Historically, caries and periodontal diseases have been considered separate entities with distinct trajectories. However, while their pathophysiologies differ, the two diseases do in fact share a number of common genetic, etiological and environmental factors. A 2016 workshop led by the European Federation of Periodontology (EFP) aimed to highlight these commonalities alongside the differences. Here, we discuss the outcomes and the preventative strategies dental professionals can use to manage both conditions successfully.
What do dental caries and periodontal diseases have in common?
Dental caries and periodontal diseases are the most common non-communicable diseases worldwide. The leading causes of tooth loss, both can have a significant impact on nutritional status, self-esteem and quality of life.
Dental biofilm accumulation is identified as an essential component in the development of both diseases. However, the progression of each disease is driven by microbial interactions with different stressors, the most notable of those being dietary sugars.
In the case of dental caries, the fermentation of dietary sugars leads to acid production, resulting in greater quantities of acidogenic and aciduric bacterial species. Consistent and excessive acid exposure then leads to the demineralization and eventual decay of the tooth structure.
In the case of periodontal diseases, biofilm accumulation at the gingival margin leads to higher proportions of proteolytic bacterial species and tissue inflammation. The inflammatory response involves increased blood glucose levels, which can drive oxidative stress, further perpetuate inflammation, and create a favorable environment for continued bacterial proliferation. Higher blood glucose levels are associated with greater severity of periodontitis.
Other risk factors for both caries and periodontal disease include:
Hyposalivation.
Rheumatoid arthritis.
Smoking.
Poorly controlled diabetes.
Macronutrient deficiencies, including vitamins B12, C, or D.
Periodontal disease is itself a risk factor for root caries. The dentin that covers the root of the tooth can be exposed when the gingival tissue recedes, and is more vulnerable to decay than enamel.
Is there a genetic element?
There is moderate evidence that an individual may be genetically predisposed to periodontal diseases and caries, with a greater evidence base in support of the former. In periodontal diseases, the main associations are with vitamin D receptors, Fc gamma receptors, and interleukin 10 genes. In caries, the main associations relate to enamel formation, salivary characteristics, immune regulation and dietary preferences. At present, no shared genetic determinants have been identified.
Common strategies for caries and perio prevention
Even though caries and periodontal diseases follow a different path, their shared cause means that they also have effective preventative measures in common. In their guidelines for the oral healthcare team, the EFP makes the following recommendations.
Risk assessment:
Routinely question every patient about their own history of caries and periodontal diseases and that of their family.
Routinely enquire about dietary behaviors and lifestyle habits to assess risk factors.
Use validated risk assessment tools to measure risk and develop tailored prevention programs.
Oral hygiene:
Recommend mechanical plaque control via twice-daily brushing with a fluoride toothpaste, such as Colgate Total SF or meridol toothpaste, and daily interdental cleaning.
For high-risk patients, recommend high-fluoride toothpastes like Colgate PreviDent 5000 Booster Plus (available in some markets as Colgate Duraphat 2800 and 5000).
For high-risk patients, consider supplementing home-use products with the application of high-fluoride in-office treatments, such as Colgate PreviDent Varnish (available as Colgate Duraphat Varnish in some markets).
To manage gingivitis, advise that fluoride toothpastes can be supplemented with chemical plaque control agents, such as Colgate PerioGard, Savacol and meridol mouth rinses, all of which contain antimicrobial chlorhexidine gluconate.
Dietary and behavioral counseling:
Educate patients on the importance of monitoring and, if necessary, reducing free sugar intake to prevent caries and periodontal disease risk.
Advise on harm reduction strategies, e.g., taking sugary foods only at mealtimes.
Offer dietary guidance in line with national recommendations, referring to dietitians or medical specialists where necessary.
Educate on the importance of vitamin D and other micronutrients in oral health.
Engage in discussions about weight loss, smoking cessation and other risk reduction strategies, signposting additional support where necessary.
Encourage glycemic control in patients with diabetes, educating on the connection between diabetes and periodontal diseases.
