A huge congratulations to Sabrina, who received her MSc exam results recently. We are very proud and pleased to announce that Sabrina is thrilled that she passed with a distinction. In order to celebrate she has put together this special edition newsletter dedicated to all things hygiene.
Sabrina wants to say a huge thank you to all her patients who have taken part in her research and supported her over the last three years with their kind words of encouragement.
Here’s an extract from Sabrina’s dissertation:
At CESRC we pride ourselves on providing pioneering advanced treatments to our patients using the most advanced equipment and materials whilst applying evidence-based healthcare decisions to our treatment planning. Treating patients rather than simply the mouth. Healthcare screening optimises your treatment outcomes. To achieve optimal oral health, we need to consider systemic health and its impact on disease progression. With a large portion of the public living with undiagnosed conditions that we can easily screen for in dental practice, the dental team is well placed for general health screening to maximise treatment results.
Therefore, in October 2021 when Sabrina set about planning her dissertation for her final year MSc healthcare screening was a hot topic. Hypertension (high blood pressure) is a serious health problem, and high systolic blood pressure (BP) remains the leading risk factor for death (Stanaway et al., 2018). There is evidence to suggest that whilst the general public is aware of the link between elevated blood pressure, heart disease and stroke incidents they do not see hypertension as a serious health problem (Volpe and Dedhiya, 2006).
Hypertension can be diagnosed when a person’s SBP is measured as >140mmHg and or their DBP is >90mmHg following repeated examinations.
The Global Burden of Diseases, Injuries, and Risk Factors Study shows that high SBP remains the leading risk factor for 10.4 million deaths and 218 million disability-adjusted life years (Stanaway et al., 2018). Three of the five top risk factors are metabolic risk factors, including high fasting glucose and high body mass index and hypertension, all with known associations with periodontal disease (advanced gum disease). It is estimated that 31.1% of adults (1.39 billion) worldwide had hypertension in 2010 (Mills et al., 2020). The Health Survey for England 2019 reported that 28% of adults had hypertension. In addition, 14% of men and 11% of women had untreated hypertension. Untreated hypertension was most elevated in men aged 55 to 64 (22%) and women over 65 (19%). It has been estimated that more than 9,000 heart attacks and at least 14,000 strokes could be prevented by improved diagnosis and management of HBP, high cholesterol, and atrial fibrillation (NHS, 2019).
There is clinical evidence to support the biological plausibility of the link between periodontitis and systemic diseases (Li et al., 2000). The ulcerated pocket epithelium in patients with periodontitis is a significant surface area. In patients without periodontal disease, there is reported to be a dentogingival surface area of approximately 5cm², and in patients with periodontitis, this increases from 8cm² to 20cm² (Hujoel et al., 2001). This epithelial lining is in constant contact with the subgingival plaque biofilm It potentially provides an opportunity for bacteria to enter the blood vessels inducing an inflammatory response throughout the body (Nesse et al., 2008).
Sabrina screened 124 patients at the practice between November 2021 and February 2022 according to the International Society of Hypertension Guidelines (Unger 2020), 68.6% 75/124 of the participants had elevated BP with 60 patients in total having a BP reading indicative of hypertension on the day. There was also a statistically significant difference between the prevalence of hypertension in patients with periodontitis compared to those with an intact periodontium (healthy gums). There was also a relationship between the measured periodontal parameters (bleeding gums) and the systolic blood pressure. Sabrina’s research concluded that the high level of undiagnosed elevated blood pressure and the apparent linear relationship with the periodontal parameters measured supported the introduction of monitoring BP as part of the patient’s periodontal care. During the study two patients have subsequently received a diagnosis of hypertension from their GP and have since started drug therapy.
The Joint EFP/ American Academy of Periodontology (AAP) Workshop on Periodontitis and Systemic Diseases 2013, advised that periodontitis patients with other risk factors for CVD, such as hypertension, overweight/obesity, and smoking, who have not seen a doctor within the last year, should be referred for an examination. In addition, modifiable, lifestyle-associated risk factors for periodontitis and CVD such as smoking, diet, and exercise should be addressed through cessation programs and advice on lifestyle modifications. (Tonetti et al., 2013). Numerous studies have investigated the link between periodontal disease and hypertension, demonstrating that periodontal disease was associated with a higher risk of hypertension, especially in severe cases of periodontal disease (Martin-Cabezas et al., 2016) (D’Aiuto et al., 2018).
A recent systematic review reinforces the positive relationship of association between periodontitis and hypertension (Muñoz Aguilera et al., 2020). The study reported that patients with moderate to severe periodontitis had greater (20%) odds of having hypertension when compared to patients without periodontitis.
Early detection of hypertension through screening in dental practice could increase awareness for those at risk of hypertension (Sproat et al., 2009). This could result in preventative action through lifestyle adjustments and early management of hypertension through referral to the patient’s general medical practitioner (GMP) and a holistic approach to the management of the periodontal disease.
Given the evidence of the association between hypertension and periodontal disease and the benefits of screening and early diagnosis, the dental care professional could play a pivotal role in prevention. We are well placed in identifying patients at risk from CVD and periodontitis through a screening program, education, promotion, and raising awareness of the links between periodontal health and NCDs.
“After feeling very anxious prior to my appointment, I left CESRC feeling much happier and in very safe and competent hands. Every member of the team that I came into contact with were kind, reassuring and helpful. The experience of the team was obvious from the word go and I would highly recommend this practice! Thank you!”
“Another great CPD evening on occlusion last week. Keep up with the study club programme as it is a great opportunity for us GDPs to stay up to date and meet other colleagues in the profession.”