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Relation of oral health, general health and NCDs (Christoph Benz)


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Relation of oral health, general health and NCDs
Christoph Benz

FDI World Dental Congress 2016 Poznań

Published in: Government & Nonprofit
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Relation of oral health, general health and NCDs (Christoph Benz)

  1. 1. General Health relation of and Christoph Benz
  2. 2. prologueprologue medicine is an “art of probabilities,” at best, a “science of uncertainty” uncertainty Sir William Osler 1849-1919 „measurement has over promised august 2015 Gene Glass 1940 and under delivered“
  3. 3. prologueprologue mechanistic evidence there is a physiological or (micro)biological explanation how condition A may pathomechanism empirical evidence evidence in patients that proofs there is a dependance of condition B on condition A gold standard: RCT NCD evidence lead to condition B
  4. 4. prologueprologue primary outcome surrogate outcomes the most important outcome, freedom from myocardial infarction and survival a real clinical endpoint measures of an effect that may correlate with a real clinical endpoint, but not necessarily cholesterol level probing depth, BOP tooth loss endocarditis bacteremia outcome measures
  5. 5. prologueprologue ethical considerations prolongation of a study difficulty to standardize study-groups large group sizes why surrogate?
  6. 6. prologueprologue because of the multitude of individual influences the same cause may lead to very different effects periodontitis is a risk factor one cause one effect? the clinical relevance is dependent on a complex interplay from genetics to behavior
  7. 7. what we knowwhat we know Disease periodontitis as risk factor association patho- mechanism Intervention: surrogate Intervention: primary Endocarditis ++ yes yes yes no Recurrent Pneumonia ++ yes yes n. a. yes Cardiovascular Disease + yes yes yes no Chronic Kidney disease + yes yes n. a. yes Diabetes Mellitus + yes yes yes no Cancer yes yes no no COPD yes yes n. a. yes Dementia yes yes no no Gastritis yes yes n. a. yes Rheumatoid Arthritis yes yes no no periodontitis
  8. 8. what we knowwhat we know one example cardiovascular disease periopathogens in atherosclerotic vessel walls Haraszthy et al. 2000, 2001, Mastragelopoulos et al. 2002, Desvarieux et al. 2006 animal model: periopathogens Offenbacher et al. 1999, Li et al. 2002 initiate atherosclerotic plaques endothelial dysfunction reversed Tonetti et al. 2007 by periodontal therapy
  9. 9. what we knowwhat we know problems … no large scale industrial or pharmaceutical interests that lead little interest of general medicine to the funding of expensive studies and politics in dental topics dental science
  10. 10. what we knowwhat we know we have found …, but the evidence is not often because they … feel insecure about their study want new research-funding sufficient. Further research is necessary. classical expression of a scientist … were obliged by peer reviewers dental science
  11. 11. what we knowwhat we know considering periodontitis, we want to recommend preventive measures what we need are relevant endpoints because we want to convince … the insurance-systems to spend money on prevention the patients to spend their own money on prevention underline our recommendations in the field of general medicine to What do we want? the practitionerthe practitioner
  12. 12. what we know in the mouth clinical endpoints what we know we have observational evidence for the practitioner tooth loss severe periodontitis inflammation less …
  13. 13. what we knowwhat we know The information and concerning 60 70 80 90 1995 2000 2005 2010 2015 12 years 35-44-years 65-74 years prevention-based dental visits [%] to talk to our patients is more than enough evidence we have today the practitioner general health?
  14. 14. what we knowwhat we know Insurance-systems? at least in Germany the highest levels 2 questions … Will we ever reach these levels? Do we really want insurance money? of evidence are required the practitioner concerning general health?
  15. 15. take hometake home never hesitate to recommend high-class preventive measures we have all the hard endpoints in dentistry and sufficient evidence in general medicine relying on the money of our patients people in the need of care poor people leaves at least 2 groups without prevention (less developed countries)