropriate guidance?
I honestly believe that this consensus report provides appropriate, updated information and guidance to all oral health professionals. It will dramatically help with appropriate screening of NCDs, including periodontitis, and evaluation of the associated risk factors. Simple interventions by oral health professionals can greatly improve overall health and reduce risks and complications.

What are the EFP’s plans to disseminate the outcomes of the workshop?
The EFP is currently preparing an outreach campaign based on those outcomes with support from our partner Curasept. It will be ready after summer and will target specific groups, including general medical practitioners, periodontists and other oral health professionals. The key messages will be presented and summarised in the form of infographics and an animated film, which will be made available in English and a few other international languages. The information materials will be made available to the dental community via a dedicated sub-site on our website,, and certainly via social media and other means of publication.

Editorial note:

The consensus report was published in the Journal of Clinical Periodontology and can be read here.

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