Awareness of physicians and dentists in Serbia about the association between periodontitis and systemic diseases: a cross-sectional study

Stojilković et al. BMC Oral Health (2023) 23:449 https://doi.org/10.1186/s12903-023-03143-3 BMC Oral Health Open Access RESEARCH Awareness of physicians and dentists in Serbia about the association between periodontitis and systemic diseases: a cross-sectional study Marija Stojilković1*, Ivana Gušić1,2, Dušan Prodanović3, Miloš Ilić4, Nevena Pecikozić1, Tanja Veljović1, Jelena Mirnić1 and Milanko Đurić1,2 Abstract Background Strong evidence supports the association between periodontitis and certain systemic diseases. The aim of the present study was to evaluate the knowledge of a group of physicians and dentists in Serbia regarding this topic and assess their professional actions to prevent and control both periodontal and systemic diseases. Methods An anonymous self-administered structured questionnaire was sent to the available e-mail addresses of randomly selected healthcare providers working in Serbia. According to the inclusion criteria, general practitioners, specialists, general dentists, and specialists working in government hospitals and private practices in various cities in Serbia were recruited in the study. The questionnaire consisted of 17 questions divided into three parts. The first part recorded the sociodemographic characteristics of participants, the second part included questions about the clinical manifestation and etiology of periodontitis, as well as knowledge of the association between periodontitis and systemic diseases, and the third part included questions about professional procedures for the prevention and control of periodontitis and systemic diseases. Results A total of 1301 health participants, 739 (57.8%) physicians and 562 (43.2%) dentists, were included in this cross-sectional study. Most respondents (94.7%) were aware of the association between periodontitis and general health. The highest percentage of respondents associated diabetes mellitus and periodontitis. Factors significantly associated with higher knowledge were female sex (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.37–2.52; p < 0.001) and dental profession (OR, 5.86; 95% CI], 4.03–8.53; p < 0.001). Participants who had higher knowledge score were more likely to ask their patients about gum/systematic health (p < 0.001) and refer them to dentists/physicians (p < 0.001). Conclusions It was concluded that compared to the group of dentists, the group of physicians had less knowledge of the relationship between periodontitis and systemic diseases. The female gender was significantly associated with better knowledge. A better understanding of this topic is associated with better clinical practice. Keywords Awareness, Knowledge, Periodontitis, Non-communicable diseases, Periodontal medicine, Physicians, Dentists, Professional practice *Correspondence: Marija Stojilković Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Stojilković et al. BMC Oral Health (2023) 23:449 Background Periodontitis (PD) is a chronic inflammatory disease of the tooth–supporting tissues [1]. The current etiology concept implies that a complex matrix of dental biofilm microorganisms is the primary cause of this disease [2]. The result of complex interactions between dental biofilm microorganisms and the host immune response is the destruction of the periodontal supportive tissues, the most common cause of tooth loss worldwide [3]. Periodontitis is the 6th most prevalent disease in the world, according to the Global Burden of Disease Study and according to the World Health Organization (WHO) Global Oral Health Report (2022), a severe form of the periodontal disease affects around 19% of the global population aged greater than 15 years [4, 5]. Patients often ignore the early stages of periodontitis, manifested as gingival bleeding upon provocation, and many of them seek help from a dentist when advanced disease signs appear. The reason for this is this disease’s relatively “silent” nature and low periodontal health awareness [6]. As periodontitis is the leading cause of tooth loss in the adult population worldwide, these patients are at risk of masticatory dysfunction, which undoubtedly affects their quality of life and self-esteem [7]. In 1891, Walter D. Miller [8] pointed out that oral health can affect systemic health and that microorganisms from the oral cavity can reach distant organs and affect them. The term “Periodontal medicine” was suggested by Offenbacher [9] in 1996, who explained the association between periodontitis and systemic health more accurately. The question arises is whether periodontitis and some systemic diseases coincidentally appear simultaneously, considering that they have many common risk factors, or whether there is a cause-andeffect relationship where these diseases can initiate/ affect each other [10, 11]. Current evidence shows that periodontitis can be a risk factor for various systemic diseases, such as ischemic heart disease, type 2 diabetes mellitus, premature birth, rheumatoid arthritis, Alzheimer’s disease, and chronic kidney disease [12–18]. The association between periodontal and systemic diseases can be explained by two mechanisms – direct and indirect. The direct pathway represents a metastatic infection caused by hematogenous bacterial dissemination from periodontal tissues [19]. Since there is a loss of pocket epithelium integrity due to periodontitis, even routine daily activities such as tooth brushing, flossing, or chewing can cause bacteria and their endotoxins to transition into the bloodstream [20]. The indirect pathway represents prolonged low-grade systemic inflammation that may influence the development of comorbidities [21]. Periodontal pathogens have the potential to stimulate the production of interleukin-1 (IL-1), interleukin-6 Page 2 of 11 (IL-6), tumor necrosis factor-alpha (TNF-α), and prostaglandin E2 (PGF2) and increase the levels of C-rea (...truncated)