Sir, in their paper Periodontitis: a potential risk factor for Alzheimer's disease,1 the authors proposed several areas for further research into the relationship between sporadic late onset Alzheimer's disease (SLOAD) and periodontal disease.

This paper and others highlight deficits in our knowledge and the need to determine which established correlations between periodontal disease and systemic diseases have no underlying relationships, which are based upon an association between the diseases, and which are causal in nature and therefore potentially warranting intervention.2 It has been also suggested that tooth eradication may reduce the systemic inflammatory burden of individuals with severe periodontitis3 and the potential value of such a 'therapeutic' approach may be deserving of consideration where causal relationships are proved?

In some areas of the UK only a few generations ago, it was common practice for a bride-to-be to have a full dental clearance and complete dentures provided in the belief that this would reduce future dental problems and financial burden on her husband.4 At the risk of re-inventing the wheel, I suggest that this subset of the UK population could prove very valuable in progressing research into understanding reported correlations between periodontal disease and systemic diseases (including SLOAD, CVD, diabetes, pneumonia, osteoporosis and cancer1,5).

Assuming statistically robust populations of early 'elective' edentulous patients and 'matched' dentate individuals with severe periodontal disease (to manage common and/or potentially confounding factors) could be recruited, they could provide retrospective epidemiological and other data on the relationship between systemic diseases and periodontal disease as assessed both clinically and implied on the basis of genetic polymorphisms identified as being disease risk factors (in dentate and edentulous patients).

For example, in the case of SLOAD, they might provide retrospective analytical routes to achieving better understanding in the following areas of research suggested by Cerajewska et al.:1

  • The relationship between cognitive and periodontal status from middle to old age

  • The levels of periodontal pathogens in brain tissue

  • Determining whether genetic polymorphisms associated with periodontal disease are also associated with periodontitis.

Furthermore, such research could be extended to include patients who have had implants placed to support complete dentures with a view to determining whether any bacteraemia and inflammatory burden changes associated with their placement, could induce systemic effects?

With the benefit of hindsight, it is extremely regrettable that women were put though the trauma of such dental clearances and thankfully this elective clinical intervention has no place in modern dentistry. However, this also means that this cohort of patients will be diminishing in number and with it the window of opportunity they offer.