Periodontitis: bad medicine?BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3219 (Published 19 May 2014) Cite this as: BMJ 2014;348:g3219
- Michaël R Laurent, geriatrics registrar1
Chapple calls for more efforts to manage periodontitis.1 I agree that this condition is associated with stomatological disability. But before concluding that it is a chronic disease that puts half of all adults at risk of atherosclerotic cardiovascular disease, type 2 diabetes, and a host of inflammatory disorders, we need direct evidence from high quality blinded randomised controlled trials to prove causality.
The recent Diabetes and Periodontal Therapy Trial was the first serious trial (n=514) to examine periodontal therapy in type 2 diabetes. Contrary to previous small studies, it found that improving multiple dimensions of periodontitis did not improve glycaemic control.2 Future trials might need to use more aggressive treatment, with antibiotics and surgical intervention.
It is likely that bad eating habits, smoking, and other lifestyle factors confound the associations between periodontitis and diabetes, chronic obstructive pulmonary disease, and cardiovascular disease in observational studies and small pilot trials. This is similar to vitamin D deficiency, which is common in the population and strongly associated in prospective observational studies with a wide range of disorders, although it has no effect on almost all disease specific endpoints in placebo controlled trials.3
Until we have proof of causality, periodontitis should be treated in its own right and be considered a marker for underlying disorders, but hopes of improving underlying comorbidities by periodontal interventions are likely to be in vain.
Cite this as: BMJ 2014;348:g3219
Competing interests: None declared.