When I went through dental school more than 15 years ago, like you, I learned a lot about microbiology and bacteria and how certain strains can lead to disease, especially in the oral cavity. The main two disease processes we deal with and see most often in the oral cavity are caries (decay) and periodontal disease (gum disease).
With periodontal disease, we were taught all about how the biofilms were formed and how each one depended on the other and how they become organized over time. We probed to find “pockets,” bleeding indices, attachment loss, presence of tartar/calculus, etc. We were also taught that it wasn’t as simple as a patient having poor homecare that leads to periodontal disease. Sometimes those who have excellent homecare, with little plaque or calculus, have severe periodontal disease.
It was these findings – that poor oral hygiene would not necessarily lead to periodontal disease and that great home care could still lead to periodontal disease – that led us to look for other “causes.” We came to an understanding of how part of the problem is, in fact, due to how our bodies respond to the bacteria present and how it can sometimes “over-react” to the situation at hand, leading to further damage, bone loss and attachment destruction.
Our treatment of choice for the typical periodontal disease patient included scaling and root planing along with supportive periodontal maintenance appointments every three months. If we saw the patient get better, then we maintained them over time to keep the disease at bay with good home care and more frequent recall visits. If they didn’t get better, we would look at surgery to help get the situation under control, even using systemic and/or locally applied antibiotics and/or rinses. And with the understanding of how our bodies could over-react to the bacteria, we added a systemic agent (Periostat) to help the body’s immune to not react as violently and curb collagenase activity.
Even after doing all of the right things, sometimes our patients do not get better and, in some cases, are getting worse at the same rate or faster than before. So, it must be their lack of commitment or poor hygiene, right? Well, maybe not. Maybe it’s a sign of bigger issues going on, outside of the oral cavity and not only impacting the oral health, but the health of the patient overall. Recent studies1 show that vitamin D deficiency can have an impact on periodontal disease in many patients and is often overlooked when we are trying to manage our patient’s oral health. Furthermore, did you know that more than 40 percent of the population2 has a vitamin D deficiency and in some population groups, more than 80 percent are deficient?
With this in mind, as dental professionals, we have to start considering that often times, what we are seeing in the oral cavity truly is linked to what is going on in the patient’s overall health. And, things like vitamin D deficiency have far-reaching effects – including cardiovascular disease, osteoporosis, cancer and several other chronic diseases.
With all of this mind, we can actually help our patients in improving their overall health as well. For example, I had a recent new patient who has never smoked or used tobacco, is in relative good health, but has some fairly aggressive periodontal disease. He stated that he had done the “deep cleaning” in the past, but had little to no results. After we had did our initial consultation, I asked him about having any bloodwork done to test for vitamin D as well regular bloodwork recently. He stated that it had been years. After a few more promptings during his follow-up visits, he finally got his bloodwork done. And guess what? His vitamin D levels were very low. It’s too early to tell how this will impact his periodontal health and stability, but we definitely helped him with his overall health.
So, next time you see a patient with periodontal issues going on, think “outside the mouth.”
(To read more by Dr. Jeff Lineberry, click here.)
Jeff Lineberry, D.D.S, F.A.G.D., F.I.C.O.I., Visiting Faculty, Spear www.cccdds.com
1. J Periodontal Res. 2015 Apr;50(2):274-80. doi: 10.1111/jre.12207. Epub 2014 Jul 7.
Low serum level of 1,25(OH)2 D is associated with chronic periodontitis.
2. Nutr Res. 2011 Jan;31(1):48-54. doi: 10.1016/j.nutres.2010.12.001.
Prevalence and correlates of vitamin D deficiency in US adults.