osteonecrosis involves third molar sites, even decades aſt er wisdom tooth extraction, especially if the periodontal ligament was not completely removed. Collaboration between medical and dental professionals is crucial for diagnosing and managing this condition eff ectively.


• Vitamin D and CoQ10 Levels: Defi ciencies in these nutrients are common in patients with periodontal disease. Vitamin D plays a critical role in bone health, while CoQ10 is essential for gum health. Naming and addressing these defi ciencies through medical and dental collaboration can signifi cantly improve oral and systemic health.


Salivary Tests: The Window to Oral and Systemic Health Salivary diagnostics are an emerging fi eld that off ers a non-invasive way to assess both oral and systemic health. Saliva contains biomarkers that can reveal infections, infl ammation, and even genetic predispositions to clinical response. Here are key salivary tests that highlight the need for medical-dental collaboration: • Pathogen Testing: Salivary tests can identify specifi c bacteria associated with periodontal disease, such as Porphyromonas gingivalis and Treponema denticola. T ese pathogens are not only harmful to oral health but are also linked to systemic conditions like cardiovascular disease, diabetes, and Alzheimer’s disease. Pg not only makes gingipains (a virulent protease), it also secretes dihydroceramide—i.e. it makes its own plaque – devastating to brains and blood vessels. If a salivary test reveals elevated levels of these bacteria, it’s a clear signal for medical and dental professionals to work together to address the infection and its systemic implications.


• Infl ammatory Markers: Saliva can be assessed for infl ammatory markers like interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α). Elevated levels of these markers indicate active infl ammation, oſt en due to periodontal disease. Medical professionals should collaborate with dentists to treat the underlying cause and reduce systemic infl ammation.


Urine Tests: The Underestimated Ally While urine tests are oſt en associated with kidney function and metabolic health, they


can also provide valuable insights into oral- systemic connections. Here is how: • Markers of Oxidative Stress: Urine tests can measure oxidative stress markers like F2-isoprostane or 8-hydroxy-2’- deoxyguanosine (8-OHdG). Elevated levels indicate increased oxidative damage, which can be linked to chronic infections, including periodontal disease. Addressing the source of oxidative stress through dental care can help reduce these markers and improve overall health.


• Calcium and Phosphorus Levels: Imbalances in these minerals can indicate bone loss, which may be related to periodontal disease or other dental conditions. A urine test revealing abnormal calcium or phosphorus levels should prompt a dental evaluation to assess bone health and prevent further complications.


• Heavy Metal Testing: Urine tests can also detect heavy metals like mercury and lead, which can accumulate from dental amalgams or environmental exposure. Elevated levels of these metals can have systemic eff ects, including neurological and cardiovascular issues. Collaboration between medical and dental professionals is essential for safely addressing heavy metal toxicity.


The Case for Collaboration T e data is clear: persistent infl ammation is at the root of medical evil, and oſt en, the root cause is found in the gums and the roots of the teeth. Without a partnership between medical and dental professionals, we cannot achieve optimal health for our patients. Here’s why collaboration is so crucial: • Comprehensive Care: Many chronic conditions, such as cardiovascular disease, diabetes, and autoimmune disorders, have oral health components. By working together, medical and dental professionals can address the root causes of these conditions rather than just managing symptoms.


• Early Detection: Diagnostic tests oſt en reveal subclinical conditions—issues that are not yet causing symptoms but have the potential to progress into serious health problems. Early intervention through medical-dental collaboration can prevent these conditions from worsening. Oſt en the fi rst symptom of a DENTAL problem is found in MEDICAL lab data and establishing open and frequent lines of communication is critical for patient success. • Patient Education: Patients are more likely


to take their health seriously when they see their medical and dental providers working together. T is unifi ed approach reinforces the importance of oral health in overall wellness and encourages patients to take proactive steps to improve their health.


• Improved Outcomes: Studies have shown that treating periodontal disease can improve glycemic control in diabetic patients, reduce the risk of cardiovascular events, and even lower systemic infl ammation. T ese outcomes are only possible through collaboration between medical and dental professionals.


Conclusion Urine, blood, and salivary tests are not just diagnostic tools, they are bridges that connect the worlds of medicine and dentistry. By recognizing the oral-systemic connections revealed through these tests, we can provide more comprehensive, eff ective care for our patients. Collaboration is not just benefi cial, it is essential. Together, medical and dental professionals can transform patient outcomes, proving that the whole is indeed greater than the sum of its parts. We can bridge the gap and work together to create a healthier future for all.


Intro – Diagnostic Testing & Collaboration Sanz M, Marco Del Castillo A, Jepsen S, Gonzalez-Juanatey JR, D’Aiuto F, Bouchard P, et al. Scientifi c evidence on the links between periodontal diseases and systemic non-communicable diseases: A consensus report. J Clin Periodontol. 2020;47(S22):16–17. doi: 10.1111/jcpe.12808.


CRP and Periodontal Disease Paraskevas S, Huizinga JD, Loos BG. The eff ect of periodontal therapy on C-reactive protein: A systematic review and meta-analysis. J Clin Periodontol. 2008;35(4):277–290. doi:10.1111/j.1600- 051X.2007.01173.x


MPO and Endodontic Infections Gomes MS, Blattner TC, Sant’Ana Filho M, Grecca FS, Hugo FN, Fouad AF, et al. Myeloperoxidase in dental and medical conditions. Arch Oral Biol. 2013;58(6):560–566. doi:10.1016/j.archoralbio.2013.01.017


Lp-PLA2 and Periodontal/Vascular Infl ammation Hasturk H, Kantarci A, Van Dyke TE. Role of infl ammation in the pathogenesis of atherosclerosis: focus on periodontal disease. J Periodontol. 2012;83(4 Suppl):S15–S22. doi:10.1902/jop.2011.110462


Galectin-3 and Osteonecrosis/Heart Remodeling De Martinis M, Sirufo MM, Ginaldi L. Galectin-3: A new marker of cardiovascular disease. Int J Mol Sci. 2020;21(14):5145. doi:10.3390/ijms21145145


Zerrin Barut et al, The role of salivary galectin-3 and galectin-9 levels in plaque-induced gingivitis and periodontitis, Heliyon, Volume 9, Issue 9, 2023, doi.org/10.1016/j.heliyon.2023.e19979.


Vitamin D and CoQ10 in Periodontal Disease Varela-López A, Giampieri F, Bullón P, Battino M, Sánchez-González C, Quiles JL. Vitamin D, Coenzyme Q10, and omega-3 fatty acids in periodontal health. J Periodontal Res. 2016;51(6):743–752. doi:10.1111/jre.12357


Salivary Pathogen Testing (Pg, Td) and Systemic Links Dominy SS, Lynch C, Ermini F, Benedyk M, Marczyk A, Konradi A, et al. Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv. 2019;5(1):eaau3333. doi:10.1126/sciadv.aau3333


Salivary Infl ammatory Markers (IL-1, TNF-α) Torrungruang K, Jitpakdeebordin S, Charatkulangkun O, Gleebbua Y. Salivary IL-1β, IL-6 and TNF-α as biomarkers for periodontal disease severity. J Clin Periodontol. 2009;36(5):387–393. doi:10.1111/j.1600-051X.2009.01378.x


Urinary Oxidative Stress Markers Tomofuji T, Ekuni D, Yamanaka R, Sanbe T, Irie K, Azuma T, et al. Periodontitis and increase in circulating oxidative stress. J Clin Periodontol. 2005;32(10):1041–1045. doi:10.1111/j.1600-051X.2005.00758.x


Urinary Calcium and Phosphorus – Bone Loss Schroeder HE. Oral Structure Biology: Including Nervous Elements. Stuttgart: Thieme Medical Publishers; 1993.


Heavy Metals and Dental Amalgams Geier DA, Kern JK, Geier MR. A prospective study of mercury toxicity biomarkers in autistic spectrum disorders. J Toxicol Environ Health A. 2010;73(19):1294–1300. doi:10.1080/15287394.2010.481273


Medical-Dental Collaboration Improves Outcomes Simpson TC, Weldon JC, Worthington HV, Needleman I, Wild SH, Moles DR, et al. Treatment of periodontal disease for glycaemic control in people with diabetes mellitus. Cochrane Database Syst Rev. 2015;(11):CD004714. doi:10.1002/14651858.CD004714.pub3


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