Editor’s note: In part 1 and part 2 of this series, published in October and November, respectively, I suggested that untreated periodontitis could compromise immunity or contribute to complications from pandemic-scale viruses such as SARS-CoV-2 and I offered two biological mechanisms to explain this possible association.
Treating periodontitis has always been important, but during this pandemic I suggest we need to become more strategic than ever in the care of our patients, especially those at risk for periodontitis. In this third and final part of the series, I propose four aspects of progressive periodontal therapy that could make a difference in the periodontal stability of our patients:
- Resurgence of adherence to self-care guidelines
- Updating our patient education with the latest information on how untreated periodontitis can affect susceptibility to viral diseases
- Improving detection accuracy for measuring changes that determine periodontal stability
- Incorporating complementary therapies that help stabilize the reduced periodontium
Encouraging patients to comply with self-care instructions
Today we know that only 20% of the risk of periodontitis is related to plaque. The lion’s share of the risk is actually from non-plaque-related risk factors.1 However, good oral hygiene has always been considered the cornerstone of periodontal health,2 and today, reducing the bacterial load anywhere in the body is important. In their contribution to the 2017 system for the classification of periodontal and peri-implant diseases and conditions, Lang and Bartold suggested that “. . . To achieve or maintain periodontal health, the composition of the subgingival microflora must be redirected to one compatible with gingival health.”2 So how do we motivate our patients to better comply with self-care recommendations?
Over the past 30 years, various models have attempted to explain the factors leading to greater adherence to oral hygiene guidelines in adult periodontal patients. In 2015, a systematic review of 15 articles related to these models concluded that a key predictor of adherence is when patients understand the severity of periodontal disease and the benefit of improving oral hygiene habits.3 Consequently, the responsibility for educating patients that untreated or unstable periodontitis can pose a threat to overall health rests with oral health care providers (OHCPs). This can be even more important during a virus pandemic. But, a note of caution here: what we say must be based on evidence. Documented sound bites will follow to educate patients on this topic.
It is also important to make it easy for patients to comply with our self-care recommendations. Offering alternatives to specific self-care procedures enhances compliance. For example, insisting that a patient floss can undermine his or her best efforts to improve oral hygiene. Thread is a gold standard. However, for various reasons, there are many people who simply cannot or do not want to floss. In this case, you may recommend using other interdental cleaning devices such as handpieces as a great alternative to flossing.
Updating evidence-based patient education
We should provide evidence-based patient education that negates the possibility that untreated periodontitis could affect viral susceptibility and/or escalate the severity of associated complications of viral diseases. What can we tell our patients that is evidence-based? Here are sound bites, backed by science, that aren’t meant to be alarming, but rather help patients see the bigger picture when it comes to health risk. These messages are not intended to scare patients away from treatment, but for those who have questioned the benefit of periodontal treatment, this information may be beneficial.
- One of the strongest defenses we have against viral infections like COVID-19 is a strong immune system so we can fight the infection. That’s why we do our best to help our patients boost their immune systems.
- There are many science-based recommendations to help boost your immune system, including eating nutritious foods and balancing your diet, getting enough sleep and physical activity, getting outside for some sunshine, and managing stress.
- But also, research shows that treating chronic infections, including mouth infections, can help improve immunity.
- Poor oral health affects immunity, and if periodontal disease (gum disease) is left untreated, it can negatively affect your overall immunity.
- For many years we have known that bacteria from gum disease can be aspirated into the lungs. When this happens, the lungs’ ability to fight infection is disrupted, which can increase the risk for viral co-infections, such as viruses like COVID-19.
- That’s why, more than ever before, we are extra diligent in screening patients for gum disease or any signs of oral inflammation. And, for those with gingivitis, it’s important to get treatment as soon as possible.
- Meticulous oral hygiene will reduce bad bacteria in your mouth. This includes brushing your teeth twice a day with an antimicrobial toothpaste and cleaning your teeth with floss or braces in between. Water irrigators and antimicrobial mouthwashes are other tools to keep your mouth clean. The goal is to reduce the bacterial load in your mouth.
Measure periodontal measurements that determine stability
Improving the accuracy of detection and measurement of changes that help determine periodontal stability using an automated detection system is crucial for progressive periodontal treatments. Maintaining periodontal health throughout life, although theoretically possible, is not realistic for most people. Because there are periods of dormancy and outbursts of destruction in periodontitis, we know that the progression of the disease is not a straight line. Fortunately, the 2017 classification system addressed this by proposing a new treatment target for patients with reduced periodontium (after initial treatment).2 Low disease activity has been established as an acceptable alternative therapeutic target, particularly in long-term disease. Clinical parameters that inform the level of disease activity are shown in Table 1.
