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The Critical Role of Dental Hygiene in Oral–Systemic Health: Evidence, Practice Priorities, and Leveraging National Dental Hygiene Month for Interprofessional Impact

Articles Periodontal and Biofilm Diseases of the Mouth Success for the Oral Systemic Practice Practice Profitability

Introduction

The past two decades have seen an expanding body of literature documenting associations between oral diseases — particularly periodontitis — and systemic conditions such as type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), adverse pregnancy outcomes, and respiratory infections. The mechanistic pathways include chronic inflammation, translocation of oral microbes or microbial products into the circulation, and immune modulation triggered by oral dysbiosis (Rajasekaran et al., 2024; Pisano et al., 2023). At the same time, preventive and therapeutic oral care delivered by dental hygienists can measurably reduce oral inflammatory burden and improve patient knowledge and behaviors. For clinicians trained in oral–systemic healthcare, translating this evidence into routine, collaborative preventive practice is essential. October's National Dental Hygiene Month (NDHM) is an annual, high-visibility opportunity to align clinical practice change, community outreach, and interprofessional collaboration around these goals (American Dental Hygienists' Association [ADHA], 2024).

Evidence linking oral disease to systemic health

Periodontitis and systemic disease: consensus and epidemiology

Consensus statements and classification updates have reframed periodontitis as a chronic, inflammatory non-communicable disease with systemic implications (Papapanou et al., 2018). Large observational studies and systematic reviews report associations between periodontitis and increased risk of cardiovascular disease events, though causality remains incompletely established and effect sizes vary by study design and confounding control (Herrera et al., 2024; Leng et al., 2023). Importantly, periodontal inflammation corresponds to systemic markers (e.g., C-reactive protein) and may act as a persistent inflammatory stimulus that interacts with atherosclerotic disease pathways (Stewart et al., 2016; Leng et al., 2015).

Diabetes mellitus and glycemic control

Periodontitis and diabetes exhibit a bidirectional relationship: poorly controlled diabetes increases susceptibility to periodontitis, and periodontal inflammation may worsen glycemic control. Meta-analyses of randomized and observational studies suggest that non-surgical periodontal therapy can produce a modest but clinically relevant reduction in HbA1c (approximately 0.3–0.6% in some meta-analyses) at 3 months, although heterogeneity between trials exists and longer-term effects are less certain (Teeuw et al., 2010; Teshome et al., 2017). These findings support periodontal care as an adjunctive component in comprehensive diabetes management.

Other systemic conditions and the oral microbiome

Emerging data link oral dysbiosis with respiratory infections, adverse pregnancy outcomes, chronic kidney disease, and neurologic conditions through mechanisms involving aspiration of oral pathogens, systemic dissemination of microbial products, and immune activation (Pisano et al., 2023; Rajasekaran et al., 2024). While causal pathways vary and evidence quality differs by condition, the consistency of oral–systemic associations across disciplines argues for an integrated prevention strategy.

(Load-bearing statements above supported by multiple reviews and consensus reports — see Papapanou et al., 2018; Teeuw et al., 2010; Pisano et al., 2023; Herrera et al., 2024; Leng et al., 2023.)

Effectiveness of dental hygiene and periodontal interventions on systemic outcomes

Multiple systematic reviews and meta-analyses indicate that periodontal therapy reduces local inflammation and can improve intermediate systemic outcomes (e.g., glycemic control, systemic inflammatory markers) (Teeuw et al., 2010; Teshome et al., 2017). Evidence for reduction in hard cardiovascular endpoints is less definitive; observational data show associations between periodontitis and CVD, and some trials suggest improvements in surrogate markers after periodontal therapy, but large-scale randomized trials with cardiovascular endpoints remain limited (Herrera et al., 2024; Leng et al., 2015). Nonetheless, the weight of evidence supports that reducing oral inflammation is biologically plausible and clinically prudent as part of overall chronic disease risk reduction.

The Dental Hygienist: A linchpin in oral–systemic preventive care

Scope of practice and competencies

Dental hygienists are trained in risk assessment, instrumentation, patient education, behavioral modification strategies, and application of preventive agents. Historical and contemporary literature frames the dental hygienist as an essential prevention professional capable of leading community oral health efforts and functioning collaboratively within interprofessional teams (Ohrn, 2004; AAOSH, 2024). In oral–systemic models, hygienists frequently perform screening (e.g., periodontal charting, risk stratification), apply evidence-based preventive therapies (scaling, polishing, local antimicrobials when indicated), and provide counseling on tobacco cessation, diet, and home care — all of which influence systemic disease risk.

Clinical innovations and integration opportunities

Examples of high-impact hygiene-led interventions include chairside diabetes screening referrals, coordinated care pathways with primary care for patients with poorly controlled glycemia, enhanced documentation of systemic risk factors in dental records, and implementation of quality metrics tied to systemic health outcomes (Prasad et al., 2019; Nayak et al., 2025). These models harness hygienists’ accessibility and preventive focus to bridge gaps between dental and medical care.

National Dental Hygiene Month: a strategic platform

NDHM (October) is promoted by the ADHA and partner organizations and provides an annual window for intensified community outreach, professional education, policy advocacy, and interprofessional programming (ADHA, 2024). For oral–systemic healthcare initiatives, NDHM can be used to:

  1. Launch targeted screening campaigns (e.g., periodontal risk plus HbA1c referrals) tied to measurable referral outcomes.
  2. Educate primary care teams about oral–systemic links using co-branded materials and short in-service sessions.
  3. Publicize preventive programs (e.g., low-cost hygiene days, school-based initiatives) to reach underserved populations.
  4. Advocate for reimbursement and workforce models that enable hygienists to practice at the top of their license in community and medical settings (ADHA policy efforts; Prasad et al., 2019).

By concentrating messaging and measuring impact during NDHM, organizations can amplify reach and create data to support sustained programs.

Practical recommendations for oral–systemic hygiene practice

  1. Systematic risk assessment: Standardize periodontal risk screening tools and integrate brief systemic risk queries (diabetes, smoking, cardiovascular history) into hygiene visits; document and track results for quality improvement. (Papapanou et al., 2018; Prasad et al., 2019).

  2. Care pathways for high-risk patients: Develop referral algorithms linking hygiene-identified high-risk patients to primary care or specialty care (e.g., diabetes clinics), and implement bidirectional communication templates. (Teeuw et al., 2010).

  3. Targeted therapeutic protocols: Use evidence-based non-surgical periodontal therapy, adjunctive localized antimicrobials when indicated, and structured maintenance intervals adapted to disease grade/stage. Align protocols with updated classification and grading systems. (Papapanou et al., 2018).

  4. Behavioral and social determinants approach: Integrate motivational interviewing, tobacco cessation support, and social needs screening; partner with community resources to address barriers to home care and access. (Ohrn, 2004).

  5. Interprofessional education and communication: Provide short, evidence-focused lunch-and-learns for primary care teams during NDHM; create simple referral and feedback loops to demonstrate value. (Prasad et al., 2019; ADHA, 2024).

  6. Measure outcomes: Track both dental outcomes (plaque scores, periodontal indices) and relevant systemic metrics (referral completion rates, HbA1c where available, patient-reported outcomes) to build an evidence base for program impact.

    Implementation challenges and future research priorities

    Barriers include siloed health records, variable reimbursement for preventive services, workforce scope limitations in some jurisdictions, and the need for large-scale randomized trials linking periodontal interventions to major systemic endpoints. Future research should prioritize pragmatic trials of hygiene-led screening and referral models, cost-effectiveness analyses, and longitudinal studies that combine microbiome, immunologic, and clinical endpoints to clarify causality and mechanisms (Rajasekaran et al., 2024; Nayak et al., 2025).

    Conclusion

    For clinicians and organizations committed to oral–systemic health, dental hygienists are indispensable partners whose preventive skills and patient access position them to reduce oral disease burden and contribute meaningfully to systemic health. National Dental Hygiene Month is an underutilized yet powerful annual opportunity to pilot and promote programs that integrate oral health into broader healthcare delivery. By leveraging evidence-based hygiene practices, establishing care pathways, and measuring outcomes, oral–systemic healthcare teams can transition from associative science to demonstrable improvements in population health.

    References

    American Dental Hygienists' Association. (2024). National Dental Hygiene Month 2024. https://www.adha.org/ndhm2024/ ADHA 
    American Dental Hygienists' Association. (2025). Events & Foundation: National Dental Hygiene Month — October. ADHA Events. https://www.adha.org/foundation/events/ ADHA
    American Academy for Oral and Systemic Health (AAOSH). (2024). The role of the dental hygienist in a comprehensive healthcare dental office and their impact on preventative oral-systemic health-care. AAOSH Connect. https://www.aaosh.org/connect/the-role-of-the-dental-hygienist-in-a-comprehensive-healthcare-dental-office-and-their-impact-on-preventative-oral-systemic-health-care
    Herrera, D., Sanz, M., Shapira, L., et al. (2024). Periodontal diseases and cardiovascular events: mechanisms and evidence. Journal of Clinical Periodontology. (Review). https://pmc.ncbi.nlm.nih.gov/articles/PMC10962307/ PMC
    Leng, W., Xu, L., & Yan, W. (2023). Periodontal disease is associated with the risk of cardiovascular disease: a systematic review and meta-analysis. Frontiers in Cardiovascular Medicine / Journal of Periodontology (systematic review). https://pmc.ncbi.nlm.nih.gov/articles/PMC10010192/ PMC+1
    Nayak, S. C., et al. (2025). Bridging the gap between dentistry and medicine: pathways for oral–systemic integration. International Journal of Integrated Health (Review). https://pmc.ncbi.nlm.nih.gov/articles/PMC11909285/ PMC
    Ohrn, K. (2004). The role of dental hygienists in oral health prevention. International Dental Journal, 54(2), 115–120. https://pubmed.ncbi.nlm.nih.gov/15646586/ PubMed
    Papapanou, P. N., Sanz, M., Buduneli, N., et al. (2018). Periodontitis: Consensus report of Workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Journal of Clinical Periodontology, 45(S20), S162–S170. https://pubmed.ncbi.nlm.nih.gov/29926951/ PubMed
    Pisano, M., et al. (2023). The interaction between the oral microbiome and systemic health. Microorganisms / Multidisciplinary Reviews in Oral–Systemic Research, 14(4), 127. https://www.mdpi.com/2036-7481/14/4/127 MDPI
    Rajasekaran, J. J., & colleagues. (2024). Oral microbiome: a review of its impact on oral and systemic health. Frontiers in Oral Biology (Review). https://pmc.ncbi.nlm.nih.gov/articles/PMC11434369/ PMC
    Stewart, R. A., et al. (2016). Increasing evidence for an association between periodontal disease and cardiovascular disease — a statement and review. Circulation (AHA). https://www.ahajournals.org/doi/10.1161/circulationaha.115.020869
    Teeuw, W. J., Gerdes, V. E. A., & Loos, B. G. (2010). Effect of periodontal treatment on glycemic control in patients with type 2 diabetes: a meta-analysis. Diabetes Care, 33(2), 421–427. https://pmc.ncbi.nlm.nih.gov/articles/PMC2809296/ PMC
    Teshome, A., Yitayeh, A., & Bekele, S. (2017). The effect of periodontal therapy on glycemic control and systemic inflammation in patients with diabetes mellitus: meta-analysis. BMC Oral Health, 17, 41. https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-016-0249-1
    Prasad, M., et al. (2019). Integration of oral health into primary health care: evidence and policy implications. WHO Bulletin / Community Dentistry and Oral Epidemiology. https://pmc.ncbi.nlm.nih.gov/articles/PMC6618181/ PMC

Periodontal Disease and Biofilm Diseases of the Mouth