ADA.org: Future of Dentistry Full Report

FUTURE OFDENTISTRY

into the gingival crevice. The use of systemic antibiotics
will be reserved for the most aggressive forms of dis-
ease, and also may be employed as part of periodontal
therapy for patients with certain systemic diseases that
have been linked to periodontitis. Considerable research
effort has focused on the use of newer anti-inflamma-
tory agents for treatment of periodontitis. While sys-
temically delivered agents have been used in both ani-
mal and human studies, topical delivery of these agents
(mouth rinses, toothpastes) seems the most logical
approach for the future. In addition, recent under-
standing of the specific events in the pathogenesis of
periodontal disease will lead to highly specific and novel
therapies. For example, IL-1 receptor antagonists may
be employed as anti-inflammatory agents (Graves et al,
1998), and, in the case of diabetes-associated periodon-
titis, blockade of the receptor for advanced glycation
endproducts (Lalla et al, 2000) may be selectively uti-
lized in affected patients.
Advances in treatment of periodontitis will focus
on procedures to induce regeneration of lost peri-
odontal tissues. Among the specific mediators being
studied for application in periodontal therapy are
recombinant bone morphogenetic proteins and
combinations of growth factors. The success of
these therapies will depend on the identification of
the appropriate biological mediator and the appro-
priate delivery system.

FUTURE CHANGES IN SYSTEMIC DISEASES
RESEARCH

Although there are a few negative findings (Hujoel
et al, 2000), the evidence in support of a link
between periodontal and systemic diseases continues
to mount. Oral infections are suspected to be a risk
factor for certain systemic diseases (that is, cardiovas-
cular disease, cerebrovascular disease, aspiration
pneumonia) and for pre-term low birth weight babies.
As supportive research evidence becomes avail-
able, dentists will need to provide more intense
management of patients' oral infections. Increased
communication by dentists with other health care
professionals can be expected.
However, without intervention studies demon-
strating a systemic therapeutic benefit from peri-
odontal therapy, there is no concrete evidence to jus-
tify a change in oral health care policy or current
standards of care. New studies in progress have the
potential to alter this position rapidly. Evidence
suggests that poor oral health may be as detrimental

to general health as other risk factors, such as smok-

ing or high cholesterol levels.

As the relationship of oral infection and certain sys-

temic diseases is further defined, dentists will be

expected to be active participants in the management

of patients with certain systemic diseases, and to

broadly consider how medical management of patients

will influence dental health and dental care. For exam-

ple, longitudinal medical studies have demonstrated

that good glycemic control limits the onset and preva-

lence of complications from diabetes mellitus.

Consequently, an important part of managing peri-

odontal diseases in these patients is the medical man-

agement of the patient. When indicated, dentists

should be checking hemoglobin A1c. Periodontal dis-

eases are the sixth complication of diabetes mellitus.

Since dentists may see patients more regularly than

physicians, dentists should be screening for diabetes

mellitus in their patients who are at risk.

If, in the near future, multicentered, randomized,

controlled clinical trials confirm that periodontal

disease causes systemic conditions, several issues

will confront the dental profession:

u Studies will need to be conducted to determine

the effectiveness of screening patients in the dental

office for certain diseases with obvious ramifications

for the oral cavity (i.e. diabetes mellitus). Further-

more, the effectiveness of screening for oral disease

by physicians and other non-dental health care

workers should be assessed. If effective, these pro-

grams will enhance the oral health and general

health status of patients.

u There will be a growing appreciation by the pub-

lic and physicians that dentistry can no longer be

considered solely a luxury, elective health care.

Recent polls indicate that 85% of the public is

already aware of the fact that poor oral health can

worsen general health.

u The recognition of the medical necessity for peri-

odontal care will increase the perceived impor-

tance of dental services, and the demand for dental

services will increase. Thus, the larger problems are

the perception among health care professionals, the

nature and system by which health care is delivered,

and access and utilization.

u Research findings providing a clear demonstration

of the medical necessity for periodontal care among

Dental and Craniofacial Research