Special Issue "Oral Health and Systemic Diseases"

The associations between dental disease and systemic health

Understanding the relationship between a patient's systemic and oral health is key for clinicians. The aim of this study was to determine if there is an association between specific findings in a dental exam, such as class V carious lesions, and the American Society of Anesthesiologists (ASA) classification as a proxy for systemic health. A retrospective chart review was performed on all patient charts that met inclusion criteria including detailed, complete, and vetted charts obtained over a three-year period in the predoctoral clinic of a United States dental college. Findings recorded at the initial exam included the decayed, missing or filled teeth (DMFT) score, the location of carious lesions and restorations, the presence of periodontal disease, the number of endodontically treated teeth and the number of fractured teeth or restorations. We found no association found between DMFT score and ASA status but did find that ASA I patients had a higher degree of occlusal carious lesions and that ASA III patients were more likely to have interproximal restorations and fractured teeth. We found associations between a greater number of missing teeth and the presence of periodontal disease with worsening ASA status. Our data suggest that ASA classification cannot be used as a reliable predictor for the health of a patient's dentition or the number of cervical caries. However, the data does demonstrate a positive correlation between the number of missing teeth and ASA status, promoting the idea that the number of missing teeth is a crude prognosticator of systemic health. This information can be used by physicians and dentists to help understand the relationships between a patient's dental and systemic health.

Evaluation of the correlation between oral infections and systemic complications in kidney transplant patients: a retrospective pilot study

BACKGROUND

Data regarding the efficacy of the dental clearance required prior to kidney transplantation (KT) for preventing post-transplant complications is controversial. The aim of this retrospective study was to investigate a possible correlation between any untreated oral infectious foci and the onset of systemic complications in KT patients.

METHODS

Patients scheduled for regular check-ups during the post-transplant period were visited at the C.I.R. Dental School in Turin, Italy. Patients were asked to bring orthopantomography (OPT) acquired prior to transplantation to compare the possible presence of untreated infectious foci at the time of transplantation with the time of their post-transplant visit. Patients were then divided, according to the evaluation of the OPT obtained prior to the transplantation, into two groups according to their dental status prior to the transplant. "Group Infected" was comprised of patients with no dental clearance, and "Group Clear" included patients with dental clearance. The medical records were then retrospectively reviewed for the evaluation of any systemic complications that occurred after transplantation. The following medical complications were considered: fever, pneumonia, urinary tract infections, systemic infections, kidney rejection, and death. Complications were divided in two groups: early complications, which occurred within 100 days of transplantation, and late complications, which occurred more than 100 days after transplantation.

RESULTS

A total of 77 patients were enrolled in the study. Group Infected was composed of 19 subjects (25%), while Group Clear was composed of 58 patients (75%). In Group Infected, 13 (68%) patients developed complications within 100 days of transplantation, and 11 (58%) did so after 100 days. In Group Clear, 31 (53%) patients had complications within 100 days of the transplant, and 23 (40%) did after 100 days. Patients in Group Infected had a statistically significant increase in episodes of fever (p = 0.03), compared to Group Clear, with a higher relative risk (RR) of 3.66 in the first 100 days after transplantation.

CONCLUSION

Within the limitations of the present retrospective pilot study, and based on the results, a correlation between the absence of dental clearance prior to KT and a higher RR of developing a fever within the first 100 days post transplantation was highlighted. The present results encourage doctors to continue research on the topic, which remains controversial. Further prospective studies are required to confirm the results of the present study.

[Dental and oral health services research in Germany]

In den letzten 8 Jahren wurde in Deutschland nicht nur „mehr Versorgungsforschung in der Zahnmedizin“ gefordert, sondern auch geleistet. Insgesamt finden sich an 12 Medizinischen Fakultäten themenbezogene Aktivitäten der Zahn‑, Mund- und Kieferheilkunde in der Versorgungsforschung; deutschlandweit werden 9 Großprojekte verortet, die vom Bundesministerium für Bildung und Forschung oder vom Innovationsfonds gefördert werden. Gleichwohl ist der Bedarf an Versorgungsforschung größer als die jetzige Leistungsfähigkeit der universitären und außeruniversitären Zahnmedizin: Um eine nachhaltige, bedarfsgerechte und zukunftssichere zahnärztliche Versorgung aller Menschen in Deutschland gewährleisten zu können, bedarf es strukturierter, methodisch versierter und in die Versorgung hinein vernetzter Verbünde, die das wissenschaftliche Fundament für erwartete Versorgungsumbrüche legen können.

Der vorliegende Beitrag soll den Stand der Versorgungsforschung in der Zahn‑, Mund- und Kieferheilkunde in Deutschland beschreiben. Die wesentlichen Herausforderungen werden adressiert: Methodenkompetenz, Zugang zu Daten und deren Nutzung sowie die langfristige Perspektive dieses Forschungsbereichs. Derzeitige Forschungsaktivitäten und Infrastruktur inklusive Förder- und Fortbildungsinstrumente werden dargestellt.

Die Erkenntnisse aus der zahnärztlichen Versorgungsforschung in Deutschland können auch für andere Länder richtungsweisend sein; umgekehrt kann Versorgungsforschung Ansätze aus anderen Ländern sinnvoll in das deutsche Gesundheitssystem übertragen. Versorgungsforschende sollten sich professionalisieren und vernetzen. Nachhaltige Strukturen (Professuren, Mittelbau) und Rahmenbedingungen (Datennutzung, Förderung) sollten geschaffen und Forschungsergebnisse zeitnah verwertet werden.