• American Academy of Periodontology. Parameter on systemic conditions affected by periodontal diseases. J Periodontol 2000 May;71(5 Suppl):880-3. [47 references]

Systemic conditions affected by periodontal diseases, including:

• Diabetes mellitus
• Pregnancy
• Cardiovascular diseases

Assessment of Therapeutic Effectiveness
Evaluation
Treatment

Dentistry

Dentists

To provide a parameter on systemic conditions affected by periodontal diseases.

Individuals with systemic conditions affected by periodontal diseases.

Evaluation

1. Comprehensive periodontal evaluation
2. Medical history
3. Referral to/consultation with other health care providers

Treatment

1. Periodontal therapy
2. Antibiotic therapy
3. Patient education/patient motivation

Efficacy of therapy, as noted by changes in:

• Gingival inflammation
• Probing depths
• Clinical attachment
• Plaque levels
• Acute periodontal infections

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Not stated

Not stated

Not stated

Not applicable

Review

Not stated

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

Approved by the Board of Trustees, American Academy of Periodontology, May 1999.

Diagnosis

Patient Evaluation

1. A comprehensive periodontal evaluation should be performed as described in the Parameter on Comprehensive Periodontal Examination.
2. The medical history should be evaluated for existing systemic diseases or conditions, medications, and risk factors for systemic diseases.
3. Other health care providers may be consulted as indicated by the patient's systemic health status, periodontal condition, and proposed treatment. Any consultation should be documented.

Therapeutic Goals

The therapeutic goals are to diagnose periodontal infections which may impact on the patient's systemic health; to inform the patient of possible interactions between the patient's periodontal disease and systemic condition; and to establish periodontal health which may minimize potential negative influences of periodontal infections. Research and clinical experience indicate that periodontal infections may have an impact on the following diseases or conditions:

• Diabetes mellitus
• Pregnancy
• Cardiovascular diseases

Preliminary evidence suggests that periodontal infections may also be associated with pulmonary disease and other remote site infections.

Treatment Considerations

Diabetes Mellitus

Periodontitis may adversely affect glycemic control in diabetes. It may also be associated with an increased risk of cardiovascular complications associated with diabetes. Periodontal treatment, especially in patients with severe periodontitis and poorly controlled diabetes, may result in improvement in glycemic control. Treatment considerations for patients with diabetes mellitus include:

1. Diagnosis of the patient's periodontal condition.
2. Consideration of consultation with patient's physician to advise of the presence of periodontal infection and proposed treatment.
3. Consideration of diagnosis and duration of diabetes; level of glycemic control; medications and treatment history; and risk factors for periodontitis which may influence diabetic complications.
4. Education of the patient regarding the possible impact of periodontal infection on glycemic control.
5. Periodontal therapy and patient motivation to establish and maintain periodontal health. Consideration may be given to the use of systemic antibiotics in conjunction with mechanical therapy (see Parameter on Periodontitis Associated with Systemic Conditions).

Pregnancy

Women with periodontitis may have increased risk for pre-term low birth weight delivery. Treatment considerations for pregnant patients include:

1. Diagnosis of the patient's periodontal condition.
2. Consideration of consultation with patient's physician to advise of the presence of periodontal infection and proposed treatment.
3. Consideration of gestational period; status of pregnancy; and risk factors for periodontitis which may influence pregnancy outcomes.
4. Education of the patient regarding the possible impact of periodontal infection on pregnancy outcomes.
5. Periodontal therapy and patient motivation to establish and maintain periodontal health. (see Parameter on Periodontitis Associated with Systemic Conditions).

Cardiovascular Diseases

Coronary artery disease.

Individuals with periodontal disease may have significantly increased risk of coronary heart disease and related events such as angina pectoris and myocardial infarction. Periodontal pathogens may contribute to atherogenic changes and thromboembolic events in the coronary arteries. Similar processes may occur in other arteries. For example, periodontal disease may increase the risk of cerebral ischemia and non-hemorrhagic stroke.

Infective endocarditis.

While bacteremias may occur in individuals with a healthy periodontium, they may be intensified in patients with periodontitis. Treatment considerations for patients at risk for or with existing cardiovascular diseases include:

1. Diagnosis of the patient's periodontal condition.
2. Consideration of consultation with patient's physician to advise of the presence of periodontal infection and proposed treatment. The American Heart Association guidelines should be followed for patients at risk for infective endocarditis
3. Consideration of diagnosis and status of cardiovascular disease; treatment and medications; and risk factors for periodontitis which may influence coronary artery disease.
4. Education of the patient regarding the possible impact of periodontal infection on the cardiovascular system.
5. Periodontal therapy and patient motivation to establish and maintain periodontal health. (see Parameter on Periodontitis Associated with Systemic Conditions).

Outcomes Assessment

The desired outcome of therapy is to prevent adverse systemic consequences of existing periodontal infection via:

1. Knowledge of the patient's medical history and systemic status, the periodontal condition, and the possible interactions between oral and systemic health or disease
2. Reduction of clinically detectable plaque and periodontal pathogens to a level compatible with periodontal health.
3. Reduction of clinical signs of gingival inflammation
4. Reduction of probing depths
5. Stabilization or gain of clinical attachment
6. Control of acute periodontal infections
7. Addressing the risk factors for periodontal disease as they affect the systemic condition.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

• Diagnosis of periodontal infections that may impact a patients systemic health
• Provide information to a patient of possible interactions between periodontal disease and systemic conditions.
• Minimize potential negative influences of periodontal infections.

Not stated

1. Each parameter should be considered in its entirety. It should be recognized that adherence to any parameter will not obviate all complications or post-care problems in periodontal therapy. A parameter should not be deemed inclusive of all methods of care or exclusive of treatment appropriately directed to obtain the same results. It should also be noted that these parameters summarize patient evaluation and treatment procedures which have been presented in more detail in the medical and dental literature.
2. It is important to emphasize that the final judgment regarding the care for any given patient must be determined by the dentist. The fact that dental treatment varies from a practice parameter does not of itself establish that a dentist has not met the required standard of care. Ultimately, it is the dentist who must determine the appropriate course of treatment to provide a reasonable outcome for the patient. It is the dentist, together with the patient, who has the final responsibility for making decisions about therapeutic options.

An implementation strategy was not provided.

Getting Better
Living with Illness

Effectiveness
Patient-centeredness

• American Academy of Periodontology. Parameter on systemic conditions affected by periodontal diseases. J Periodontol 2000 May;71(5 Suppl):880-3. [47 references]

Not applicable: The guideline was not adapted from another source.

2000 May

American Academy of Periodontology - Professional Association

American Academy of Periodontology

Ad Hoc Committee on Parameters of Care

Members: Donald A. Adams; Erwin P. Barrington (Chair); Jack Caton, Jr.; Robert J. Genco; Stephen F. Goodman; Carole N. Hildebrand; Marjorie K. Jeffcoat; Fraya Karsh; Sanford B. King; Brian L. Mealey; Roland M. Meffert; James T. Mellonig; Myron Nevins; Steven Offenbacher; Gary M. Reiser; Louis F. Rose; Paul R. Rosen; Cheryl L. Townsend (Chair); S. Jerome Zackin.

Not stated

None available

This summary was completed by ECRI on October 12, 2000. The information was verified by the guideline developer on October 17, 2000.

This NGC summary is based on the original guideline, which is copyrighted by the American Academy of Periodontology.