Periodontal Medicine and Systemic Interactions
Periodontal Medicine and Systemic Interactions
The exam tests bidirectional relationships and the medication/medical-history decisions that change periodontal care.
Core rules
- Diabetes: hyperglycemia amplifies inflammation and bone loss; periodontitis worsens glycemic control. Meta-analyses show periodontal therapy lowers HbA1c by roughly 0.4% - clinically meaningful but no substitute for medical management.
- Cardiovascular disease, adverse pregnancy outcomes, rheumatoid arthritis, obesity, osteoporosis and aspiration pneumonia are linked; the strongest evidence concerns diabetes and CVD risk markers such as CRP.
- Drug-influenced gingival overgrowth: phenytoin, nifedipine and other calcium channel blockers, cyclosporine; manage with plaque control plus drug substitution, then surgery.
- Anticoagulants: do not stop warfarin for routine scaling when the INR is therapeutic; check the last INR and rely on local measures.
- Antibiotic prophylaxis: required for high-risk cardiac conditions (prosthetic valve, previous infective endocarditis, certain congenital heart disease, prosthetic material within 6 months); not routine for joint prostheses.
- MRONJ: antiresorptives and antiangiogenics; avoid elective surgery in high-risk patients, obtain consent, and consider a drug holiday only with the physician.
Worked example
A patient on warfarin with INR 3.1 needs quadrant scaling. Do not discontinue the drug; verify the INR within 24–48 hours, use local anesthesia carefully, and control bleeding with pressure and sutures if needed. Prophylaxis is unnecessary unless a cardiac indication exists.
Traps
Stopping anticoagulants reflexively; prescribing prophylaxis for all joint replacements; treating pregnancy as a contraindication to scaling (second trimester is ideal); attributing overgrowth to plaque alone.