Other modifiable risk factors

Other modifiable risk factors

Links between rheumatoid arthritis and periodontal diseases have been proposed and investigated and emerging evidence indicates the true relationship between the diseases may be bi-directional. Several small studies have demonstrated that periodontal treatment may positively influence rheumatoid arthritis disease activity, but no definitive evidence is currently available.

Emerging evidence suggests that other factors which impact systemic health such as stress, diet, obesity and level of physical activity are associated with periodontitis and that diet may influence the outcome of periodontal therapy. However, evidence supporting lifestyle modifications to address these potential risk factors, such as physical exercise, dietary counselling and weight loss is inconsistent and low certainty at best and the BSP implementation of European S3 – level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice (BSP-S3)⁶ guideline notes that further research is needed.

Patients should be encouraged to eat a healthy balanced diet which is high in vegetables, fruit, nuts, seeds and starchy foods and low in sugar, salt and saturated fats, to drink adequate water and to take regular exercise as advised within public health guidelines.^{50, 51}

The Delivering Better Oral Health (DBOH)⁷ toolkit notes that there is emerging low-certainty evidence that alcohol consumption is associated with periodontitis^{52, 53} and that possible mechanisms of action may be related to alcohol’s negative impact on bone density and saliva secretion. In terms of general health, there is also convincing evidence that a high level of alcohol consumption is a risk factor for cancers of the mouth, larynx, pharynx and oesophagus, as well as many other chronic diseases. Alcohol brief interventions are recommended in primary care settings for harmful and hazardous drinkers, as evidence suggests these are effective in reducing alcohol consumption.⁵⁴ Guidance published by NHS Health Scotland details how the issue of alcohol can be raised with patients in a dental setting.⁵⁵ 

Addressing lifestyle issues with a patient requires sensitivity and it may be useful to deliver advice in the context of how changes to their diet and/or alcohol consumption will help the patient care for their oral tissues and their general health.