PERIODONTAL DISEASE AND CARIES
The physical and psychological consequences of periodontal disease can have a significant impact on quality of life (15). Periodontitis, the more advanced form of periodontal disease, is the primary cause of tooth loss in adults. It may result in low birthweight and premature births (1). In the US, 47% of adults suffer from periodontitis; the approximate prevalence of mild, moderate, and severe periodontitis is 9%, 30%, and 9%, respectively (16).
In NYC, 53% of adults have had at least 1 tooth extracted, and 25% of adults aged 65 years and older have had all of their teeth extracted because of periodontal disease or tooth decay (17). Periodontal disease can be divided into 2 stages: gingivitis, in which the gums become swollen, and periodontitis, which occurs when infection spreads to the bone and tissue that support the teeth, causing gingival recession (18). Periodontitis is generally preceded by gingivitis, but gingivitis does not always progress to periodontitis (19).
Smoking increases the risk of gingival attachment loss (20) and oral bone loss (21), and may account for more than half of periodontal cases in US adults (22). Current smokers are 2 times as likely as former smokers and 4 times as likely as those who never smoked to have poor oral health status (23). Only 57% of current smokers visited a dentist in the past year, in contrast to 64% of former smokers and those who never smoked (2007 data) (2).
Diabetes is a risk factor for gingivitis and periodontitis (24). Poor glycemic control may affect risk for periodontal disease, and periodontitis may increase the risk of developing poor glycemic control. Autoimmune diseases, HIV, cancer therapy, certain medications, and age can also increase susceptibility to periodontal disease (25).
Caries is the most prevalent chronic disease in both children and adults (29). Ninety-two percent of adults aged 20 to 64 years have had dental caries in their permanent teeth, and 23% of adults aged 20 to 64 years have untreated decay (29). Counsel patients on avoiding smoking and sugary snacks, and on other measures they should take to prevent oral health problems (30,31) (Box 3).
| BOX 3. PROMOTING ORAL HEALTH IN ADULTS
- Look in the mouth for evidence of poor health, including decay and lesions (26).
- Refer patients with white or red lesions that persist for longer than 2 weeks to an appropriate specialist such as an otolaryngologist for evaluation (26-28).
- Refer patients with evidence of tooth decay or periodontal disease to a dentist.
- Counsel patients to
- Encourage patients to visit a dentist regularly, especially pregnant women, adults ≥65 years old, smokers, and those with diabetes (3,4).
PDF version of Box 3
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