The majority of our patients suffer from different degrees of cardiovascular disease concurrently with periodontitis and its sequelae linked to tooth loss and the resulting masticatory dysfunction. Management of periodontitis is more complex in these patients: The medical risk profile, the medications, and the management of the common risk factors are challenging and require specialist attention. Optimal management cannot ignore the emerging evidence that periodontitis may be a modifiable risk factor (and surely is a risk marker) of atherosclerosis and cardiovascular events such as stroke or myocardial infarction. This, along with the need to preserve a healthy dentition, masticatory function, and oral esthetics and well-being, provides the rationale for optimal control of periodontitis in these populations even in older patients. On the other hand, periodontal therapy might increase the short-term risk for increased endothelial dysfunction and atherosclerotic plate instability immediately after a treatment episode, questioning the risk-benefit profile of treatment. Knowledge in this area is imperfect and slowly emerging. This presentation will discuss current understanding and present possible avenues for optimal patient management.
Maurizio S. Tonetti, DMD, PhD, MMSC, FRCPS, FRCS(ENG), is the executive director of the European Research Group on Periodontology (ERGOPerio) and editor-in-chief of the Journal of Clinical Periodontology. He has held the positions of professor and head of the Department of Periodontology at the University of Connecticut’s School of Dental Medicine and at the University College London. He has also been an adjunct professor at the University of Bern in Switzerland and at the University of North Carolina at Chapel Hill. Dr Tonetti maintains a part-time private practice limited to periodontology and implant surgery with an emphasis on regeneration, minimally invasive surgery, and microsurgery. His research interests include regeneration and bioengineering of lost periodontal structures and the incorporation of dental implants in the management of periodontal patients. He is considered one of the most influential periodontists worldwide, and he has been engaged in the planning and delivery of worldwide advanced educational programs in the fields of periodontology and implant dentistry.
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