Blood Testing
Periodontal disease has been shown to be intimately related to certain key indicators of heart disease, diabetes and other systemic conditions. When periodontal disease has been diagnosed, it is our policy to test for certain blood markers to determine if our patients’ systemic health has been affected by their periodontal disease and/or vice versa. These tests can either be performed in a physician’s office, at a medical lab, or with an FDA-approved finger nick test in our office. The tests we are most concerned about at this time include:
High Sensitivity C-Reactive Protein (hs-CRP)
C-reactive protein is a protein produced in the liver as a response to inflammation anywhere in the body. Elevated levels of CRP may predict risk of heart attack up to eight years in advance and can increase the risk of a heart attack by seven fold. Elevated hs-CRP levels are now considered the single most important indicator of future heart attack and stroke. While most people over the age of 40 have annual cholesterol testing, CRP testing is new. Since 50% of those who have heart attacks or stroke have normal cholesterol levels, adding CRP testing can increase the detection of a significant number of patients who are at risk for heart attack or stroke. Elevated CRP levels can also help diagnose a host of other diseases in the body, such as cancer.
A value of 1 is considered low risk. A value of 2 is above average risk and a value over three is considered high risk for future heart attack and/or stroke.
The rationale for testing is to allow us to see if periodontal disease has contributed to an increased risk of future heart attack and/or stroke. If a patient has elevated levels of hs-CRP, treating periodontal disease and removing the inflammation it causes can lower CRP level and may significantly reduce the patient’s risk of future coronary events. The test results may also help physicians determine if there is a systemic disease contributing to the periodontal disease.
Glycated Hemoglobin – (Hb-A1c)
On those occasions when blood glucose is high, the hemoglobin in the blood may be marked or “glycated”. The percentage of the hemoglobin that is glycated is an indication of the patient’s level of glucose (or blood sugar) control over the last two months. A value of less than 5.9% is normal, a value over 7% is typically considered diabetic, and 6%-7% is typically considered pre diabetic. Since periodontal bacteria in the bloodstream can increase blood sugar and A1c, treating the periodontal disease can reduce Hb-A1c and diabetes risk. It is important to note that periodontal disease can seriously impact one’s ability to control his or her blood sugar. Research also shows that it is possible for elevated blood sugar to cause a pre-diabetic to become diabetic. The Hb-A1c test is only a screening test and more testing to include a fasting blood glucose test is necessary to confirm the presence of diabetes. It is up to the physician to make the determination of the presence or absence of diabetes.
Cholesterol
Cholesterol levels have been shown to increase with periodontal disease. It is beneficial to record a baseline cholesterol level before treatment for periodontal disease begins, and again once treatment is complete.
Vitamin D3
Vitamin D deficiency contributes to periodontal disease. It is estimated that approximately 75% of the U.S. population is deficient in Vitamin D. Screening for Vitamin D deficiency in patients with periodontal disease is part of our protocol. The majority of patients we have tested for Vitamin D deficiency have been found to be deficient, some dramatically. Vitamin D deficiency is also implicated in other serious diseases, to include mental impairment, depression, osteoporosis, cancer and cardiovascular conditions. If deficient, collaboration with the patient’s physician is recommended so that deficiencies can be treated.
