For patients who present with Stage IV advanced periodontitis, comprehensive management of their dental conditions can be challenging because the goal of therapy is not only to address their periodontal condition and help patients return to health but to also address the aesthetic and functional rehabilitation of their condition and long-term maintenance to ensure continued health. Patients with Stage IV periodontitis are at significant risk of edentulism if they are not treated or receive inadequate care. Therefore, careful planning, efficient therapy, and continued supportive care throughout and after therapy are essential to helping these patients keep their teeth. This article looks at a multi-specialty approach to the management of a patient with advanced (Stage IV) periodontitis. 

In 2017, the World Workshop on Periodontal and Peri-implant Diseases and Conditions defined periodontitis based on stage and grade. While “stage” describes the severity, complexity, extent, and distribution of disease, “grade” defines the disease’s biologic features, including the rate of progression, rate of potential poor outcome, and impact of periodontal disease treatment on the patient’s systemic health.^1,2 While “grade” involves 3 categories based on evidence of progression as slow, moderate, and rapid progression (Stage A to C) with risk factors as grade modifiers, “stage” categorizes periodontitis based on severity and complexity into Stage I to Stage IV. ¹

Stage III and Stage IV describe advanced periodontitis. Patients in both categories are categorized by interdental attachment loss of 5 mm or more, with radiographic evidence of bone loss that extends to mid-root and beyond.^1,2 Complexity for Stage III and Stage IV periodontitis patients involves more than 6 mm of probing depth, vertical bone loss of 3 mm or more, and furcation involvement that is type II or type III. For Stage III patients, it also involves tooth loss involving 4 or more teeth and a moderate ridge defect, while for Stage IV patients, it involves tooth loss involving 5 or more teeth and a severe ridge defect.^1,2 Additionally, Stage IV periodontitis patients require complex rehabilitation due to masticatory dysfunction, secondary occlusal trauma with tooth mobility of 2 or more degrees, severe ridge defect bite collapse, flaring of teeth, and less than 20 remaining teeth (<10 pairs) in both arches.^1,2   

 The need for complex rehabilitation sets Stage IV patients apart from Stage III patients, and the management of Stage IV patients is significantly more complicated. Early diagnosis is essential, and having a treatment plan that is started immediately rather than delayed is important to preventing further loss of teeth and complications with rehabilitation to restore aesthetics and function.^3,4 Stage IV periodontitis patients have a higher risk of periodontal disease-related tooth loss compared to Stage I patients in studies involving a follow-up period of 10 to 30 years (hazard ratio of 3.73), as well as a higher risk for pathologic tooth migration and other functional consequences.³

Recommendations for Management of Advanced (Stage IV) Periodontitis Patients

In 2022, the European Federation on Periodontology (EFP) developed S3-level clinical practice guidelines implementing an interdisciplinary approach to rehabilitate Stage IV periodontitis patients due to the fact that failure to treat or inadequate treatment of these patients can result in additional loss of periodontal tissue, further tooth loss, and the potential for complete edentulism.³ The goal of their guidelines is to summarize evidence-based recommendations for individual intervention involving a multi-disciplinary approach to Stage IV periodontitis.³

Based on their recommendations, assessment of Stage IV periodontitis patients comprises 5 critical dimensions³:

1. Evaluation of the amount of periodontal breakdown, patient function, and aesthetics; completing the periodontal exam, charting, and appropriate x-rays; and functional and aesthetic assessment checking for hypermobility, tooth vitality, secondary occlusal trauma, stable posterior stops, fremitus, subjective/objective assessment of chewing function, aesthetics, and phonetics.
2. Assessment of the number of teeth lost due to periodontal disease using a history of probable cause of tooth loss.
3. The prognosis of individual teeth. Establishing tooth prognosis for Stage IV periodontitis patients is important, especially when differentiating between teeth with questionable vs hopeless prognoses.
4. Restorative factors, such as the extent of edentulous spaces, distribution, and restorability of retained teeth, including the technical complexity of planned prostheses and interventions that require dental implants based on adequate ridge dimensions.
5. The prognosis of overall care, meaning the overall case prognosis has to be established using individual susceptibility of the patient via primary grade criteria, which also includes the probability of disease recurrence or progression.

In categorizing patients who have Stage IV periodontitis, 4 major phenotypes were identified:

• Case type 1. Patients with tooth hypermobility due to secondary occlusal trauma that can be corrected without tooth replacement. 
• Case type 2. Patients with pathological tooth migration characterized by tooth elongation, drifting, and flaring, which is amenable to orthodontic correction.
• Case type 3. Partially edentulous patients who can be prosthetically restored without full-arch rehabilitation.
• Case type 4. Partially edentulous patients with a dentition who need full-arch rehabilitation using either a tooth- or an implant-supported or -retained prosthesis.

For Stage IV periodontitis patients, the “no-treatment” option is highly discouraged due to the potential for complete edentulism.³ In recommending therapy for Stage IV patients, Herrera et al³ advised the use of recommendations made by the EFP for treating Stage I to III patients and added modifications for Stage IV patients. Sanz et al⁵ recommended the following steps for treating Stage I to Stage III patients:

• Step 1. Guiding behavioral change to have patients undertake successful supragingival plaque control. The goal is to build motivation and adherence, find ways to circumvent barriers, and develop skills for dental plaque removal.
• Step 2. Controlling, reducing, and eliminating bacterial biofilm and calculus involving subgingival instrumentation with or without adjunctive physical and chemical agents, local/systemic host modulation, adjunctive subgingival local delivered antimicrobial agents, or adjunctive use of systemic antimicrobials.
• Step 3. Therapy to address pockets that are more than 4 mm deep and bleeding and/or the presence of deep pockets (≥6 mm) with the goal of gaining further access for debridement, regeneration, and resection of lesions that add complexity to the management of periodontitis, such as intrabony and furcation defects. The goal is to meet the endpoints of therapy prior to starting supportive maintenance, although it might not be completely accomplished for Stage III patients.
• Step 4. Supportive therapy. The goal of therapy is aimed at maintaining periodontal stability in all treatment patients using steps 1 and 2.

In 2014, Trombelli et al⁶ looked at the impact of professional plaque removal performed during supportive therapy and found that the extent of patient adherence to professional mechanical plaque removal significantly impacted tooth mortality, with patients who attended regular maintenance visits showing tooth loss of 0.6 teeth vs 1.8 for those who did not over a 5-year period. Seirafi et al⁷ found that in private practice in Iran, bleeding on probing (BOP) was associated with increased tooth loss, and erratic-compliant patients had more BOP than regular-compliant patients. Campos et al⁸ concluded from a meta-analysis of multiple studies that there was a 26% increase in tooth loss for noncompliant patients vs patients compliant with supportive periodontal therapy. Kim et al⁹ found increased tooth loss (26% and 30%, respectively) with noncompliant and erratic-compliant patients compared to completely compliant supportive-maintenance patients (4%) in the Korean population. Hirata et al¹⁰ found that patients with prior loss of 8 or more teeth were more likely to have further tooth loss during supportive maintenance.

Based on these and other findings, the recommendation for treating Stage IV periodontitis patients is supportive therapy before, during, and after active therapy to improve oral hygiene and patient motivation.³ In addition to the recommendations for Stage I to Stage III periodontitis patients (steps 1 to 4), Herrera et al³ added these guidelines for the clinical management of Stage IV patients:

1. Temporary control of secondary occlusal trauma (extracoronal splinting, relief of fremitus by limited occlusal adjustment)
2. Orthodontic therapy (usually for flared teeth and other pathologic tooth migrations)
3. Rehabilitation of one or multiple tooth-delimited edentulous spaces
4. Rehabilitation of unilateral/bilateral posterior free edentulous sites
5. Tooth-supported, full-arch, fixed prostheses
6. Tooth-supported, full-arch, removable dental prostheses
7. Implant-supported, full-arch, fixed dental prostheses
8. Implant-supported, removable prostheses.

Recommendations for Treating Advanced (Stage IV) Periodontitis Patients 

In management of different categories of Stage IV periodontitis patients, the treatment pathways include the following³:

• Case type I. Patient with hypermobility due to secondary occlusal trauma without requiring teeth replacement. Therapy involves temporary teeth splinting or initial limited occlusal adjustment. The need for longer-term splinting occurs only after steps 1 and 2 of periodontal therapy are completed.
• Case type 2. Pathologic tooth migration causing tooth elongation, drifting, or flaring. Therapy is orthodontic therapy planned during step 2 and, in some cases, step 3. The actual orthodontic therapy is recommended to start after shallow maintainable pockets are attained and inflammation is controlled during the supportive-maintenance phase.
• Case type 3. Partially edentulous patients who can be prosthetically restored without full-arch rehabilitation. The timing of intermediate restoration is planned carefully based on the individual or the case in keeping with the patient’s wishes and aesthetic considerations. Interim restorations are usually utilized after step 2 or 3, depending on the situation. Definitive restorations or implants are usually performed during step 4 after successful completion of step 3.
• Case type 4. Partially edentulous patients who need to be restored by full-arch rehabilitation, either tooth- or implant-supported, with either fixed or removable prostheses. For these patients, the interim prosthesis occurs after the completion of step 1. Step 2 is performed with the interim prosthesis in place. Definitive restoration occurs after stage 3 with successful completion of periodontal therapy and control of periodontal inflammation.

CASE REPORT 

A healthy, 54-year-old African American female presented as a patient with Stage IV periodontitis, case type 4. The patient was very concerned about the health of her gums, aesthetics, function, and phonation with her anterior teeth (Figures 1 and 2). Following completion of steps 1 and 2, interim restorations were completed for the patient involving a temporary bridge from tooth No. 5 to 12. Following step 3, extraction of teeth Nos. 6 to 11 was performed, with implants replacing teeth Nos. 6 to 9 (4.0-mm × 12-mm BioHorizon implants) and No. 10 (a 4-mm × 10.5-mm BioHorizon implant). Figures 3 to 8 show surgical management. Figures 9 to 11 show restorative rehabilitation of her dentition. The patient was very motivated with oral hygiene and maintenance visits, and 4 years later, she presented to see us and was able to save all of her remaining teeth. 

Figures 1 and 2. Initial patient presentation.

Figures 3 to 8. Surgical pictures.

Figures 9 to 11. Four-year postoperative pictures showing restorative rehabilitation.

CONCLUSION

A high level of complexity is involved in the treatment of patients with Stage IV advanced periodontitis to ensure that they can be able to achieve periodontal health as well as be able to maintain function and aesthetics. The ability for these patients to remain motivated and compliant with their care is also essential to their being able to retain their dentition long-term. Recommendations made by Herrera et al³ include that the patients must be informed in detail about their periodontal condition, including their treatment options and risks. They also discourage early extraction of questionable teeth that might be able to respond to therapy and recommend completing steps 1 to 3 of periodontal therapy, ensuring completion of periodontal therapy prior to orthodontics, long-term tooth splinting, tooth-supported fixed and removable prostheses, and implant-supported fixed and removable prostheses.^3,5 In planning restorations for patients with Stage IV periodontitis, it is important that restorations be designed to achieve function and aesthetics using a multi-disciplinary approach. It is also essential that patients are highly motivated with their oral hygiene and supportive maintenance.

REFERENCES

1. Papapanou PN, Sanz M, Buduneli N, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89(Suppl 1):S173–82. doi:10.1002/JPER.17-0721 

2. Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontol. 2018;89(Suppl 1):S159–72. doi:10.1002/JPER.18-0006. Erratum in: J Periodontol. 2018;89(12):1475. 

3. Herrera D, Sanz M, Kebschull M, et al; EFP Workshop Participants and Methodological Consultant. Treatment of stage IV periodontitis: The EFP S3 level clinical practice guideline. J Clin Periodontol. 2022;49(Suppl 24):4-71. doi:10.1111/jcpe.13639

4. Rasaeipour S, Siadat H, Rasouli A, et al. Implant rehabilitation in advanced generalized aggressive periodontitis: a case report and literature review. J Dent (Tehran). 2015;12(8):614–20.

5. Sanz M, Herrera D, Kebschull M, et al; EFP Workshop Participants and Methodological Consultants. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47(Suppl 22):4-60. doi:10.1111/jcpe.13290. Erratum in: J Clin Periodontol. 2021;48(1):163.

6. Trombelli L, Franceschetti G, Farina R. Effect of professional mechanical plaque removal performed on a long-term, routine basis in the secondary prevention of periodontitis: a systematic review. J Clin Periodontol. 2015;42(Suppl 16):S221–36. doi:10.1111/jcpe.12339 

7. Seirafi AH, Ebrahimi R, Golkari A, et al. Tooth loss assessment during periodontal maintenance in erratic versus complete compliance in a periodontal private practice in Shiraz, Iran: a 10-year retrospective study. J Int Acad Periodontol. 2014;16(2):43-9. Erratum in: J Int Acad Periodontol. 2014;16(3):77.  

8. Campos ISO, de Freitas MR, Costa FO, et al. The effects of patient compliance in supportive periodontal therapy on tooth loss: A systematic review and meta-analysis. J Int Acad Periodontol. 2021;23(1):17-30. 

9. Kim SY, Lee JK, Chang BS, et al. Effect of supportive periodontal therapy on the prevention of tooth loss in Korean adults. J Periodontal Implant Sci. 2014;44(2):65-70. doi:10.5051/jpis.2014.44.2.65 

10. Hirata T, Fuchida S, Yamamoto T, et al. Predictive factors for tooth loss during supportive periodontal therapy in patients with severe periodontitis: a Japanese multicenter study. BMC Oral Health. 2019;19(1):19. doi:10.1186/s12903-019-0712-x 

ABOUT THE AUTHORS

Dr. Soolari received his DMD degree in 1990 from the University of Mississippi School of Dentistry where he received multiple awards. He received his specialty training in periodontics from Eastman Dental Center and his MS degree from the University of Rochester in New York. He has been a Diplomate of the American Academy of Periodontology since 1997. Dr. Soolari was a consultant with National Naval Medical Center Postgraduate Periodontics in Bethesda, Md, and a former clinical associate professor at the University of Maryland. He is in private practice at Soolari Dentistry in Silver Spring, Md. He can be reached at asoolari@gmail.com.

Dr. Obiechina completed her training in periodontics and implant dentistry at Columbia University in 2001. She received her DMD degree from the University of Pittsburgh in 1998. She is the recipient of the Melvin Morris Award for clinical excellence in periodontics from Columbia University as well as the Northeast Regional Board Student Award for excellence in periodontics. She has given multiple seminars for dentists on periodontics and implant dentistry and has published works, including books on dental implant therapy and periodontics for dentists as well as articles for multiple peer-reviewed journals. She remains involved in active private practice at Shady Grove Smiles in Gaithersburg, Md, in addition to being an educator. She can be reached at drobiechina@yahoo.com. 

Disclosure: The authors report no disclosures. 

An innovative article published today in the British Dental Journal defends the permissibility of biological human enhancement to fall within to proper domain of dentistry, exploring topics that have never been discussed in the dental science literature before.

The natural norm of human dentition is to produce only two sets of teeth that will be lost over time. Oral diseases such as dental caries and periodontitis are widely prevalent in the human species, therefore it could be argued that there is still no consensus on what the natural state of human oral health biology is. The article discusses a growing interest in the development of novel biological interventions that might, in the future used to prevent the onset, or even cure these conditions.

Caries and periodontitis develop as a result of a gene-environmental interaction. Incidence of these diseases have increased over the years because of the modification of human diet (environment). As a response, adaptation to human behaviour (oral hygiene habits) have been implemented to control the environmental factors contributing to the development of these diseases. However, the “gene” part of it, has not been well explored on the pursue to oral health and managing these diseases.

Lead author Dr Vitor Neves from King’s College London explains: “Since untreated carious lesions and periodontitis are, still, amongst the top six most common diseases that affects humans worldwide, it is important to further explore other permissible ways to eradicate these conditions.”

In the opinion piece, “Beyond oral hygiene, are capacity-altering biologically based interventions within the moral domain of dentistry?”, the authors discuss the ethical issues regarding the use of biological human enhancement as a tool to contribute to eliminating these common oral diseases.

The authors argue that dentistry should seek the prevention and cure of dental caries and periodontitis using novel, biological capacity-altering interventions, in view of considerations of wellbeing and consistency with accepted dental practices.

The paper can be viewed here: https://www.nature.com/articles/s41415-021-3335-y

RELATED ARTICLES

Periodontal Disease Increases Risk of Major Cardiovascular Events

Bacteria That Cause Periodontitis Spread from Parents to Their Children

Periodontitis May Double Risk of High Blood Pressure

Recent research from the Journal of Psychiatric Research suggests that there is a connection between patients suffering from gingivitis and those living with depression. The study included 6,544 patients with chronic gingivitis and 6,544 without chronic gingivitis. A total of 16.3% of individuals with chronic gingivitis received an initial diagnosis of depression within 10 years, compared to 8.8% of those without chronic gingivitis receiving a depression diagnosis. While the oral systemic link has been discussed for years, these new findings suggest mental health, in addition to physical health, can deteriorate due to poor oral care.

In recent years, we have continued to see a positive and significant association between oral health and the systemic impact that it can have on patients. The current data shared by the Journal of Psychiatric Research further supports the proposed connection between gum disease and depression. The most obvious explanation for the link stems from the behavioral effects of stress, depression, and anxiety. Individuals suffering from these mental illnesses may lose motivation to keep up with their oral health habits, which may lead to significant oral health issues. Depression in particular can cause people to decrease at-home oral hygiene, cancel dental visits, engage in unhealthy diets and increase the likelihood of self-medication and smoking.

On a biological level, depression and anxiety cause significant issues that can impact oral health. The stress that these conditions create manifests itself in the body as a hormone called cortisol. As cortisol levels increase, the immune system gets weaker, leaving the patient at an increased predisposed at-risk of mouth conditions such as gingivitis and periodontitis. Additionally, certain medications prescribed for depression and anxiety can cause dry mouth (Xerostomia). When the oral cavity has a lack of saliva, there is a reduction in antimicrobial and host defense components (immunoglobulins), making the individual more susceptible to cavities and gingival inflammation. The gingival sulcus is a flash point in the body because the gingiva can be the entry point for bacteria to enter. The oral cavity is the most-accessible place in our body for bacteria, so the revelation that oral health can affect our mental health is a topic that many dental professionals are already aware of.

Previous research has long suggested that a common link between oral health and mental health is inflammation. However, today’s modernized and less invasive dental equipment can help address this problem, such as BIOLASE dental lasers, which can manage periodontal disease and which in turn reduces the inflammatory process. Dental lasers can precipitate a complete set of interactions at the cellular level that results in the reduction of inflammation, and thus reduces discomfort and accelerates tissue healing. More specifically, Erbium lasers, such as the Waterlase, are particularly efficient at removing both calculus and biofilm for decontamination, resulting in less inflammation. Having a susceptibility to depression alone does not cause a patient to have poor oral health, but if depression works to suppress good inflammation and enhance bad inflammation, then these connections may begin to unveil.

Many dental professionals are actively consuming research and studies outside of dentistry alone, understanding that oral health directly affects our physiological, behavioral, mental, and overall health. Oral health care professionals can monitor medications of respective patients as related to oral health conditions and potentially interact with the patient’s physicians for their overall well-being. The systemic link can often be overlooked, creating a possible disconnect between patients and their medical providers, because this information is not always as clear to physicians when assessing a patient for mental illness. Overall, it is important to discuss these topics so that oral health care providers can interact with medical professionals to enhance the systemic and mental health of our patients.

About Dr. Samuel Low

Samuel B. Low, D.D.S., M.S., M.Ed., was named Vice President, Dental and Clinical Affairs, and Chief Dental Officer of BIOLASE in October of 2016. Dr. Low is Professor Emeritus, University of Florida, College of Dentistry and Associate faculty member of the Pankey Institute, with 30 years of private practice experience in periodontics, lasers and implant placement. He is also a Diplomate of the American Board of Periodontology and past President of the American Academy of Periodontology.

Dr. Low provides dentists and dental hygienists the tools for successfully managing the periodontal patient in general and periodontal practices. He was selected “Dentist of the Year” by the Florida Dental Association, Distinguished Alumnus by the University of Texas Dental School, and the Gordon Christensen Lecturer Recognition Award. He is a Past President of the Florida Dental Association and past ADA Trustee.

Dr. Low received his Doctor of Dental Surgery (D.D.S.) and Master of Science (M.S.) degrees from the University of Texas at Houston. He also completed his residency in Periodontics at the University of Texas at Houston, and received a Masters of Education from the University of Florida.

RELATED ARTICLES

Mental Health and Dentistry: Know the Signs, Eliminate the Stigma, and Find Help – CLICK HERE

Mental Health Initiative Launches for Dental Professionals – CLICK HERE

The Oral-Psychiatric Link – CLICK HERE

The COVID-19 pandemic has led to a renewed focus on how we can all stay as healthy as possible. To reduce the spread of this virus, we wear masks to cover our nose and mouth, knowing that this is the primary portal where the virus and other bacteria are spread. However, for too many other serious and life-threatening illnesses, the obvious and well-documented correlation between oral health and overall health is generally overlooked.

Systemic Consequences of Oral Health

Clinical literature has documented the connection between oral health and overall health for years, where bacteria in our mouths can be the primary site for the cause or worsening of serious chronic diseases, including heart disease, stroke, diabetes, certain cancers, and Alzheimer’s/dementia.

Most recently, oral health conditions also have been documented to impact COVID-related conditions.

In a recent study published in the Journal of Clinical Periodontology, it was determined that gum disease may raise the chances of hospitalization or death if COVID-19 strikes. The study found that of the 568 patients, those with periodontitis, the most severe form of gum disease, were at least three times more likely to have severe COVID‐19 complications.

Additionally, periodontitis has been connected to high blood pressure. The American Heart Association confirms this link in reporting a study of 500 adults with and without gum disease that found that approximately 50% of adults could have undetected hypertension.

Periodontitis afflicts over 40% of all adults in the United States and can lead to significant dental and medical consequences. There are safe and affordable treatment options available for individuals with periodontitis after being properly diagnosed by a dental professional.

Simply visiting the dentist and taking care of your oral health can vastly improve your overall health, and it is our job to work with medical professionals hand in hand to bridge the gap for our patients.

What is surprising is that with all this evidence, except for ENT specialists, most physicians are comfortable still viewing the mouth as the domain of the dental, not medical, profession. It is time for this to change and to put the mouth back in the body where it obviously belongs.

The Legal Divide

Unfortunately, legal obstacles in most states prohibits physicians and dentists from practicing together in the same group. This leads back to the same issue, an illogical historical chasm between two vital healthcare services.

ProHEALTH Dental’s unique model of integrating dental and medical services bridges the gap that the legal issues create with four key goals in mind.

• Educate the public about the importance of oral health and that dentistry is a lot more than just restorative and cosmetic care of our teeth.
• Educate physicians and dentists about the need to work together and coordinate care for the betterment of the patients they serve.
• Educate the insurance industry that coverage for oral health services will save vast sums in future costs of healthcare and help their insureds lead healthier and more productive lives.
• Develop coordinated care protocols for diseases where the literature is clear that poor oral health is a causative or exacerbating factor.

Since its founding in 2015, ProHEALTH Dental has entered into clinical affiliations with leading healthcare systems such as the Mount Sinai Health System, as well as large medical groups including ProHEALTH Care, Riverside Medical Group, Westmed Medical Group, and CareMount Medical, which collectively include thousands of physicians who serve more than 3.5 million patients. Through these affiliations, ProHEALTH Dental creates a coordinated care model that includes:

• Cardio-diagnostic and sleep apnea screenings as part of routine dental hygiene visits with any abnormal findings reported to the patients’ treating physicians.
• Development of clinical protocols for patients whose underlying medical conditions pose an enhanced risk if they suffer from poor oral health.
• Patient education tools and surveys to ensure they understand that their mouths and bodies are connected clinically.
• Medical data sharing and creating a path to an integrated electronic health record.

To our knowledge, no other community-based dental organization has as its mission and model to break down the anachronistic and illogical chasm between medicine and dentistry and look to the whole patients’ health.

Every day, our clinicians at ProHEALTH Dental tell our patients to “put your health where your mouth is.” We believe it’s time for healthcare professionals, medical and dental schools, professional societies and governing bodies, and insurers to work together to do the same.

More information about this vital issue can be found at phdental.com.

Dr. Cooper is the founder, board chair, and clinical advisor at ProHEALTH Dental. He is board certified in internal medicine. He earned his MD at New York Medical College and completed his residency at North Shore University Hospital in Manhasset, New York.

Mr. Travis is the CEO at ProHEALTH Dental. Previously, he was executive vice president and general counsel of an international cancer company, where he oversaw all mergers and acquisitions. He began his career as a practicing lawyer and founded a law firm focused on healthcare.

RELATED ARTICLES

THE REAL PURPOSE OF THE NEW PATIENT PHONE CALL – CLICK HERE

DENTAL SUCCESS BEGINS AT THE FRONT DESK – CLICK HERE

VALUE EVERY PATIENT’S EXPERIENCE – CLICK HERE

Despite the remarkable progress of vaccination in the United States and other countries such as the United Kingdom, the COVID-19 pandemic is unfortunately far from over. The catastrophic situation in India and Brazil highlights the tragic consequences of the sidelining of science.  

Meanwhile, healthcare professionals still face several challenges given the threat of new variants, the lack of biomarkers to identify those at risk for severe complications and death, the lack of predictable treatment, and the scarcity of knowledge on the duration of the immunity conferred by the vaccines. It has become clear that hidden sources of infection may play a crucial role in the pathogenesis of severe COVID-19.

The Role of Oral Health

Last year, after reading about the importance of inflammatory markers in the progression of COVID-19 lung disease, particularly IL-6, my research partner Carla Cruvinel Pontes, DDS, MsC, PhD, and I wrote an article suggesting a link between periodontal disease and its potential to contribute to elevated local and systemic IL-6 levels.

Since then, our findings have been corroborated by clinical studies suggesting high IL-6 levels to be a strong predictor of severe acute respiratory syndrome in COVID-19 patients and periodontitis to be a risk factor for complications. Notably, the study from Marouf et al. (2021) showed that periodontitis resulted in 8.8 times higher risk for death, 4.6 times higher risk for needing mechanical ventilation, and 3.5 times higher risk for ICU admission after accounting for significant confounders, such as age, comorbidities, and smoking.

At the beginning of 2021, I was contacted by an experienced radiologist and medical educator from the UK, Dr. Graham Lloyd-Jones. He had also been in contact with a professor from Birmingham and former president of the European Academy of Periodontology, Iain Chapple. Together, Dr. Cruvinel Pontes, Dr. Lloyd-Jones, Prof. Chapple, and I decided to expand our understanding of the role that oral health, particularly periodontitis, can play in the pandemic.

Our collaboration resulted in the development of a solid medical hypothesis, recently published in the Journal of Oral Medicine and Dental Research, which has been in the spotlight on more than 200 websites worldwide, live radio, and TV. Here, we explain the reasons behind the vast public interest in our study and why it has the potential to change the course of the pandemic.

When a Hypothesis Is More Than a Concept

Many hypotheses are born from scientific exploration. It is crucial to mention that our hypothesis study was born from radiologic lung image findings from COVID-19 patients, and not simply from scientific curiosity. Simply put, Dr. Lloyd-Jones noticed that the disease pattern seen radiographically in COVID-19 lung disease did not match other viral lung infections.

COVID-19 lung disease develops in the base of the lung, as opposed to the mid- and upper areas, as typically seen with infections caused by inhaled pathogens. Vascular changes in small lung vessels are evident early in the disease process in computed tomography (CT) images, including peripheral vasodilation, immunothrombosis, and small filling defects (clots). Microangiopathy and pulmonary infarcts, characterizing thrombosis on both sides of the capillary bed (in both venules and arterioles), have been confirmed in lung autopsies.

Based on the radiological findings, COVID-19 initial lung disease seems to be vascular in nature, as opposed to a primary disease of the trachea and airways. But how does it reach the lung vessels?

With the knowledge that saliva is a reservoir for the virus and that salivary viral levels are strong predictors of poor outcome and disease severity, as well as findings suggesting that SARS-CoV-2 does not reach the lungs through inhalation, we propose that the virus enters the blood circulation in the mouth, from where it reaches the lungs.

The oral cavity biological foundation for this model includes:

• Many oral and gingival cells express ACE-2 receptors, including cells from the gingival sulcus.
• SARS-CoV-2 RNA has been found in saliva and gingival crevicular fluid. The virus can invade salivary glands and mucosal and gingival cells.
• The periodontal environment can favor viral replication and passage through the permeable sulcular or pocket epithelium. Poor oral hygiene, periodontal inflammation, and viral-bacterial synergy can potentially mediate SARS-CoV-2 entrance to the mucosal or gingival blood circulation.
• Higher severity of COVID-19 and risk of death have been linked to periodontitis.
• Other respiratory conditions have been linked to periodontal disease and poor oral hygiene.

COVID-19 and periodontitis have multiple common risk factors, such as aging, specific ethnic groups, male sex, type A blood group, obesity, cardiovascular disease, diabetes, chronic kidney disease, chronic obstructive pulmonary disease, dementia, Down syndrome, learning difficulty, and physical disability (see the figure).

What Does It Mean If This Model Is Correct?

If the hypothesis is proven correct, decreasing the viral load in saliva can mitigate transmission and decrease the risk for lung complications and death. Simple measures can prevent the virus from entering the blood circulation in the oral cavity.

For example, maintenance of optimal daily oral hygiene can fight infection, including toothbrushing twice daily for at least 2 minutes with a fluoridated toothpaste, along with daily interdental cleaning. Periodontitis patients are likely to need longer brushing times.

Also, the use of commercial mouthwash products can inactivate the virus in vitro, whether it’s 15 ml of 0.05% to 0.1% cetylpyridinium chloride (CPC) for 30 seconds twice a day, or 20 ml of 0.147% ethyl lauroyl arginate (ELA) for 30 seconds twice a day. However, daily oral hygiene cannot be replaced by the use of oral rinses.

Regular dental visits are essential to preventing infection as well.

Can Oral Rinses Prevent COVID-19 Lung Disease?

Currently, there is a scarcity of clinical studies on the effect of oral rinses in COVID-19. However, because these over-the-counter products are widely available and have been proven to be safe for unsupervised home use, we suggest the use of CPC and ELA mouthwashes before and after social interactions.

This simple measure can potentially lower the risk for viral entrance to the blood circulation and COVID-19 lung disease while we wait for clinical studies to confirm their efficacy. In places where oral rinses may not be available, studies on pulmonary conditions indicate that even boiled water that has cooled down or a saline solution can be used as an oral rinse to decrease the salivary viral load.

Simple Preventive Measures Can Make a Difference

The reason why health authorities worldwide are not implementing non-invasive, inexpensive, and preventive measures is obscure. In countries such as Brazil and India, the devastating situation has been linked to the overlooking of science. In fact, scientific opinions have been ignored in multiple countries.

As healthcare professionals, we have strong reasons to believe that the mouth plays a crucial role in the pandemic. We urge health authorities and professionals to recommend preventive measures in private and public contexts, especially CPC and ELA oral rinses. Due to their availability, general safety, and potential to decrease COVID-19 lung disease, need for mechanical ventilation, and death, we believe that this recommendation can truly make a difference.

Results from ongoing studies will certainly shed more light on the efficacy of mouthwash products against COVID-19. Meanwhile, let’s do our part and listen to what science is telling us. It strongly suggests that COVID-19 lung complications can start in the mouth, so this is also where preventive measures should begin.

Reference

Lloyd-Jones G, Molayem S, Pontes CC, Chapple I. (2021) The COVID-19 Pathway: A Proposed Oral-Vascular-Pulmonary Route of SARS-CoV-2 Infection and the Importance of Oral Healthcare Measures. J Oral Med and Dent Res. 2(1):1-25.

Dr. Molayem received both his bachelor of arts in history and DDS at UCLA. Thereafter, he completed a specialty program in periodontics at the Herman Ostrow USC School of Dentistry. He is the founder of both the UCLA and USC Journals of Dental Research, which have been going on for 13 and 11 years, respectively. He has lectured and has published in dental implants and periodontics and is the co-founder of Synergy Specialists, the largest agency for traveling dental specialists in the United States. Dr. Molayem has been practicing periodontics in a private practice setting in Southern California for the past 10 years. More recently, he has been conducting research and has published the most comprehensive connection to date between the mouth and COVID-19 in the Journal of the California Dental Association. He can be reached at smolayem@gmail.com.

Related Articles

Delayed Dental Treatment Negates the Mouth-Body Connection

COVID-19 Patients With Periodontitis Face Greater Risk of Dying

Today’s Dental Practices Need On-Point Messaging to Improve Oral and Systemic Health

Researchers at the National Institute for Dental and Craniofacial Research (NIDCR) have catalogued 120,000 oral mucosa cells by type and function. The NIDCR believes this cell atlas will serve as a detailed community resource to help researchers answer key questions about oral biology and disease.

The NIDCR’s researchers conducted a census of oral mucosal cells from gum and inner cheek tissues of people with and without severe periodontitis. By analyzing gene expression cell by cell, they were able to catalog cells by type and function and reveal a previously unknown role for connective tissue cells in orchestrating immune responses linked to periodontitis.

“There’s been a huge international effort to create a cell by cell atlas of the human body,” said senior author Niki Moutsopoulis, DDS, PhD, a principal investigator at NIDCR.

That initiative, the Human Cell Atlas, was launched in 2016 and is led by scientists at the Broad Institute in Cambridge, Massachusetts, and the Wellcome Sanger Institute in Cambridge, United Kingdom.

“We wanted to do our part by contributing data from the oral mucosa,” said Moutsopoulos.

The oral mucosa is composed of four main types of cells. Epithelial cells form the surface layer, while endothelial cells line the blood vessels that supply nutrition and oxygen. Stromal cells give structure to the mucosa, and immune cells survey the surroundings to capture and destroy foreign particles. 

However, Moutsopoulos and her colleagues performed a deeper dive, the NIDCR said, identifying distinct subpopulations with unique traits and functions among the four cell types. One type of stromal cell, called fibroblasts, caught the researchers’ attention.

“The most striking part of the study was the prominent immune signature of fibroblasts in the oral environment,” said Moutsopoulos. “We usually think of stromal cells, such as fibroblasts, as mere producers of connective tissue. But our analyses suggest that they also play a role in immune function, particularly related to recruiting neutrophils.”

Neutrophils are immune cells that migrate into the oral cavity to defend us against pathogens and are thought to play a protective role against periodontitis. In fact, the NIDCR said, genetic deficiencies in neutrophil recruitment are linked to severe periodontitis. But neutrophils also are known to over-congregate in the gums of people with common forms of periodontitis.

Gene expression data from the new study suggests that stromal cells are wired to induce inflammatory responses and send signals that recruit neutrophils in healthy people. The same stromal cells appear to become over-activated in periodontitis, resulting in an exaggerated immune response that could contribute to disease progression.

“This new piece of information is one of the many insights that can be gleaned from the oral cell catalog,” said first author Drake Williams, DDS, PhD, a clinical research fellow at NIDCR.

“Another opportunity afforded by this atlas is that we were able to map the expression of genes linked to periodontitis susceptibility at the cell level, within the oral tissues. We envision that this information will provide clues towards understanding cell-specific functions that mediate periodontitis pathogenesis in different subsets of patients,” said Williams.

The oral cell catalog also can be used to understand oral diseases beyond periodontitis, NIDCR said. The data from healthy volunteers, who were carefully screened for oral and systemic health, serves as a baseline that can be compared against other disease states.

The researchers have contributed their cell atlas to the oral and craniofacial network of the Human Cell Atlas project. They plan to expand the catalog to include cells from patients with inherited forms of oral mucosal diseases.

“The study provided an opportunity to view the oral mucosa through a new lens,” said Moutsopoulos. “We really enjoyed putting it together and had fantastic colleagues that contributed to this effort.”

The study, “Human Oral Mucosa Cell Atlas Reveals a Stromal-Neutrophil Axis Regulating Tissue Immunity,” was published by Cell.

Related Articles

Better Gum Disease Prevention Could Save Billions in Healthcare Costs

Another Study Confirms Link Between Alzheimer’s and Gum Disease

Therapies Put the Body’s Own Repair Processes to Work in Regenerating Bone

Researchers at the University of Iowa College of Dentistry and Dental Clinics are developing techniques for using the body’s own internal repair processes to tailor specific bone regeneration strategies to the specific causes of bone damage.

Deferoxamine, which treats iron poisoning, can be used to activate hypoxia-induced factor-1, which promotes angiogenesis and bone regeneration. But there have been safety concerns in this research as well as complicating factors such as chronic inflammation that are common among older individuals.

However, the researchers are using a small molecule known as phenamil to reduce inflammation and promote endogenous bone regeneration. They also have engineered a novel nanomaterial scaffold that mimics the bone collagen structure and delivers deferoxamine and phenamil locally and controllably.

“The drugs themselves are not new, and people have been using them. But we are developing a new method for controlled release of the drugs that can be delivered at a specific location,” said Dr. Hongli Sun, associate professor in the Department of Oral and Maxillofacial Surgery at the Iowa Institute for Oral Health Research.

These innovations could pave the way for treatments to rejuvenate and repair significant bone damage, even for older adults, the school said. Sun and his colleagues recently received a five-year National Institutes of Health grant for more than $1.7 million to support this research.

The researchers also are developing a specific bone regeneration strategy tailored to the specific needs associated with periodontitis-induced bone and tooth loss. The strategy treats the bacteria that causes periodontitis while continuously and effectively directing the body’s own repair processes to the site of the damage, the researchers said.

Although Sun has only been at the College of Dentistry since 2018, the school said, he has had remarkable success in developing his own research and securing grant funding for his projects.

From developmental biologists like Dr. Brad Amendt to research design and biostatistical support from Dr. Xian Jin Xie to mechanics support from the College of Engineering to clinical expertise from oral surgeons and periodontists, the school said, Sun has found a range of collaborators who make his work better.

“For any major research like this, we really need a well-rounded team, with a lot of different experts from different areas,” Sun said. “And I came to Iowa because I knew I would get strong support from other researchers, support staff, and the administration.”

Related Articles

Metal-Free, Implant-Supported Full-Arch Rehabilitation: Biopolymer Reinforced for an Implant-Supported Fixed Prosthesis

University of Queensland to Use 3D Printing to Rebuild Teeth and Tissues

Fish Scales and Bullfrog Skin Targeted for Oral Tissue Repair

More effective prevention of gum disease could save billions in healthcare costs and lead to healthier lives, according to the European Federation of Periodontology (EFP).

The EFP commissioned the Economist Intelligence Unit (EIU), which is the research and analysis division of the Economist Group, to provide a comprehensive analysis of the financial and human cost of gum disease in France, Germany, Italy, the Netherlands, Spain, and the United Kingdom.

The report makes it clear that periodontitis is largely preventable with good oral hygiene and regular dental checkups, the EFP said. But little progress has been made in the prevention and management of periodontitis in Western Europe, with prevalence remaining largely unchanged over the past 25 years. 

Many people only visit a dentist when they have a problem and avoid regular appointments because of the cost, the report said.

Also, most if not all periodontitis treatment in Spain and Italy is paid for by patients or private insurance, so periodontitis treatment for low-income families is almost unaffordable, the report said.

And while dental care appears to be free on paper in the United Kingdom and in France, the report continued, only part of the dental procedures involved in treating periodontitis are covered, and the remainder of the costs are paid for out of pocket.

After providing evidence that professional management of periodontitis is cost-effective, the EFP said, the report argues that “publicly covered dental care for periodontitis deserves a review from policymakers and commissioners Europe-wide.”

The report then seeks to capture the attention of policymakers in the six countries studied, emphasizing the economic and societal benefits of action in the early treatment of periodontitis and arguing that “given the prevalence and preventable nature of periodontitis, new ways of thinking about gum health are needed to increase awareness and action at a national level.”

The report makes four recommendations.

First, the report says that the prevention, diagnosis, and management of periodontitis is cost-effective. It called the role of home care by patients of paramount importance in preventing gingivitis and periodontitis.

Efforts to eliminate gingivitis, preventing progression to periodontitis, would save considerable costs over 10 years compared to “business as usual,” ranging from 7.8 billion Euros in the Netherlands to 36 billion Euros in Italy, the report said.

But neglecting to manage gingivitis could significantly increase costs and reduce healthy life years, the report continued, so “an emphasis on self-care and prevention is critical from both an individual and a societal perspective.”

Second, the report says that better integration of dental and general healthcare is required. Sharing information across disciplines may improve both patient care, because of the common risk factors shared by some dental and physical health conditions, and contribute significantly to dental and general health research, the report says.

Integration also may encourage shared responsibility across healthcare disciplines to address unmet oral health needs in vulnerable and marginalized communities, the report says.

Third, a synergy of societal and individual public-health campaigns is needed. One without the other would exacerbate oral health inequalities both within and across countries, the report said. Societal-level prevention is crucial to the prevention of periodontitis, as it is highly prevalent in deprived areas.

Individual public health campaigns need to pay special attention to less affluent communities and embed prevention and early intervention in community settings such as schools for the prevention of caries and health centers for the prevention of gum disease, the report says.

Finally, the report says dental care needs to be more affordable. The cost of accessing a dentist is a barrier to early treatment for many people, the report says, so they are more likely to go to the dentist when there is something wrong rather than for checkups or preventive treatment, which is essential for avoiding periodontitis.

Not all periodontitis treatment is covered by the public health system in the United Kingdom and France, and the patient pays for the remainder. In Spain and Italy, most of not all periodontal treatment is paid for by the patient or via private insurance. Periodontitis treatment for low-income families is almost unaffordable.

Professionally managed periodontitis is cost-effective, the report says, and policymakers and commissioners across Europe should review publicly covered dental care for the disease.

Few studies have modelled the economic burden of periodontitis and the return on investment (ROI) of treatment, the EFP said. The report’s authors developed a model to examine the ROI of preventing and managing periodontitis, with separate modelling for France, Germany, Italy, the Netherlands, Spain, and the United Kingdom.

The model used in the study was based on EFP treatment guidelines that outline four intervention points in the progression from health to gingivitis, undiagnosed periodontitis, and diagnosed periodontitis. The estimates for the current national situation in each country determined the number of individuals starting at each stage of the model.

The authors modelled the transition between the stages over a 10-year period according to five scenarios:

• Baseline: current prevention and treatment situation continues.
• Rate of gingivitis management falls from 95% to 10%.
• Incident gingivitis is eliminated through improved oral homecare, preventing periodontitis.
• No periodontitis is managed.
• 90% of periodontitis is diagnosed and managed.

The model calculated the impact of each scenario on total costs, ROI, and the change in healthy life years compared to the baseline. The cost of continuing with the baseline scenario ranged from 18.7 billion Euro in the Netherlands to 96.8 billion Euro in Italy over 10 years.

In all countries, reducing gingivitis management lowered healthy life years and had a negative ROI. Eliminating gingivitis led to rises in healthy life years, reduced costs, and a strong ROI in all countries.

No management of periodontitis resulted in reductions in healthy life years and a negative ROI for all countries. Diagnosing and managing 90% of periodontitis increased healthy life years in all countries, and despite cost increases, there was a positive ROI.

Eliminating gingivitis and increasing the rate of diagnosing and treating periodontitis to 90% had a positive ROI for all countries and gains in healthy life years compared to business as usual. Neglecting to manage gingivitis had the opposite effects.

The report calls for greater emphasis on self-care and prevention at the individual and societal level, including nursery-based dental care and toothbrushing workshops in schools. While the workshops would primarily target caries prevention in children, instilling good oral hygiene regimens into the daily routine from a young age also should benefit periodontitis prevention in adult years, the EFP said.

“It is hugely challenging to determine to economic and societal costs of a complex disease like periodontitis, which is why we needed an independent expert group like the EIU to undertake this modeling,” said Iain Chapple, former treasurer and secretary general of the EFP.

“Their data clearly demonstrates that by far the biggest ROI comes from the prevention of periodontitis, i.e., by treating gingivitis, something traditionally regarded as trivial and ignored, rather than with treatment being directed at periodontitis, which is of course too late for prevention,” said Chapple.

“I am delighted with the analysis presented by the EIU, highlighting the benefit to healthcare providers of treating gum disease early to realize gains in health life years, advancing the European Federation of Periodontology’s purpose of promoting periodontal health for a better life,” said EFP secretary general Nicola West.

Related Articles

Another Study Confirms Link Between Alzheimer’s and Gum Disease

Does Oral Health Affect Pregnancy?

Bacteria That Cause Periodontitis Spread from Parents to Their Children

Researchers at the University Medical Center Greifswald have confirmed the results of a previous study that found an association between inflammatory gum disease due to periodontitis and Alzheimer’s disease.

“It is very difficult to conduct meaningful methodological studies of the effects of periodontal disease, a common severe form of gum disease,” said Dr. Christian Schwahn of the university’s Polyclinic for Dental Prosthetics, Geriatric Dentistry, and Medical Materials Science.

“Statistical models that have only recently been developed make it possible to simulate a controlled clinical study by combining available data from treated patients and untreated patients,” said Schwahn.

The long-term Study of Health in Pomerania/Life and Health in Western Pomerania (SHIP) has been examining the influence of dental diseases on the general health of people since 1997, finding that inflammatory gum disease affects 15% to 45% of people depending on age.

“For the first time, the connection between the treatment of gum disease and the onset of Alzheimer’s disease in a quasi-experimental model of 177 patients treated periodontally in the Greifswald GANI-MED study and 409 untreated participants from the SHIP study will be analyzed,” said Schwahn.

The researchers used magnetic resonance imaging (MRI) data as an indicator for the onset of Alzheimer’s disease and compared it with MRI data from the US Alzheimer’s Disease Neuroimaging Initiative so they it be used as an individual measure of the loss of brain substance typical of Alzheimer’s disease.

Periodontitis treatment carried out by a dentist specializing in gum disease showed a positive effect on the loss of brain matter, which could be assessed as moderate to severe.

The researchers said that the results were remarkable because the periodontitis patients were younger than the age of 60 at the time of the MRI examination, and the observation time between the dental treatment and the MRI exam was 7.3 years on average for the patients. 

“Our approach clearly lies in the prevention and timely treatment of gum disease, which can be triggered by a large number of germs, in order to prevent such possible consequential damage in advance,” said Thomas Kocher, director of the Polyclinic for Dental Conservation, Periodontology, Endodontology, Pediatric Dentistry, and Preventive Dentistry.

“We will continue to have to rely on observational studies that simulate a controlled clinical study in this area,” said Schwahn. “A clinical study with a placebo treatment in a patient group, i.e., with patients who have intentionally not been treated by the dentist, is not feasible for ethical and medical reasons.”

The study, “Effect of Periodontal Treatment on Preclinical Alzheimer’s Disease—Results of a Trial Emulation Approach,” was published by Alzheimer’s & Dementia.

Related Articles

Apnea Treatment May Reduce Dementia Risks

Gum Bacteria Imbalance Linked to Alzheimer’s Disease Biomarker

Periodontitis Treatment Attacks Harmful Bacteria and Spares Helpful Bacteria

“Gum diseases are preventable” is the slogan for Gum Health Day 2021, a worldwide initiative on May 12 promoted by the European Federation of Periodontology (EFP). The event aims to educate the public about detecting and preventing gum diseases such as gingivitis, periodontitis, and peri-implantitis and explain why continuing to visit the dentist during the pandemic is important to overall health.

In addition to causing tooth loss and other oral problems, gum diseases are linked to major systemic health issues including diabetes, cardiovascular disease, chronic kidney disease, rheumatoid arthritis, Alzheimer’s disease, some cancers, pregnancy complications, and erectile dysfunction, the EFP said.

Recent research also has linked gum diseases COVID-19 transmission as well as severe COVID-19 complications and outcomes, suggesting that establishing and maintaining gum and oral health may become an important part of patient care, the EFP said.

“Gum Health Day 2021 aims to remind people that gum health is a key factor for health and well-bring even if, unfortunately, it’s still sometimes overlooked,” said Henrik Dommisch, coordinator of Gum Health Day 2021.

“Gum diseases that could be effectively prevented and treated still affect hundreds of millions of adults worldwide. It’s time to take decisive action against gum diseases. We can beat them just by keeping a good oral hygiene and going regularly to visit our dentist, periodontitis, or hygienist,” said Dommisch.

The awareness initiative will be celebrated in more than 40 countries in Europe, the Americas, Africa, Asia, the Middle East, and Australasia by EFP-affiliated societies of periodontology and by other scientific societies, dental organizations, hospitals, dental practices, universities, and companies.

Among the Gum Health Day 2021 materials that the EFP has produced are four short animated videos showing how among other factors bad breath, sensitive or loose teeth, and smoking can either trigger or be a sign of gum disease.

Most adults in developed countries are affected by gum disease at some point in their lives, the EFP said, even if they are not aware of it because gum diseases are usually painless and often go unnoticed for a time.

The EFP is inviting all members of the dental community to join this awareness day by disseminating Gum Health Day 2021 messages and materials, particularly on social media, and by signing the EFP Manifesto “Perio & General Health,” an international call to dentists and medical professionals to be more proactive in terms of the prevention, early detection, and treatment of gum disease and to acknowledge it as a major public health issue.

Besides activities organized at the national level, the EFP is holding a Gum Health Day 2021 Perio Talks live session at the EFP’s Instagram page, @perioeurope, on May 12 at 7 pm CET. It will be open to everyone and led by Dommisch with representatives from some EFP-affiliated societies.

The speakers will exchange ideas and experiences during the session and answer questions and suggestions from participants about how to educate the population to prevent and tackle the threat posed by gum diseases.

“Gum Health Day 2021 is a major EFP global initiative to get the public informed every year of the value of healthy gums as an integral part of a healthy life. Prevention of diseases is the best approach to a healthy life, and Gum Health Day 2021 will greatly get closer to our vision of periodontal health for a better life for everybody,” said Lior Shapira, EFP president.

“New associations between gum disease and COVID-19 are now being identified,” said Shapira.

“A new paper published in the Journal of Clinical Periodontology has found that the dental biofilm of symptomatic coronavirus patients can harbor ribonucleic acid (RNA) molecules of the SARS-CoV-2 virus and might act as a potential reservoir with an essential role in the transmission of COVID-19,” said Shapira.

“This reveals a previously unknown and unexplored human habitat of the viral RNA and could open a door to further research in developing COVID-19 containment strategies,” Shapira said.

Related Articles

Americans Prioritized Oral Health During the Pandemic

AAE Declares May “Save Your Tooth Month”

Bacteria That Cause Periodontitis Spread from Parents to Their Children