Periodontal disease and poor health outcomes
The article by Galgut (Br Med J 2010; 340:c2735) linking poor health
with gum infections is certainly interesting, but it leaves a number of
That people with poor periodontal health have other poor health
outcomes is not in doubt, but is the link coincidental or causative?
Perhaps people who smoke , drink alcohol to excess, use illicit drugs and
have a poor diet do not have high expectations of dental health and do not
clean their teeth efficiently, nor do they visit dentists regularly. Many
patients with mouth cancer have poor periodontal health, but the link is
only an association rather than causative.
The NICE guidelines for the prevention of endocarditis following
dental treatment have recently been revised; the evidence that dental
manipulation causes clinically significant bacteraemias seems to have been
And where should these many patients with periodontal disease be
referred to? There is limited secondary care provision for specialist
cases, and NHS dentists will not have the time or inclination to treat
such patients in primary care. Very few patients I see in secondary care
for other mouth problems who have periodontal disease have the motivation
or resources to pay privately for such treatment, so who will pay for
Patients with good oral health may well have good health outcomes.
This is because they accept personal responsibility for various aspects of
their own health, and tend to be non-smokers.
There is no evidence that improving periodontal conditions lessens
the risk of infection of prosthetic joints, as few such infections are
caused by oral organisms,3 so this conclusion unsupported by references
should not really be a take-home message in a prestigious medical journal.
1. Prophylaxis against infective endocarditis. Antimicrobial
prophylaxis against infective endocarditis in adults and children
undergoing interventional procedures. NICE guidelines (2008)
2. Seymour RA. Dental treatment, antibiotic cover and infective
endocarditis: a major rethink. Dent Update 2008 Jul-Aug;35(6):366-8, 370.
3. American Dental Association; American Academy of Orthopedic
Surgeons. Antibiotic prophylaxis for dental patients with total joint
replacements. J Am Dent Assoc 2003 Jul;134(7):895-9.
East Lancashire Maxillofacial Service
Royal Blackburn Hospital
Blackburn BB2 3HH
Competing interests: No competing interests