What will it take to prove the oral-systemic links?

What will it take to prove oral-systemic links?

Richard H. Nagelberg, DDS

 

A mountain of evidence has accumulated indicating associations between the mouth and the body; however, they have not yet been proven. The lack of proof is the reason for the reluctance of many companies, organizations, and individual health-care professionals to accept and, more importantly, act on those mouth-body connections for the benefit of our patients.

What do we know for certain at this point? There is an overwhelming body of evidence indicating that the untreated or inadequately treated periodontal lesion results in ulceration of the gingival epithelium due to the destruction of the subjacent connective tissue. The ulcerations are a gateway to the bloodstream and points distant, for live bacteria, bacterial toxins, and inflammatory mediators. No one disputes this. It is also known that periodontitis is a bacterially induced, localized, chronic inflammatory disease. And it is this inflammatory component of periodontitis that causes clinically significant connective tissue and bone destruction. No one disputes this.

One way to prove causality of different systemic events and conditions from periodontal disease and/or periodontal pathogens would be to conduct an interventional study concluding that successful treatment of periodontitis and/or reduction of periodontal pathogens results in lower incidence of atherosclerosis, cardiovascular events, adverse pregnancy events, etc. This type of study would take decades to conduct and require enormous resources due to the length of time it takes for the systemic events to occur and manifest. The logistics of such a study would also be a nightmare: patients relocate throughout their lives, others drop out of the study for various reasons ... not to mention mortality unrelated to the systemic conditions being studied.