Recently, I had a patient who presented with generalized gingivitis. Her husband was also recently diagnosed and treated for generalized chronic periodontitis. She asked the familiar question “How did I get gingivitis? I brush and floss every day.” These questions opened the door for an interesting discussion about her risk factors. She has two children under the age of 4 and she works full time as a nurse. Both of these contribute to her disrupted and inadequate sleep patterns. She is overweight and her diet is deficient in multiple servings of fruits and vegetables each day. In spite of her stated oral hygiene regimen, she had generalized adherent plaque along the cervical area of most teeth. Her blood pressure reading was elevated on this day, even though she has not been diagnosed with hypertension. We discussed all of these factors but the light bulb came on for her as we discussed the real enemy…pathogenic biofilm. As I painted her a picture of how pathogenic biofilm thrives in an environment of inflammation, and showed a contrast between her condition of gingivitis and that of her husband’s with periodontitis, she suddenly sat up straight and asked, “Is there any way some of my husband’s bad bacteria has gotten into my mouth and made my inflammation worse or even caused it?” Funny, how we love to look for ways to assign blame, isn’t it?
I’m curious how the masses of dental professionals would have responded to her question. While we cannot assign blame for the manifestation of generalized gingivitis solely on her husband’s pathogens, the reality that they are exchanging good and bad bacteria is certainly accurate. What I tell my patients is that you do not transmit the disease through salivary exchange, but you can pass on the pathogens that are culprit. When risk factors and the host response are unfavorable, disease will manifest itself. Periodontal disease is very opportunistic and we now know it is a perfect storm of converging factors. The susceptible host and specific pathogens do influence the disease.
So, in this scenario would you recommend an evaluation of the patient’s pathogen profile and pathogen load prior to treating her gingivitis? I hope so. As it turns out, her husband presented with 2 high-risk pathogens and 4 moderate risk pathogens at his time of diagnosis. Wouldn’t you want to know if your patient with gingivitis also has evidence of high-risk pathogens? My experience is that testing both individuals that are exchanging saliva can be a powerful motivator for both to get healthy and more importantly, stay healthy. In addition, when high-risk pathogens are present whether the patient has gingivitis or periodontitis, their risk for heart attack and stroke are elevated. My gingivitis patient presents with many of the same risk factors for cardiovascular disease: elevated stress, elevated blood pressure, inadequate sleep, diet insufficient in adequate antioxidants, being overweight and hosting an elevated level of oral inflammation which drives up inflammatory burden systemically. As dental professionals we need to connect the dots for our patients in helping them relate their oral health to its potential influence on their overall health. After all, periodontal pathogens are not just associated with periodontal disease, research supports these pathogens can complicate cardiovascular disease, colon cancer, pancreatic cancer, rheumatoid arthritis, other autoimmune diseases and elevate risk for oral and pharyngeal cancer.
Exchanging spit is one thing but exchanging pathogens could contribute to an adverse outcome. When you are treating one patient for periodontal disease, inquire about with whom they are exchanging saliva, and if that person has not had a recent periodontal assessment, recommend that person also be screened. More often than not, the OralDNA® MyPerioPath® test results of the couple mirror each other. In my opinion, treating one individual without recommendations to screen and, if necessary, treat both individuals sharing saliva are conversations we should be having for the health of our patients.
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- Exchanging Spit and What Else? - January 19, 2018