The Mouth-Body Connection
Research has recently proven what dentists have long suspected: that there is a strong connection between periodontal disease and other chronic conditions such as diabetes, heart disease and osteoporosis.
Periodontal disease is characterized by inflammation of the gum tissue, presence of disease-causing bacteria, and infection below the gum line. Infections and bacteria in the mouth can spread throughout the body and lead to a host of problematic health issues. Therefore, maintaining excellent oral hygiene and reducing the progression of periodontal disease through treatment will have benefits beyond preventing gum disease and bone loss. It may also save you from the chance of developing another serious condition.
- Periodontal Disease and Diabetes
- Periodontal Disease, Heart Disease and Stroke
- Periodontal Disease and Pregnancy
- Periodontal Disease and Respiratory Disease
- Periodontal Disease and Osteoporosis
Diabetes is a serious, incurable disease that is characterized by too much glucose, or sugar, in the blood. Type II diabetes occurs when the body is unable to regulate insulin levels, meaning too much glucose stays in the blood. Type I diabetics cannot produce any insulin at all. Diabetes affects between 12 and 14 million Americans, and can lead to a variety of health issues, such as heart disease and stroke.
Research has shown people with diabetes are more likely to develop periodontal disease than non-diabetics. Diabetics with insufficient blood sugar control also develop periodontal disease more frequently and severely than those who have good management over their diabetes.
The connection between diabetes and periodontal disease results from a variety of factors. Diabetes sufferers are more susceptible to all types of infections, including periodontal infections, due to the fact diabetes slows circulation, allowing bacteria to colonize. Diabetes also reduces the body’s overall resistance to infection, which increases the probability of the gums becoming infected. Similarly, diabetes inhibits the body’s healing responses and can complicate post-surgical healing and success.
Moderate to severe cases of periodontal disease elevate sugar levels in the body, increasing the amount of time the body has to function with high blood sugar. Diabetics with periodontitis are most likely to suffer from increased levels, making it difficult to keep control of their blood sugar. Further, high glucose levels in saliva promote growth of gum disease-causing bacteria.
Blood vessel thickening is another concern for diabetics. Blood vessels function by providing nutrients and removing waste products from the body. When they become thickened by diabetes, these exchanges are unable to occur. As a result, harmful waste is left in the mouth and can weaken the resistance of gum tissue, leading to infection and disease.
Smoking and tobacco use is detrimental to anyone’s oral and overall health, but it is particularly harmful to diabetics. Diabetic smokers 45 and older are in fact 20 times more likely to develop periodontal disease than those who do no smoke.
It is very important for everyone to brush teeth effectively, floss daily, and visit the dentist regularly, but it is especially essential that diabetics practice these measures.
Coronary heart disease occurs when fatty proteins and a substance called plaque (different from the bacterial plaque found on your teeth) build up on the walls of your arteries. This causes the arteries to narrow, constricting blood flow. Oxygen is restricted from traveling to the heart which may eventually result in shortness of breath, chest pain, and even heart attack.
The association between periodontal disease and heart disease is so apparent that patients with oral conditions are nearly twice as likely to suffer from coronary artery disease than those with healthy mouths. Periodontal disease has also been shown to exacerbate existing heart conditions. Additionally, patients with periodontal disease have been known to be more susceptible to strokes. A stroke occurs when the blood flow to a region of the brain is suddenly stopped. This may occur, for example, when a blood clot blocks a blood vessel leading to the brain.
One of the causes of the connection between periodontal disease and heart disease is oral bacteria entering the bloodstream. There are many strains of periodontal bacteria. Some strains can enter the bloodstream and attach to the fatty plaques in the coronary arteries. This attachment leads to clot formation and increased risk to a variety of issues including heart attack.
Inflammation caused by periodontal disease creates an increase in white blood cells and C-reactive protein (CRP) systemically. CRP is a protein that has long-been associated with heart disease. When levels are increased in the body, it amplifies the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, causing the liver to produce extra CRP, which then leads to inflamed arteries and possibly blood clots. Inflamed arteries can lead to blockage, which can cause heart attacks or strokes.
Coronary heart disease is the leading cause of death in the United States for both men and women. Enacting positive oral hygiene practices and obtaining treatment for periodontal problems may help prevent the risk of developing this unfortunate condition, though periodontal disease and it’s direct effects on cardiovascular diseases is as yet not completely clear.
Pregnancy causes many hormonal changes, which increase the likelihood of developing periodontal disease such as gingivitis, or gum inflammation. Fortunately, halting the progression of periodontal disease through practicing high standards of oral hygiene and treating existing problems can help reduce the risk of periodontal disease-related complications by up to 50%. Untreated, advanced periodontitis has been linked to premature, low birth weight of the baby.
There are several factors that contribute to why periodontal disease may affect the mother and her unborn child. One is an increase in prostaglandin in mothers with advanced stages of periodontal disease, particularly periodontitis. Prostaglandin is a labor-inducing compound found in periodontitis, associated with the presence of disease-causing oral bacteria.
Another compound that has recently been linked to premature birth and low birth weights is C-reactive protein (CRP). CRP is a protein that has long-been associated with heart disease. Periodontal disease increases CRP levels in the body, which then amplify the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, causing the liver to produce extra CRP, which then leads to inflamed arteries and possibly blood clots. Inflamed arteries can lead to blockage, which can cause heart attacks or strokes. Although it is not completely understood why elevated CRP predisposes to pre-eclampsia, studies have overwhelmingly proven that extremely high levels of CRP in early pregnancy definitely increases the risk.
If you are pregnant, it is important to practice effective home care for preventing gum disease. Your dentist or periodontist can help assess your level of oral health and develop preventative measures and treatment plans to best protect you and your baby.
Respiratory disease occurs when fine droplets are inhaled from the mouth and throat into the lungs. These droplets contain germs that can spread and multiply within the lungs to impair breathing. Recent research has shown that bacteria found in the mouth and throat can be drawn into the lower respiratory tract and cause infection or worsen existing lung conditions.
Bacteria that grow in the oral cavity and are aspirated into the lungs can cause respiratory problems such as pneumonia. This occurs mostly in patients with periodontal disease. Periodontal disease has also been shown to have a role in the contraction of bronchitis and emphysema. Chronic obstructive pulmonary disease (COPD), a respiratory condition characterized by blockage of the airways, and caused mostly by smoking, has also been proven to worsen if the patient also has periodontal disease.
One of the reasons for the connection between respiratory problems and periodontal disease is low immunity. Patients who experience respiratory problems generally have low immunity, meaning bacteria can easily grow, where they would normally be controlled by the body’s immune system. Active, untreated periodontal disease may only worsen respiratory issues.
If you are diagnosed with respiratory disease or periodontal disease, we can work with your physician to plan how to best treat both conditions and eliminate further complications.
Osteoporosis is a condition common in older patients, particularly women, that is characterized by the thinning of bone tissue and loss of bone density over time. Osteoporosis occurs when the body fails to form enough new bone, or when the body absorbs too much old bone. A major factor in the development of osteoporosis is a drop in levels of sex hormones in post-menopausal women, as well as older men. Sufferers of osteoporosis must take extra care in daily activities, as they are at increased risk for bone fractures.
Because periodontal disease can also lead to bone loss, the two diseases have been studied for possible connections. Research found that women with osteoporosis were more likely to have missing teeth. Studies conducted over a period of 10 years also discovered that osteoporosis patients could significantly reduce tooth loss by controlling periodontal disease. Further, it was found that post-menopausal women who suffer from osteoporosis are 86% more likely to also develop periodontal disease.
One of the reasons for the connection between osteoporosis and periodontal disease is an estrogen deficiency. Estrogen deficiency speeds up the progression of both oral bone loss and other bone loss. It also accelerates the rate of loss of fibers and tissues which keep the teeth stable. Tooth loss occurs when these fibers are destroyed.
If you are diagnosed with osteoporosis, it is extremely important to take preventative measures against periodontal disease to protect your teeth and oral bones.
Medication-Related Osteonecrosis of the Jaws
Medication-Related Osteonecrosis of the Jaws (MRONJ), also known as Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ) is a condition that develops when a patient has been taking a variety of medications which interfere with the body’s ability to heal injured bone. Most commonly, this has been associated with patients taking a bisphosphonate, a class of drugs which interfere with osteoclast function, most often to treat osteopenia or osteoporosis. Osteoclasts are the cells which break down old or dead bone tissue, the first half of bone metabolism (i.e replacement) or healing. This allows the bone-forming cells, osteoblasts, to continue their work and tip the balance in favor of greater bone production or replacement, over bone destruction. The problem occurs when surgery or infection occurs in the jaws, probably related to the presence of oral bacteria in the healing bone site. People who have been taking bisphosphonate drugs for several years have, on occasion, developed an area of bone that does not heal normally and requires further intervention to treat. This is most common in patients who are being treated with infusions of the long-acting intravenous forms of these drugs, and most often among people taking these treatments as part of cancer therapy to control bone destruction from tumor spread. It is much less common for people taking oral medications for osteopenia or osteoporosis. However, there is a risk of this condition following dental surgery, e.g. tooth extraction, gum surgery or implant placement, and it is imperative that you discuss with us if you have taken these medications before treatment. Remember however, that the type of drug you’ve taken, as well as the length of time you’ve been on it, along with your general health and other medications you may be taking, are major factors in your risk, or not, for this problem arising. Please discuss with us any medications you’ve been taking and any questions or concerns you may have.