Evidence-based Treatment Recommendations for Oral & Systemic Health

The gold standard for the treatment of periodontal disease and maintenance of good oral health has been demonstrated consistently in the literature as being regular scaling and root planing or non-surgical periodontal therapy (NSPT).22 In studies that have also shown an impact on overall health such as improved endothelial function and improvements in the lumen size of the carotid intima media, NSPT has in most instances been at least one of the interventions. Other interventions delivered concomitantly with scaling and root planing in these oral-systemic studies, have included the application of local drugs into the periodontal pockets such as Arestin™; the addition of chlorhexidine rinses; and inclusion of systemic antibiotics (See Table 3). However, daily plaque removal must always accompany these interventions or the benefits will be lost. One large Scottish epidemiological study demonstrated systemic benefits from just daily toothbrushing.23

Table 3. Periodontal Disease, Inflammation & Cardiac Function.

Seinost G, et al. Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis. Am Heart J. 2005Scaling & root planing (S&RP) plus chlorhexidine rinses and systemic antibiotics

Significant improvement in endothelial function (P=.0003)

Significant decrease in CRP (p=.026)
Piconi S, et al. Treatment of periodontal disease results in improvements in endothelial dysfunction and reduction of the carotid intima-media thickness. FASEB J. 2009Non-surgical periodontal therapy (NSPT)Significant improvement in both CRP and carotid intima-media thickness

Reductions in oral bacteria
Tonetti MS, et al. Treatment of periodontitis and endothelial function. N Engl J Med. 2007Intensive periodontal therapy

Control: community care
Endothelial function and CRP values improved in both groups
D’Aiuto F, et al. Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol. J Dent Res. 2005 1. S&RP
2. S&RP + Arestin (ITG)
3. Control (no tx)

CRP was reduced in both treatment groups

Statistically significant difference between treatment groups in LDL cholesterol for the intensive treatment group (ITG)
Higashi Y, et al. Periodontal infection is associated with endothelial dysfunction in healthy subject and hypertensive patients. Hypertension. 20082 Tx arms (those with and without hypertension) each of which received either no Tx or S&RP & Antibiotics

Reduced CRP and improved endothelial function in the treatment groups for both those with and without hypertension
Elter JR, et al. The effects of periodontal therapy on vascular endothelial function: a pilot trial. Am Heart J. 2006S&RP

Surgery and extractions, as needed
Statistically significant reductions in endothelial dysfunction (p=.034)

CRP reduced but not statistically significant
Source: S.E. Lavigne, 2011.

This daily toothbrushing can be done with either a traditional toothbrush or an electric toothbrush. Numerous general population studies and systematic reviews have shown the superior benefits of the use of an oscillating-rotating (O-R) electric toothbrush in daily plaque removal and improvements in oral inflammation when compared to a manual toothbrush.24 Recommendations for the use of these electric brushes could be of major benefit to the Baby Boomer population as they age and potentially lose some of their manual dexterity. Additionally, some studies have shown positive benefits of the use of the O-R toothbrush in nursing home settings including caregiver preferences for the use of the electric brush.25-28 One of the reasons cited for their preference of the O-R power brush over the manual brush in these studies was the larger handle size and control they had as well as elimination of the fear of being bitten. Introduction of power toothbrushes into nursing home settings may help to improve the oral health of the residents by encouraging more consistent oral care by the caregiver staff.

For those individuals who have reduced salivary flow, contacting the patient’s physician to discuss potential prescription changes to drugs that do not have a xerostomic effect would be a good starting point. If drug change is not a possibility, then prescription of a sialogogue agent such as pilocarpine to enhance salivary flow would be advisable. Recommendation of dry mouth products such as Biotene™, have been shown to be helpful in controlling some of the symptoms of dry mouth. Additionally, for those with continued xerostomia who may be at risk for root caries application of a fluoride varnish and prescription of a fluoride mouth rinse have been shown to be successful preventive interventions.