By Dr. Rajesh DoolabhThere is a Chinese proverb that goes like this: "A smile will gain you ten more years of life."The links between oral health and overall health are being established on a daily basis and the implications are astounding! Imagine if by simply brushing and flossing regularly, you were able to prevent a heart attack?
The link between diseases of teeth and supporting structures, and systemic disease is at the centre of a number of on-going studies. What we currently know is that definitive links do exist between gingival (gum) disease and periodontal disease; and cardiovascular disease, diabetes mellitus and pregnancy complications. And while the research moves forward, what we are learning today is that a healthy smile truly may add ten years to your life.
Periodontitis is a set of inflammatory diseases affecting the periodontium — that is, the tissues that surround and support the teeth. Periodontitis involves progressive loss of the alveolar bone around the teeth, and if left untreated, can lead to the loosening and subsequent loss of teeth. Periodontitis is caused by microorganisms that adhere to and grow on the tooth's surfaces, along with an overly aggressive immune response against these microorganisms.
Inflammation is the central pathologic feature of periodontal disease, and bacterial plaque is the etiologic factor responsible for inducing the host inflammatory processes. Increased plaque accumulation results from ineffective oral hygiene and is further complicated by the presence of local factors such as calculus (tartar), overhanging dental restorations, or crowded and mal-aligned teeth.
Smoking, genetics, stress, medication (including oral contraceptives, anti-depressants and certain heart medications), pregnancy, clenching or grinding your teeth, poor nutrition, diabetes and other systemic diseases have all been implicated as risk factors for gum disease.
Diabetes mellitus is an extremely important disease from a periodontal standpoint. This complex metabolic disease is characterized by chronic hyperglycaemia, a diminished immune response and increased susceptibility to infection, often leading to destructive periodontal disease.
Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways. The glucose content of gingival fluid is higher in patients with diabetes, changing the environment of the oral micro-flora, inducing qualitative changes in bacteria that could account for the severity of periodontal disease observed in poorly controlled diabetic individuals.
Severe periodontal disease can increase systemic blood sugar, contributing to increased periods of time when the body functions with a high blood sugar, often extremely difficult to control. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.
This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.
Additional studies have recently suggested that gingival disease predisposed certain people to developing early signs of diabetes. Clearly a link between oral health and blood sugar control exists.
Is it possible that oral infection is related to coronary heart disease (CHD)?Periodontal infection may affect the onset of atherosclerosis and CHD through certain mechanisms.
Periodontitis and CHD share many risk factors and have distinct similarities in basic pathogenic mechanisms. Periodontal disease results in chronic systemic exposure to products of microorganisms. Low-level bacteraemia may initiate host responses that alter blood coagulability, endothelial and vessel wall integrity, and platelet function resulting in atherogenic changes and possible thromboembolic events. Systemic infections are known to induce a hypercoagulable state and to increase blood viscosity. In patients with systemic or periodontal infection, fibrinogen and white blood cell counts are often increased. These predispose the patient to thrombus formation. The combination of increased blood viscosity and thrombogenesis leads to an increased risk for both central and peripheral vascular disease.
Patients with CHD with exuberant inflammatory responses often have hyperinflammatory monocytes/ macrophages which secrete significantly increased levels of pro-inflammatory mediators in response to the bacterial challenge. Thus, in the presence of even small amounts of pathogenic plaque, extensive periodontal destruction occurs.
Case-control studies have shown that poor dental health is a significant risk factor for cerebrovascular ischaemia i.e. stroke. In one study, gingival bleeding, subgingival calculus and periodontal lesions were significantly greater in male stroke patients than in controls.
Many studies, in which the periodontal condition is known to have preceded the CHD-related events, support the concept that periodontal disease is a risk-factor for CHD, independent of other risk factors.
Research has extensively examined the relationship between maternal infection and pre-term labour, pre-mature rupture of membranes and low-birth weight.
Although there are some conflicting findings and potential problems regarding uncontrolled underlying risk factors, most clinical studies indicate a positive correlation between periodontal disease and preterm birth.
How might this occur?Periodontitis is a remote gram-negative infection. The microorganisms involved reach the amniotic fluid by haematogenous spread from the oral cavity, or alternatively by oral-genital contact. Maternal infection may lead to the presence of amniotic bacterial products which stimulate production of host-derived cytokines in the amnion. These cytokines stimulate increased prostaglandin production, leading to the onset of pre-term labour and resultant low birth weight infants.
Data from previous studies raise the possibility that maternal periodontal infections also may have adverse long-term effects on the infant’s development.
Education for patients and health care providers regarding the biological plausibility of the association and the potential risks is indicated, and there is sufficient evidence at this time for health care policy recommendations to provide maternal periodontal treatments for the purpose of reducing the risk of adverse pregnancy outcomes.
While a greater understanding is essential to solving this puzzle, there are steps that you can take at home to take charge of your own health today. We recommend the following steps to all of our patients in order to maintain a healthy and beautiful smile:
- Make sure to brush after every meal and floss daily. A sound oral hygiene regime should be completed in circa 5 minutes, with 3 minutes dedicated to brushing (not forgetting the tongue) and 2 for both flossing and rinsing, in that order.
- Visit your dentist every six months for a routine examination and scaling and polishing, which we truly believe is the cornerstone to sound dental and overall health.
References
Jemin K., Salomon A. Periodontal disease & Systemic conditions: a bidirectional relationship. Odontology; Vol.94(1); 10-21 (2006)
Yiorgios A.B.(DDS)(PhD) et al. Exploring the relationship between periodontal disease and pregnancy complications. Journal of the American Dental Association; Vol137(2); 7-13 (2006)
Carranza F.A. et al. Clinical Periodontology 9th Edition: W.B. Saunders Co.(2002)
