The NobleDentist Blog

This is an article by Shari Rudavsky that recently appeared in the Indianapolis Star.

Gum disease can contribute to heart problems, diabetes and other illnesses, studies indicate.

The periodontal disease that’s giving you a toothache might not only be hurting your gums; it could also be affecting other aspects of your health, from your heart to your blood sugar, a growing body of research suggests.

In recent years, studies have shown links between gum disease and other maladies. Experts stop short of calling periodontal disease a causal factor in conditions like diabetes or low birth-weight babies, but they do suspect it could be a potent risk factor.

“The basic message that we want to get across is that periodontal disease and oral infection is a risk factor,” says Dr. Preston D. Miller, president of the American Academy of Periodontology. ” A direct link has not been established, but all the studies I know of indicate that there is a connection.”

One of the strongest links has been drawn between diabetes and gum disease. Diabetics generally respond poorly to infections; infection in the mouth is no exception. Treating periodontal disease may decrease a patient’s dependence on insulin, experts say, though it won’t end it altogether.

Conversely, diabetics—even those who are undiagnosed—are more likely to develop periodontal disease. Sometimes periodontists even sound the first alarm about diabetes after seeing a rapid decline in a person’s oral health, says Dr. Howard Tenenbaum, a professor of periodontology at the University of Toronto.

But it’s not just diabetics who should worry about gum disease, experts say. Studies show people with periodontal disease are almost twice as likely to suffer heart disease as those whose gums are healthy.

Nobody knows exactly why that is, but some speculate that oral bacteria may travel through the bloodstream to the heart, where they attach to fatty plaques in the arteries and contribute to the formation of clots.

While much of the research has focused on the role full-blown periodontal disease plays, an Indiana University School of Dentistry professor is asking whether the process starts years before, with gingivitis, a local inflammation of the gums that may affect as much as 80 percent of the population.

A three-year federal grant for $1.3 million will help Dr. Michael Kowolik and colleagues test the hypothesis that even small amounts of dental plaque can stimulate the body to produce a reaction that over time would increase a person’s risk of a heart attack.

Dental plaque already is a suspect in other illnesses. Research on patients in long-term care facilities and intensive care units who do not receive regular dental care or even brushing suggests that as plaque builds up, so does the risk of aspirational pneumonia, says Toronto’s Tenenbaum.

Now Kowolik and colleagues at IU’s Oral Health Research Institute want to see if plaque has an impact on healthy individuals.

The grant calls for inducing gingivitis in 128 participants with healthy gums who agree not to brush their teeth for 21 days. The plan is to compare levels of plaque and gum inflammation as well as markers for heart disease at the beginning of the study and after 21 days of negligence.

Higher risk predicted

Even if the study shows these markers do increase with gum inflammation, it will not prove a direct correlation between heart disease and periodontal disease, Kowolik cautions. It will, however, confirm the importance of good oral hygiene.

“If I’m right and the amount of plaque that builds up on teeth does produce a systemic reaction, it doesn’t prove that it will cause a heart attack but simply that it will produce some of the risk factors,” he says. “In the end, what we might show, if we can reduce insult to the body by practicing good oral hygiene, then dentists and dental hygienists could be more significant to society for general hygiene.”

That significance could extend beyond heart disease. Periodontal disease might also have a hand in preterm births, many experts believe. Infections in other parts of the body, such as the urinary tract, have been known to travel to the placenta and cause inflammation, which could play a role in low birth weight and early labor, notes Ray White, a professor of oral and maxillofacial surgery at the University of North Carolina.

So it seemed equally plausible that bacteria in the gums could also travel through the bloodstream and have a similarly detrimental effect.

Effect on pregnancy?

The Oral Conditions and Pregnancy study has already suggested that indeed a correlation exists between poor obstetric outcomes and periodontal disease.

More recently, White looked at wisdom teeth’s contribution. His work has shown that many periodontal problems start around these teeth, even in people who don’t realize they have a problem.

“The message is, if you’re planning on getting pregnant, you better go and make sure you don’t have gum disease,” White says. “What we’re showing is that, at least for some young people, periodontal problems start in the lower teeth.”

To help get that word out, the American Academy of Periodontology is promoting a campaign to encourage patients and obstetricians to discuss oral health, Miller says.

Check ‘probing depth’

The academy also urges people to take greater control of their periodontal health and ask dentists about their teeth’s “probing depth,” measured on a level of one to seven. The higher the number, the worse the disease.
“Patients should understand that a five is as important to periodontal disease as a 200 is to cholesterol,” says Miller, a periodontist in private practice in Memphis. “The layman has to look after himself.”

Still, at least one IU dentist believes that the layman could use a little help. Dr. Gerardo Maupome, a professor at the Oral Health Research Institute at the IU School of Dentistry, wants to explore the possibility of using health educators in the Hispanic community to teach their patients, who typically have poor access to medical or dental care, about preventing periodontal disease.

Maupome is hoping to find funding to start a pilot project in East Chicago that will teach this population, many of whom also are diabetic, about proper dental hygiene.

If this plan comes to fruition, Maupome says, the program could wind up preventing not just dental disease but also problems with diabetes.

Are you at risk?

There’s no great secret to preventing periodontal disease. Just practice standard good preventive dental care, says the Academy of General Dentistry.

Brush and floss daily and see your dentist for regular professional cleanings.

Here are some signs and symptoms that you might have periodontal disease, according to the American Academy of Periodontology:

• Pain in your mouth.
• Bleeding gums when you brush or eat hard food.
• Spaces developing between your teeth.
• Swollen or tender gums.
• Receding gums.
• Persistent bad breath.
• Pus between your teeth and gums.
• Sores in your mouth.
• Changes in the way your teeth fit together.