Let's Talk Oral Health
Let's Talk Oral Health is an expert podcast designed specifically for oral health professionals. This first season brings together experts from around the globe to discuss the latest trends in preventing periodontal and peri-implant diseases. LTOH is your go-to source for dental research topics, practical insights, and interviews featuring top professionals in the field.
Let's Talk Oral Health
Unlocking the Oral-Systemic Health Connection
How does the health of your mouth mirror the health of your entire body? Join us for a discussion with Professor Maria Clotilde Cara, a leading authority in periodontology from the University Paris Cité, as we unravel the relationship between oral health and general health. Learn about common risk factors for periodontal disease and discover the importance of a systemic approach to prevent periodontal and peri-implant diseases.
This is let's Talk Oral Health, the expert podcast for oral health professionals brought to you by Sunstar.
Speaker 2:Welcome to let's Talk Oral Health expert series by Sunstar. In this series destined to healthcare professionals, we welcome leading experts to discuss how to prevent periodontal and peri-implant diseases using a 360 strategy. In today's episode, we will welcome Professor Maria Clotilde Cara, and with her we will discover how the systemic health factor can help to prevent periodontal and peri-implant diseases. Hello everyone, my name is Rachel and this is let's Talk about Health by Sunstar. Hello Clotilde, hello Rachel. We are thrilled to have you with us today. Let me first, then, introduce you to our audience. You are a professor in periodontology at the University Paris Cité in France. You also work at the Rothschild Hospital, where you oversee the EFP accredited postgraduate program in periodontics and implant dentistry. One of your key research interests is the oral systemic link, the topic of today. Literature has shed light that on more than 50 systemic diseases on which oral health has an impact, concluding that a better oral health improves general health. But can the reverse be said, meaning, can we say that a better systemic health improves oral health? Clotilde, what would you say?
Speaker 3:Yes, of course, rachel. Oral health is part of general health by definition. The World Health Organization tells us that being in oral health is really part of general health. It is also reasonable to think if we have systemic disease, this may impact on our health. So if we want to well understand the link between systemic health and our health, we need to tackle two angles.
Speaker 3:The first one is the concept of risk factors. A risk factor is something, a condition, a disease that increase or decrease the chance that we will develop another disease. And when we are talking about non-communicable chronic diseases like cardiovascular disease, diabetes, obesity and for our health, we can mention periodontitis we have several risk factors that contribute to the disease. So we need to understand what are these risk factors and what is the contribution in a single patient, and we have to address them with preventive measure and eventual treatments.
Speaker 3:The second point is the comorbidities, because when we have one non-communicable chronic disease, most of the time over time the patient may develop a second disease. So comorbidity means that we have two or more diseases that coexist in the same patients. These two diseases may be linked by a cause relationship, so one disease causes the other disease, or they may be the results of exposure to risk factors that act on both diseases and we have to consider that whenever we have a comorbidity, the morbidity burden so the burden of the disease, increases, as well as the complexity of the treatment. So the patient has to be considered in a global perspective. We have to take into consideration the risk factors that are present and also the eventful other systemic diseases that are present.
Speaker 2:Talking about these two angles, it actually comes down to prevention Prevention of the risk factors and prevention of the accumulation of inflammation. In one of your recent articles, imperi Implant Diseases you mentioned primordial prevention. Would you care to develop what primordial prevention is?
Speaker 3:Yes, primordial prevention is a very interesting topic. We are not used to talk about primordial prevention, but it is a form of prevention that comes before everything else. It targets the general population, healthy people. We target them to avoid exposure to risk factors in order to decrease the chance to develop a disease. In other words, primordial prevention is promoting healthy behavior at the population level. So meaning physical, good physical exercise, good and balanced diet, no smoking, for example. And if we want to apply primordial prevention to our health, definitely we have to include good oral hygiene behavior and regular attendance to the dentist.
Speaker 3:Indeed, we try to understand if we can apply some primordial prevention strategies to avoid or reduce the occurrence of pre-implant diseases very recently and unfortunately or reduce the occurrence of peri-implant diseases very recently and unfortunately, there is no study in the literature that specifically assesses the effectiveness of this kind of prevention on peri-implant disease occurrence. But we understood that it is the base of everything. So we should work on that. We should develop some kind of primordial prevention strategies in order to prepare the patient to receive, for example, implants. So act before implants are placed in order to have the best ideal condition to receive this kind of dental treatment, to make an example in cardiovascular health, research was able to identify at least seven metrics that define an ideal cardiovascular health. These include low BMI, good blood pressure, balanced diet, regular physical exercise, no smoking. We do not have the corresponding definition of ideal heart health at the patient level. So to apply primordial prevention at the patient level. So to apply primordial prevention. But we should work on that because definitely preventive strategy is very important.
Speaker 2:Is there another type of prevention?
Speaker 3:Another type of prevention which is much more known is the primary prevention. In this form of prevention we always target patients who have not yet developed the disease, but they are at risk because they are exposed to some risk factors. So the primary form of prevention means risk factor control Try to identify the risk factors and modify them if possible. For example, smoking. Smoking is a risk factor for periodontitis, is a risk factor for peri-implant diseases. We can act, promoting quit smoking to our patients and so apply a primary prevention.
Speaker 3:Other primary prevention recommendations for peri-implant diseases include glycemic control in diabetic patients, because we know that when glycemia is not controlled there is an increased risk of peri-implantitis and implant failure. So it's very important to check that in diabetic patients. Failure so it's very important to check that in diabetic patients. And then we have to promote good oral hygiene behavior. Of course, regular attendance to support the peri-implant care and, if the patient has a history of periodontitis, regular attendance to support the periodontal care.
Speaker 3:That's very important because patients with a history of periodontitis have an increased risk of peri-implant diseases and an increased risk of implant failures, almost four times higher than the patient has no history of periodontitis. So it's very important to follow this patient over time. Never forget this is a chronic disease, so it has a high chance of recurrence. So the prevention before the disease is established is very important, but also during the follow-up to avoid the recurrence. So the primary prevention is a matter of changing some behavior that are not good for her health. And this is a very challenging task because sometimes just thinking our eigen behavior changing that is not so easy. But it's a cardinal point to promote and to prevent our diseases talking about behavioral change.
Speaker 2:I just wanted to inform our audience that we have an episode on behavioral change in a psychological approach. In this 360 strategy to prevent periodontal and peri-implant diseases, you detail the concept of primordial prevention. How would you apply that pragmatically in the dental office?
Speaker 3:So dentists have a role in promoting general health. We do not have to forget that the patient is a person and we do not have to stop to the oral cavity or to the teeth. So we need to take the time to inform the patient about the link between systemic health and oral health. This is very important because raising the awareness in our patient may help to change those behaviors that are not good for our health, periodontal health and general health and promote health as a whole. So we need to inform the patient, to explain, to counsel the patient and give the good advice. This takes time, of course, but it will allow the dentist to personalize the approach, either in the preventive strategies and also in the treatment eventually needed.
Speaker 2:So primordial prevention can only be done with an assessment of the risk profile of the patient. So let's take some examples now. If we take obesity as a risk in the profile of a patient, a recent study by Sansar demonstrated that obesity accelerates tooth loss at a relatively young age. What would you say about that?
Speaker 3:Yes, obesity is a typical example of a non-communicable chronic disease that affects a not negligible part of the population.
Speaker 3:If we consider the prevalence of obesity, overweight and obesity worldwide is 35%.
Speaker 3:In France it's 17%, it's estimated 17%, and indeed the literature is showing that whenever we have overweight and obesity, there is a linear and proportional relationship with the risk of periodontitis.
Speaker 3:So it appears that people that have an increased BMI have 35% increased risk of periodontitis, and this is also even true, even stronger, in younger age, between 18 and 34 years old.
Speaker 3:That's why, because obesity is a chronic disease, it may be the result of an unhealthy diet together with a sedentary lifestyle, but definitely, whenever it is established as a chronic disease, it is an inflammatory disease. So it can contribute to many other inflammatory diseases metabolic, cardiovascular and also at the level of the oral cavity, for example, periodontitis. We also know that obesity increases the risk of tooth loss and in this relationship we may see also a bi-directional relationship, meaning that people presented with partial or completed entheolism are at increased risk of being obese compared to people that are dentate, and this is also due to the fact that whenever we lose, we start losing teeth and these are not replaced properly with dental prosthesis, the patient may have to change the nutritional habits, select some food they can chew better than others, and this sometimes leads to an unhealthy diet and so will increase the chance to gain weight and eventually obesity and to other metabolic consequences like insulin resistance, diabetes, high blood pressure. So it's like a visor cycle that installs and is linking periodontitis in tooth loss to systemic health through nutrition.
Speaker 2:So this example of obesity, which is a risk factor by itself, also relates to nutritional habits. Could you maybe develop the role of nutrition as a risk factor in periodontal and peri-implant diseases?
Speaker 3:Nutrition is a very interesting topic. We have some guidelines, general guidelines, to preserve a good and balanced diet and this is cardinal for general health. These guidelines include the concept that energy intake in terms of calories does not have to exceed the energy expenditure. Of course this may vary from an individual to another and according to age, but as a general rule the fat intake does. They do not have to exceed 30% of the general energy, total energy intake. This to avoid a pathological weight gain. But if we want to see the impact of nutrition on oral health, in particular on periodontal health, in particular periodontal health, the literature is suggesting that patients with periodontitis may have a lower intake of dairy products like milk, an increased administration of sugar carbohydrate, which are linked to the inflammatory pathway, and some vitamin deficiency like vitamin D. So we should work on nutrition, we should check the nutritional aspect eventually to promote our periodontal health. Definitely this is part of the primordial and primary prevention strategies.
Speaker 2:Another example of this factor would be diabetes, for which there is a well-established bidirectional link with periodontal diseases. Would you have another example of a systemic risk factor that impacts oral health?
Speaker 3:I will make the example of sleep. These are emerging risk factors, or better risk indicators, for oral health and periodontal health. Now we are having a nice body of literature supporting the role of sleep on horror health. I can explain a little bit more into details.
Speaker 3:Sleep is essential for life. Sleep has a cardinal role for general health. Whenever we do not sleep enough or we have a poor sleep quality or we develop a sleep disorder on a chronic basis, general health will be impacted, mostly because sleep regulates the immune and inflammatory systems and also has a different role in hormone release and memory consolidation and growth, for example. Consolidation and growth, for example. So the literature is showing that whenever we sleep not enough and most of the time is less than five hours or too much, more than eight, nine hours per night, we will have an increased risk of periodontitis. We will also have an increased risk of tooth loss, so missing teeth, due to the fact we are not sleeping enough time per night.
Speaker 3:The literature is also showing that the fact of having a chronic sleep disorder increases the risk of severe gingival inflammation and periodontitis and, in particular, the fact of having obstructive sleep apnea increased the risk of periodontitis. Data from a recent meta-analysis showed that we have an 85% increased risk for obstructive sleep apnea patients having severe periodontitis than non-obstructive sleep apnea patients. This is really not negligible. There is a high percentage of people presented with comorbidity, so obstructive zipagnia and periodontitis. So dentists can ask questions about sleep, can ask the patient if they sleep well, if they feel refreshed during the day or otherwise, if they feel very sleepy and tired, if they sleep enough, etc. So we can easily assess sleep quality, sleep duration and eventually the presence of sleep disorder, to assess these risk factors for general health and now we know, also for our health and periodontal health.
Speaker 2:We have come to an end of our discussion. Clotilde, if you had to select a few key insights for our audience to take away, what would you choose?
Speaker 3:The first key message is the risk assessment. This is a very important exercise. I think we need to do it at first, as a first step to understand the needs of the patient and to adapt, so personalize the treatment strategies and the preventive strategies. But it's also very important to repeat this exercise. Risk assessment has to be repeated at almost every follow-up visit because it can change. The exposure to risk factor can change, because we may have new risk factors, we may have behavioral changes going on or some other diseases that have been developed, so a condition of comorbidity. And once we have done that, we can manage some of them, some of risk factors, but sometimes it's out of our expertise. So we need to work with other health professionals, like in a multidisciplinary team, in order to have an holistic approach of the patient in a global way, as I said, and we also have to consider all the time the systemic health impact on our periodontal health.
Speaker 2:Let's summarize a little bit. In this episode we tackle the oral-systemic link from a different angle and we discovered how the systemic health can be one tactic in a 360 approach to prevent periodontal and peri-implant diseases. Actually, we learned that it's all about a holistic approach of health that helps to combat efficiently oral and general diseases, and that promoting oral and general health goes to an approach of all the common risk factors and the alleviation. All this could not have been possible without the knowledge of our guests. So, clotilde, thank you again very much for discussing this topic with us and for sharing your insights with our audience. Thank you, rochelle, it was a pleasure. Once again, thanks to our audience for listening. In this was let's Talk Oral Health by SunStyle. Thank you and see you soon.
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