Dr. Ira Lamster and colleagues’ October JADA article, "The Relationship of Periodontal Disease to Diseases and Disorders at Distant Sites" (Lamster IB, DePaola DP, Oppermann RV, Papapanou PN, Wilder RS. JADA 2008;139[10]:1389–1397), presents misleading statements and glaring omissions. The authors present no discussion of the focal infection theory that serves as the basis for the current "oral-systemic connection" and was an unmitigated disaster for medicine, dentistry and their patients in the early- to mid-20th century.1
The contention that 20 years of literature support for the concept that periodontal disease has adverse effects on distant tissues and so forth misleadingly implies that causation/significant associations have been established when such is not the case. Years of poorly performed studies support nothing. Micro-floras associated with periodontal disease have been found in atheromatous plaque, but the authors ignore the 50 or more other bacterial species found in the same place at the same time.2
The statement in the abstract that "it is too early to provide specific recommendations" implies that such recommendations are forthcoming. This is highly unlikely given the lack of success to date.
The concept of "disease mongering" is gaining wide interest with the disclosures of various financial entities promoting an ever-increasing list of "new" diseases requiring our attention and patient dollars, along with the illumination of their manipulation of the clinical trials and data presentation.3,4 Such diseases may include restless legs syndrome, epidemic manic depression, sexual disorders (primarily male) and of course "pre-everything" (atherosclerotic disease, diabetes, hypertension, mental disease, Alzheimer disease, Parkinsonism and so forth). I suggest the all-inclusive category of "predeath" to account for them all.
Disease mongering can be defined as "the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments."4 As presently constituted and promoted by some, the oral-systemic connection is a classic example of disease mongering, with the attendant medicolegal, financial and ethical liabilities of charging money for treatment that has not been demonstrated to work.
Finally, the most glaring omission in this article is a list of the participants along with their affiliations (both scientific and financial) and a complete disclosure of real or potential conflicts of interest of those who attended the "Oral and Systemic Diseases: From Bench to Chair—Putting Information Into Practice" workshop held July 23–24, 2007. This would have allowed for determination of their possible biases—and also the detection of those not invited who may hold opinions and data that might have irritatingly refuted this "consensus." Because this information was not provided, this article can be suspected of serious bias.
The admonition from Nobel laureate Richard Feynman is appropriate: "We’ve learned from our experience that the truth will come out. Other experimenters will repeat your experiment and find out whether you were right or wrong. Nature’s phenomena will agree or they’ll disagree with your theory. And, although you may gain some temporary fame and excitement, you will not gain a good reputation as a scientist if you haven’t tried to be very careful in this kind of work."5
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