Misinformation About Oral/Systemic Links

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I’m an unusual registered dental hygienist in more ways than one. Many years ago, I studied under the late Michele L. Darby, an eminent professor who changed my thinking about science and research. After a couple of years of mentorship by Professor Darby in a BS and MS program at Old Dominion University, I became a critical thinker and ended up teaching research methodology at Fairleigh Dickinson University’s School of Dentistry. I don’t claim to be a scientist or a researcher, but I learned early on from Professor Darby how to be objective in the analysis and evaluation of issues in my chosen profession.

Years ago, the American Dental Association recruited dental professionals to become evidence-based dentistry advocates (or EBD Champions) through an annual conference. I attended 3 of these conferences in downtown Chicago as a journalist and learned skills that have enabled me to share what I learned with colleagues and students. Unfortunately, this conference has not been held since 2016, despite a tremendous need to continue this endeavor.

Dental providers (dentists and dental hygienists) are not routinely taught critical thinking skills as a necessary component of dental and dental hygiene education. Medical health care providers, on the other hand, have learned to recognize the importance of teaching these skills to students, and they are able to incorporate evidence into everyday practice.

Evidence-based medicine refers to the incorporation of evidence from research, clinical expertise, client preferences, and other resources to help make complex decisions about clients.

Misinformation vs Disinformation: What’s the Difference?

At the beginning of the COVID-19 pandemic, we were scared and struggling to find information on an unknown virus. And as we now know, there was a lot of false and misleading information about the illness, including treatment. For example, hydroxychloroquine sulfate was approved by the United States Food and Drug Administration to treat malaria, lupus, and rheumatoid arthritis, but it was never approved to treat COVID-19. Clinical trials with medications to fight COVID-19 are required to determine whether it can be used to fight the disease.

Misinformation about hydroxychloroquine sulfate was widespread, especially on social media. Misinformation is wrong or false information, and it is a term that does not care about intent.¹ Another example of COVID-19 misinformation is vaccinations. There are many organizations dedicated to antivaccine activities.^2,3 Thanks to technology, misinformation travels very fast and, if deliberately weaponized, can become disinformation.¹

Disinformation is defined as knowingly spreading misinformation or even accurate information that has been spun in a way with deliberate intentions to deceive.^1,4,5 The information may not be factually wrong, but it is information that is twisted in a way that has a deliberate harmful effect on a target.

Disinformation is a common tool of espionage and was used in the Cold War between rival nations (the United States and the former Soviet Union). Propaganda is another example of disinformation, and it is sometimes used to make someone look good or bad, depending on intent.¹ Fake news (misinformation) about COVID-19 vaccinations, for example, have led to disinformation and harm to health. Disinformation is mostly reserved for false or misleading information that is being spread on purpose to hurt or damage someone like a government, organization, or public figure.¹

Oral/Systemic Links and Misinformation

I used to own a Yahoo Group called the Periotherapist, which was founded in 2003. There were several hundred members at the time, and we were all new at social media chatting. Oral/systemic links were a new topic that kept popping up, and I would argue that a link (association) isn’t the same as cause/effect. For example, numerous studies have shown that coffee drinking is associated with a low risk of dying from all causes of death, including cancer. Over time, in studying data from a compilation of studies, coffee drinking wasn’t found to be a cause of any cancers and could even reduce the risk of some types of cancers. Evidence, however, was inadequate due to inconsistent results across studies and issues with data quality.

The association between oral and general health has been in the headlines for decades, and in the late 1980s, Finnish researchers proposed that chronic dental infections played a role in myocardial infarction.⁶ Various hypotheses were tested in subsequent decades, studying the relationship between oral and systemic diseases like cardiovascular disease, adverse pregnancy outcomes, diabetes mellitus, respiratory disease, kidney disease, Alzheimer disease, and other medical conditions.⁶

It’s easy to frame the story about oral/systemic links in a biased manner. Sources matter and we’re all a bit biased, even if we don’t know it. You won’t hear a lecturer in a continuing education course say, “I’m a little bit biased so you’d better watch out!” Rather, the speaker will come across as knowledgeable about his/her subject, so many people in the audience will just accept the information as gospel.

Many of the oral/systemic links appear to be exaggerated when it comes to scientific evidence or lack evidence to establish cause/effect. This information may come as a complete surprise to you, and I don’t mind in the least if you challenge my sources or my opinion. I, too, am biased, but my educational background taught me to be as objective as humanly possible when it comes to scientific research.

For example, many oral health care providers refer to the perio/cardio link as cause/effect. Even though the relationship between periodontal disease and some distant site disorders like atherosclerotic vascular disease (ASVD), the quality of the data isn’t consistent across studies, and there is no scientific confirmation that therapeutic periodontal treatment interventions prevent heart disease or stroke or modify the course of ASVD.^7,8 Harvard Health Publishing, a consumer health education division of Harvard Medical School, explained the association (link) between periodontitis and heart disease based on evidence to date, noting that there may not be a direct connection between periodontal and cardiovascular disease.⁹

Many people with heart disease have healthy gums, and not everyone with periodontal disease develops cardiovascular disease.9 At this point, we can only say that we have “suspicions” that periodontal disease may be an independent risk factor for cardiovascular disease. Even though there’s no causal evidence that treating periodontal disease will prevent cardiovascular disease or its complications, the connection is powerful enough to warrant being vigilant about periodontal disease prevention and treatment.⁹

Misinformation about the various oral/systemic links is common, probably because we “wish” them to be true. We recognize periodontal disease's infectious and inflammatory nature, and we recognize the association between periodontal disease and systemic inflammatory conditions. Misinformation comes into play when we purposely overstate results or create “fake news,” as has been done with COVID-19 on social media.

Finding Objective Information on Oral/Systemic Links

Objective information cannot always be found by reading professional organization websites. Professional associations often promote research that is slanted to give an advantage to an association’s mission. It can include cherry-picking data to promote one side or ignoring another perspective.

Where does a dental professional search to find accurate information that doesn't fall into the category of mis/disinformation? Scientific inquiry relies on objectivity so how can you find objective information? My personal go-to for objective information on oral health topics is the Cochrane Oral Health Group. They are coordinated and supported by an editorial team in the UK at the University of Manchester who look at the quality of the evidence and provide summaries of what’s known/unknown about oral interventions to date. Go here to visit Cochrane: https://oralhealth.cochrane.org/about-us

In the search bar, enter the topic you’d like to review.

Objective information is hard to come by these days. Don’t believe everything you hear or read and be careful what or whom you use as a trusted source of information.

References

1. “Misinformation” vs. “disinformation”: get informed on the difference. Dictionary.com. Accessed June 29, 2021. https://www.dictionary.com/e/misinformation-vs-disinformation-get-informed-on-the-difference/
2. Steffens MS, Dunn AG, Wiley KE, Leask J. How organisations promoting vaccination respond to misinformation on social media: a qualitative investigation. BMC Public Health 2019;19(1):1348. doi:10.1186/s12889-019-7659-3
3. Hoetz P, Batista C, Ergonul O, et al. Correcting COVID-19 vaccine misinformation: Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force Members. EClinicalMedicine. 2021;33:100780. doi:10.1016/j.eclinm.2021.100780
4. Rogers LS; JH Bloomberg School of Public Health. Meeting COVID-19 misinformation and disinformation head-on. Johns Hopkins Bloomberg School of Public Health. Published March 24, 2021. Accessed June 29, 2021. https://www.jhsph.edu/covid-19/articles/meeting-covid-19-misinformation-and-disinformation-head-on.html
5. Volkin S. Recognizing disinformation during the COVID-19 pandemic. Hub. May 8, 2020. Accessed June 30, 2021. https://hub.jhu.edu/2020/05/08/thomas-rid-disinformation-in-covid-19-pandemic/
6. Pickett, FA. Discussion of strength of science related to oral-systemic links. Can J Dent Hygiene. 2012;46(2):89-90. Accessed June 30, 2021. https://www.cdha.ca/pdfs/Profession/Journal/v46n2.pdf
7. Lockhart PB, Bolger AF, Papapanou PN, et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, Council on Clinical Cardiology. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation. 2012;125(20):2520-2544. doi:10.1161/CIR.0b013e31825719f3
8. Top things to know. American Heart Association Professional Heart Daily. April 18, 2012. Accessed June 30, 2021. https://professional.heart.org/en/science-news/periodontal-disease-and-atherosclerotic-vascular-disease/top-things-to-know
9. Gum disease and heart disease: the common thread. Harvard Health Publishing. February 15, 2021. Accessed June 30, 2021. https://www.health.harvard.edu/heart-health/gum-disease-and-heart-disease-the-common-thread