DENTISTRY

Mette Foundation Board Learns More During Dental School Visit

Dr. Kitrina Cordell outlines links between oral and systemic health to members of the Norman Mette Foundation during their annual visit to the School of Dentistry.

Evidence is growing that the dentist's role as a health care provider has become increasingly important to their patients.

"Oral health and general well-being are inextricably linked as noted by the fact that many conditions plaguing the body are manifested in the mouth," Dr. Kitrina Cordell told members of the Norman Mette Foundation Board of Directors during their annual spring meeting at the School of Dentistry.

The group's meeting marked the 17th consecutive year that more than a dozen members of the board came to the University of Michigan School of Dentistry and the U-M Health System to learn more about advances in oral health care, medicine, classroom and clinical education, and research.

Cordell, an oral and maxillofacial pathologist, clinical assistant professor, and associate director of the School's oral pathology biopsy service, briefed the group about the growing awareness of relationships between oral health and systemic disease. [See sidebar, page 15.]

Dr. Russell Taichman, professor of dentistry and director of the Scholars Program in Dental Leadership, also addressed the group, describing discoveries about links between periodontal disease and heart disease and diabetes.

The Mouth as an "Early Warning" System

"We constantly emphasize to our students, in both classrooms and clinics, that they are not just dentists, they're also health care providers," Cordell said.

Underscoring that point, she cited a report from the U.S. Surgeon General's 2000 Report on Oral Health that noted the mouth can function as an "early warning" system for some diseases and that early identification of oral disease can contribute to diagnosis and treatment of systemic diseases.

"The general dentist is on the frontline of the defense of oral disease," she said. "Since not all patients receive regular medical care, the dentist may be the first to diagnose a systemic disease based on oral findings."

She said that diseases can be diagnosed during clinical, radiographic, microscopic, biochemical, or other examinations.

Taking a patient's blood pressure was cited as one example.

In response to a board member's question, Cordell said all dental and dental hygiene students routinely take a patient's blood pressure and ask about the health history of patients treated in the School's clinics.

Pointing to research cited by the National Institute of Dental and Craniofacial Research, Cordell said that periodontal disease may exacerbate existing heart conditions and that people with periodontitis may be more likely to develop cardiovascular disease than those without periodontal infection.

Cordell also noted that systemic lupus erythematosus has cardiovascular implications such as increased atherosclerosis, as well as other systemic implications that can be potentially life threatening.

From Early Suspicions to Today's Research

Taichman discussed some of the oral/systemic links, including diabetes and periodontal disease.

One observation he shared with board members was from a sailor's diary nearly four hundred years ago as he circumnavigated the globe with Ferdinand Magellan in 1520:

We entered the Pacific Ocean, 3 months and 20 days without fresh food of any kind...The gums of the upper and lower teeth of some of our men were so swollen that they could not eat under any condition. 19 of our men died.

"Even back then, we had some early suspicions about possible connections between oral and systemic health," Taichman said, "because the condition described then, compared to what we know now, was most likely due to a lack of sufficient vitamin C."

Taichman said he believes the "Rosetta Stone" that points to possible dental and systemic links was discovered more than a decade ago, in 1994, by the School of Dentistry's Dr. Walter Loesche. Loesche and others investigated the oral and systemic health of more than five hundred individuals at the Veterans Administration Hospital in Ann Arbor.

"In a nutshell, the research showed that those with periodontitis were about three times as likely to have coronary disease," he said. "This is a key study that shows how periodontal disease may affect systemic health."

Taichman added, "Other clinical studies and some laboratory studies are showing that diabetes seems to be a major risk factor for periodontal disease. I'm emphasizing the word 'seems' because we have yet to prove a link between the two. It's difficult to do because research is both time consuming and expensive."

Association Between Dental and Systemic Disease

Studies have shown a relationship between dental disease and: systematic infections, cardiovascular disease, diabetes, osteoporosis.

Part of the observed associations may be compounded by: smoking, stress, dietary intake, behavioral factors (self care, professional care).