Gum Disease Tied to Glaucoma - Implications for Sedation Dentists

Every day more evidence emerges that poor oral health has implications beyond the oral cavity itself, and most recently a landmark study out of Harvard Medical School links a type of glaucoma to poor oral health. The term "glaucoma" describes a group of disorders which damage the optic nerve, causing vision loss. Often a slow and largely asymptomatic disorder, glaucoma has been called the "silent thief of sight" as those affected usually do not notice how much vision they have lost until the disease has become significantly advanced. Glaucoma is a disorder of concern for sedation dentists, as certain presentations of the disease contraindicate benzodiazepine use.

Scientists at the Massachusetts Eye and Ear Infirmary at Harvard Medical School studied 39,909 men 40 years and older who did not have glaucoma at the outset of the study. The researchers collected information about their eye and oral health every two years, including the number of teeth they had lost and any history of periodontitis with bone loss. Over the 26 years of the study, 483 cases of primary open-angle glaucoma were confirmed and recorded.

Upon analyzing the data, the researchers found that the risk for primary open-angle glaucoma was 43 percent higher in men who reported the loss of one or more teeth than men who reported no lost teeth. Add periodontal disease into the mix, however, and the risk for glaucoma became a staggering 86 percent higher than in men with healthy mouths.

So clearly there's a dramatic correlation between tooth loss, periodontitis and open-angle glaucoma, but of course that does not prove a causative effect. So, if a causative effect does exist, how might tooth loss affect vision? Well, the gum tissue and bone at the base of each tooth is subject to inflammation in the presence of bacteria. In particular, upregulation of inflammatory factors such as interleukin-6 and Tumor Necrosis Factor (TNF-α) can cause persistent, damaging inflammation even where a bacterial infection may no longer be present.

These inflammatory factors can permeate the surrounding tissues up to and including the optic nerve, which passes fairly close to the maxilla on its way to the brain. Inflammation, while helpful in combating bacterial infections, is actually damaging to the tissue, especially when it occurs over a long period of time. Optic nerve damage is the causative factor in glaucoma, which affects an estimated three million Americans, but is only successfully diagnosed in half of that population.

So what does this mean for sedation dentists? Patients who need moderate-to-extensive restorative care can lower their risk of glaucoma by receiving treatment, and are often best cared for under sedation. Patients who already have glaucoma, and need sedation to receive treatment come with additional complication. Benzodiazepine sedatives (such as triazolam) increase the intraocular pressure, making them contraindicated in acute, closed-angle glaucoma. However, patients with open-angle glaucoma can safely receive treatment under DOCS protocols.

Maintaining a healthy mouth continues to have a beneficial effect on the rest of the body, lowering the risk of conditions from heart disease to glaucoma, and sedation dentists promote these benefits by helping patients finally get the care they need.

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The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.