In this issue of DocScopy for MedBound Times, we proudly feature Dr. Sadia Afrin Zumu, a dental professional with a BDS from Sapporo Dental College and Hospital, Dhaka University, Bangladesh, and an MS in Oral Medicine from National Cheng Kung University, Taiwan.
Interviewed by Dr. Nirainila Joseph from MedBound Times, Dr. Sadia shares her insights on the critical topic of periodontal diseases and their link to systemic health. She explores various diseases that may be caused or exacerbated by periodontal issues, the potential pathways of these connections, and effective strategies for maintaining periodontal health to enhance overall well-being. With her background in both clinical dentistry and academic research, Dr. Sadia provides valuable insights into how managing periodontal health can significantly impact broader health outcomes.
Dr. Nirainila Joseph: Can you please introduce yourself to our readers?
Dr. Sadia Afrin Zumu: I am Dr. Sadia Afrin Zumu. I completed my BDS from Sapporo Dental College and Hospital, Dhaka University, Bangladesh in 2016. Later, I completed an MS in Oral Medicine from National Cheng Kung University, Taiwan in 2023.
Dr. Nirainila Joseph: In this interview, we are about to explore the crucial connection between periodontal health and overall systemic health. To start, Dr. Sadia, what are periodontal diseases and how do they affect your oral health?
Dr. Sadia Afrin Zumu: Periodontal disease is one of the oral diseases that can affect the gingiva around the teeth. In advanced stages, it can also affect the periodontal ligament and surrounding bone of teeth. According to the effect of periodontitis on oral health, it can be classified as (ADA)
Gingivitis - Bleeding on probing may present but no loss of attachment
Early periodontitis - Attachment loss 3-4mm, grade 1 furcation involvement.
Moderate periodontitis - Attachment loss 4-6mm, grade I or II furcation involvement, class I mobility
Advanced periodontitis - Attachment loss >6 mm, grade II or III furcation involvement, class II or III mobility
Refractory & Juvenile periodontitis - Juvenile forms of periodontitis which affect children or young adults.
Dr. Nirainila Joseph: That was a detailed explanation. Can you now discuss the different systemic conditions that may be connected to periodontal diseases?
Dr. Sadia Afrin Zumu: In the case of diabetes mellitus, patients may develop a dry mouth. Saliva has an antibacterial effect on the mouth, so more plaque and calculus may develop in the case of a dry mouth. Without treatment, this condition may turn into periodontitis.
When it comes to cardiovascular disease (CVD), chronic periodontitis has both direct and indirect effects. The direct effect involves viable bacteria spreading into the vascular endothelial cells, potentially causing vascular dysfunction. The indirect effect involves an increase in the patient's serum ADMA level and a decrease in nitric oxide production. Decreased nitric oxide and increased serum ADMA levels can also lead to vascular dysfunction, potentially resulting in CVD in patients with periodontitis. Additionally, elevated levels of serum inflammatory mediators are a risk factor for kidney disease.
Periodontitis is also connected to respiratory disease. The untreated bacteria from periodontitis may easily enter the respiratory tract, potentially causing Chronic Obstructive Pulmonary Disease (COPD), a serious lung disease.
Research has found that obese patients have a higher likelihood of developing periodontitis compared to patients with a healthy weight. This is because obesity decreases antioxidants and increases reactive oxygen species in the body, leading to chronic inflammation and tissue destruction.
Periodontal biofilm is a reservoir of anaerobic and gram-negative bacteria. These bacteria release enzymes, endotoxins, and metabolic by-products which can cause DNA damage and induce mutations. Oral bacteria may act as oral carcinogens.
Both osteoporosis and periodontitis cause bone resorption. Patients with periodontal disease often have poor oral health, which is related to low birthweight and preterm babies.
Dr. Nirainila Joseph: That's interesting and quite eye-opening! It's incredible to learn how closely systemic diseases are connected with periodontal health and the complex pathways involved. In general, how do periodontal diseases contribute to the progression or exacerbation of other systemic diseases, and vice versa?
Dr. Sadia Afrin Zumu: Periodontitis is one of the chronic inflammatory diseases. Chronic inflammation may be the reason for low immunity. Low immunity is the harbor of systemic diseases. Nitric oxide controls the level of inflammation in the vessels, and vascular tone, and modulates the release of different growth factors. As I mentioned previously, periodontal disease decreases the production of nitric oxide which may progress to systemic diseases.
Dr. Nirainila Joseph: What do current research findings suggest about the relationship between periodontal health and overall systemic health?
Dr. Sadia Afrin Zumu: The oral cavity is a part of the body. Several epidemiological research studies have found periodontal health has a bidirectional relationship with overall systemic health. Poor oral health is one of the risk factors for systemic diseases. Periodontal bacteria plays an important role in the progression of systemic disease.
Dr. Nirainila Joseph: What role do other factors play in mediating the relationship between periodontal health and systemic health?
Dr. Sadia Afrin Zumu: Immune response and microbial composition have a role in periodontal and systemic health. Low immunity increases the risk of chronic inflammation and systemic diseases. Periodontal bacteria can enter into the other parts of the body and increase the risk of systemic diseases.
Dr. Nirainila Joseph: You previously spoke about periodontal diseases influencing pregnancy-related conditions such as preterm birth and low birth weight. Can you elaborate on it?
Dr. Sadia Afrin Zumu: Periodontal bacteria release some by-products that interact with decidua or directly with uterine muscle contraction. Bacteria migrate from periodontal tissues to the blood circulation and may stimulate pro-inflammatory mediators. All these may be the reasons for preterm birth and low birth weight.
Dr. Nirainila Joseph: What challenges or limitations do researchers face in studying the links between periodontal diseases and systemic conditions and how can these be addressed?
Dr. Sadia Afrin Zumu: The main challenge is that people are not very concerned about their oral health, making it difficult to gather participants for studies. We need to raise awareness among people about periodontal or oral health and its connection to systemic health.
Dr. Nirainila Joseph: How do lifestyle factors influence both periodontal diseases and systemic health outcomes?
Dr. Sadia Afrin Zumu: Smoking lowers immunity, promotes bacterial invasion, and increases inflammatory mediators which influence both periodontal and systemic health. Excessive sugar consumption and unhealthy diet also promote both diseases by decreasing anti-oxidants in the body. Stress also has an effect on periodontal disease. Due to poor mental health, patients can't take care of their oral health which may lead to future periodontal diseases. Stress hormone, cortisol also suppresses immune system of the body.
Dr. Nirainila Joseph: This is very informative and understanding these connections will undoubtedly help patients take control of these factors to better manage and prevent periodontal disease. To build on that, how does periodontal treatment improve outcomes for people with other chronic conditions, such as heart disease or diabetes?
Dr. Sadia Afrin Zumu: Periodontal treatment decreases the production of inflammatory mediators in the body. If the release of inflammatory mediators decrease, it may automatically help to improve chronic conditions.
Dr. Nirainila Joseph: Can you share any promising strategies or interventions that have been identified for diagnosing, preventing or managing periodontal diseases in individuals at risk for systemic conditions?
Dr. Sadia Afrin Zumu: We know that prevention is better than cure. So lifestyle modification is very important as an unhealthy lifestyle is related to periodontal disease. Another strategy we can follow as dentists when patients come to the clinic for other dental treatments, we can check their periodontal condition and make aware them of this. We can also take a history about their lifestyle and any systemic disease etc. We can also teach them about proper brushing techniques as improper brushing also turn into periodontal disease.
Dr. Nirainila Joseph: This is a great approach and I completely agree with focusing on preventive strategies. Now, how can dental professionals contribute to educate patients of the systemic implications of periodontal diseases and encourage integrated approaches to patient care?
Dr. Sadia Afrin Zumu: Dental professionals can organize dental camps at the grassroots level of the city to educate people about oral health. They can offer free dental check-ups once a week to attract more people and raise awareness about the seriousness of periodontal disease. Additionally, they can display awareness posters in their clinics or play educational videos in the waiting room to highlight the systemic implications of periodontal diseases.
Dr. Nirainila Joseph: What are some practical tips for individuals to maintain good periodontal health and reduce the risk of systemic diseases?
Dr. Sadia Afrin Zumu:
Dr. Nirainila Joseph: During their detal checkups, what should patients discuss with your dentist if they have a chronic illness that could be affected by their oral health?
Dr. Sadia Afrin Zumu: I think patients need to discuss how to modify their lifestyle and how to clean the oral cavity using proper brushing, and flossing techniques.
Dr. Nirainila Joseph: Thank you for sharing your valuable insights. What is that one key piece of advice you would give to patients with chronic conditions, such as diabetes or heart disease, about managing their periodontal health?
Dr. Sadia Afrin Zumu: Patients with systemic diseases should visit the dentist at least once a year. It's crucial for them to receive proper treatment if they have periodontal disease, as it can exacerbate their systemic condition. Maintaining oral hygiene is essential, and adopting a healthy lifestyle is equally important.
MedBound Times expresses sincere gratitude to Dr. Sadia Afrin Zumu for sharing her valuable insights on our platform.