The incorporation of periodontics at hospital cardiac rehabilitation units is a necessity in Spain. 

Early diagnosis of gum disease, management of infections caused by oral pathogens, and fostering periodontal health are, among other tasks, what periodontists can do in this area, and their work is especially useful in cardiac rehabilitation, transplant or intensive care units.

 The aim is to foster the incorporation of oral health promotion and management initiatives within certain hospital units, with the benefits that this will have for oral and general health for different patient groups. 

“In the hospital environment, the periodontist can play an essential role,” say Drs. Blas Noguerol and Elena Figuero, coordinator and member, respectively, of the SEPA-SEC Working Group on Periodontal Health and Cardiovascular Health of the Spanish Society of Periodontology and Osseointegration (SEPA) and the Spanish Society of Cardiology (SEC), which is supported by DENTAID and its VITIS^® gingival and Perio·Aid^® brands. 

Fundamentally, Dr. Blas Noguerol explains, “including the periodontist and periodontal advice within certain hospital units will allow for the diagnosis of periodontal diseases in undiagnosed patients who are at risk because of their periodontal condition.” In addition, he adds that “this will facilitate the integration of this speciality in the working teams and the inclusion of oral health habits in the general fostering of a healthy lifestyle.” 

CARDIOLOGY, ICU AND TRANSPLANTS 

In the case of cardiovascular units, the incorporation of the periodontist is especially necessary and urgent. Since periodontitis is currently considered a cardiovascular risk factor, the function of a periodontist would be to diagnose and treat periodontal disease in patients at risk of or already affected by heart attack; in addition, [the periodontist] would deal with the integration of oral health habits with cardio-health advice at cardiac prevention and rehabilitation units. 

The role of the periodontist with patients admitted to intensive care units (ICUs) is also considered essential. These patients, who are often unconscious, are at high risk of contracting pneumonia because they breathe in periodontal bacteria through their mouths, and this may cause serious respiratory infections. In this case, as Dr. Noguerol points out, “from the point of view of periodontics we must carry out treatments that, although difficult to apply in these patients, may mean the difference between life and death.” 

At transplant units it is now also crucial to establish and extend measures for periodontal health. In these units there are patients who receive drugs that trigger and/or accentuate periodontal alterations; among them are immunosuppressants which prevent rejection of transplanted organs. In these cases, as Dr. Noguerol advises, “periodontal care should be comprehensive and the cooperation of the periodontist is very important, although most periodontal health interventions n this patient group may be done on an outpatient level.” 

MUCH TO BE DONE 

Despite these benefits, the implementation of specific periodontist-guided programs with periodontal care and advice is still scarce in Spain. “Patients who have suffered a heart attack or who have undergone an organ transplant are often not given any indication in this regard,” warns Dr. Noguerol. 

There is, however, an evident change in trend, especially through collaborative initiatives such as that established between SEPA and SEC. “The experience of our working group with cardiologists could not be more positive. They have internalised this culture and in the coming months we will begin to see results,” says Dr. Noguerol. 

In this sense, adds the SEPA expert “I think that cardiologists are one step ahead of other medical specialists and I hope they will help us foster this attitude throughout the rest of the hospital sector.” Specifically, SEPA is initiating the creation of a cooperative network with many of the cardiac rehabilitation units in Spain, emphasising the message of early diagnosis and advice on oral health. 

Furthermore, as SEPA-SEC working group member Dr. Elena Figuero reports, “our research team at the university is conducting a study to assess whether periodontal treatment in patients with periodontitis and a history of acute myocardial infarction improves cardiovascular function.” Undoubtedly, in the opinion of this expert, “the results of this study will allow us to work with relevant scientific data to give an even greater impetus to include oral health habits among the cardio-health advice provided by cardiac rehabilitation units." 

SOLID EVIDENCE IN CARDIOLOGY 

And there is growing, solid evidence backing the link between periodontal and cardiovascular health. Reduction of periodontal inflammation has been shown to improve the state of systemic inflammation, which is closely related to the development of ischaemic cardiovascular events. It has likewise been observed that the reduction of the bacterial load after periodontal treatment reduces the chances of cardiovascular colonisation by periodontal pathogens. 

Dr. Blas Noguerol insists that due to the above, “all patients in cardiac rehabilitation units should be the object of a specific periodontal care and control protocol, an objective set in the MimoCardio-Take Care of your Gums initiative.” 

Meanwhile, says Dr. Elena Figuero “SEPA is also committed to training Spanish dentists in specific competences related to the management of these patients.” This will be a parallel program to that of hospital cardiology units and, with the Spanish Society of Primary Care Physicians (SEMERGEN), it will also include family doctors.