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Periodontitis can also be caused by another, serious illness. Therefore, it must always be investigated why a patient has developed periodontitis. Wijnand Teeuw provided insight into the factors that could play a role in the development of periodontitis during the Up-to-date theme of Quality Practice Mondhygiene. He explained a few things on the basis of two images: a question mark and a volume mark.
The question mark: why periodontitis?
In a patient with periodontitis, you should consider why he developed periodontitis. "If you do not know why someone has periodontitis, I think you should not treat them," says Teeuw. So do not go to work routinely, but ask this question again for each patient. Incidentally, the same applies to caries. Only periodontitis has more direct health consequences. If you do not ask the question 'why', then the treatment becomes too simple. Only slab is removed, because previously it was thought that this was the only cause.
The volume knob: there must be balance
If a car drives fast, the volume knob needs to be opened further to hear the radio. If the radio is good to hear, there is balance. If the volume knob is far open when the car is not running so fast, then there is an imbalance, because then the radio is very loud. Parodontitis can occur during imbalance in the body. This works differently for each patient. In the case of one, the volume knob must be turned harder for balance or imbalance than for the other. If a patient has little or no resistance, then there is imbalance. The majority of patients with periodontitis have a different defense. If it is clear what the volume knob is turning, then the treatment can be adjusted accordingly. All factors that can disturb the balance will have to be visualized before a treatment can be started. If the cause is not fully known, you can not address the cause or source.
Factors for imbalance
In addition to the biofilm, there are several factors that determine whether someone is in balance or imbalance. The influence of environment, lifestyle and genetics has been known since the 1980s. In addition, 'epigenetics' plays a role: a carrier of a wrong gene does not necessarily have to suffer from it. As far as lifestyle is concerned, we are still learning about this. Account is also taken of the influence of systemic diseases and other lesser-known factors, such as overload. The factors can also influence each other. For example, a physical illness often has consequences for the lifestyle or vice versa. And many a disease can cause stress and make medicine use necessary. This can lead to periodontitis.
Diseases affect periodontitis
In the meantime more than 50 physical diseases are associated with periodontitis, such as cancer, rheumatism, respiratory tract infections and cardiovascular diseases. Certainly if a patient has several of these diseases, the risk of periodontitis increases. A patient can be treated by different doctors for different diseases, while all of them can be caused by the same factors. Think for example of smoking or a certain diet.
Intake periodontitis patient
In order to get a clear picture of all factors, an intake in a periodontitis patient will take a lot of time. If underlying physical factors such as stress, diabetes mellitus, rheumatoid arthritis etc. are suspected, we will have to look for interdisciplinary cooperation. Teeuw indicates a number of diseases how they influence the development of periodontitis.
In someone with cancer, the assumption is that only surgical treatment in the oral cavity does not directly affect the development of periodontitis. Local radiation, on the other hand, can influence the bone structure and blood flow in such a way that it promotes very progressive periodontitis. The reduction of the immune system probably lasts throughout life. Antibiotics support for periodontitis treatment may therefore be required. With chemo, the immune system is gone for a while, but is back soon. Patients are often chronically fatigued after and during chemotherapy. That is why consultation with the oncologist will take place. Ask how the defense is at that moment.
Rheumatoid arthritis is an autoimmune disease, mainly affecting the joints. In rheumatic patients the physical inflammation is increased and the volume control is too loud, the immune system is too high. This increases the chance of periodontitis. Medication in patients with rheumatism has just been set up to reduce the level of inflammation. There are studies that indicate that this medication can sometimes also be protective against periodontitis. On the contrary, it has also been shown that sometimes the immune system is suppressed in such a way that the chance of secondary infections, such as periodontitis, is actually increased. With this medication, it is also good to ensure that the risk of sepsis is increased by the bacteria that always occurs after a periodontal treatment. For some rheumatic patients it is therefore better to stop the medication before undergoing periodontitis treatment. A good interdisciplinary treatment with a rheumatologist is then necessary.
Diabetes mellitus is a chronic disease, in which sugar regulation is disrupted, often resulting in high blood sugar levels. Due to high blood sugar levels, different organs, but also vital processes become disrupted, which are involved in the maintenance of the cardiovascular system, wound healing and the defense against infections. In the long term, complications arise in the area of CVD. Due to the increased risk of infections and poor wound healing, periodontitis is diagnosed two to three times more frequently in diabetic patients. Good blood sugar regulation is important for achieving a healthy periodontal situation. The sugar regulation turns at 1: 1 to the volume button for periodontitis. Achieving a good attitude is therefore essential, also for the mouth. Here too, an interdisciplinary treatment with a diabetes attendant is important. Hidden disease If it is unclear how periodontitis is caused, it may be necessary to refer a patient to the GP to find out if there is an unknown underlying disease. For example, research into ACTA has shown that 25% of people with severe periodontitis already had blood sugar levels that indicate the presence of diabetes mellitus. About 20% of these people were not aware of this. From this it can be concluded that periodontitis may be an early indication of having diabetes mellitus. Dental hygienists may therefore be able to contribute to the early detection of underlying diseases, such as diabetes mellitus.
About W.P. van der Schoor
Peter van der Schoor is a dentist implantologist and lecturer in the field of oral implantology. Peter gives since 1986 courses and lectures in the Netherlands and abroad. He is also frequently consulted as a troubleshooter for various implantsystems.