The Connection Between Periodontal and Other Condition

Periodontal Disease and Diabetes

It is well documented that people who suffer from diabetes are more susceptible to developing infections than non-diabetes sufferers.  It is not widely known that periodontal disease is often considered the sixth complication of diabetes, particularly when the diabetes is not under proper control.

Periodontal disease (often called periodontitis and gum disease) is a progressive condition that often leads to tooth loss if treatment is not promptly sought.  Periodontal disease begins with a bacterial infection in the gingival tissue which surrounds the teeth.  As the bacteria colonize, the gum pockets become deeper, the gums recede as tissue is destroyed and the periodontitis eventually attacks the underlying bone tissue.

Diabetes is characterized by too much glucose (or sugar) in the blood.  Type II diabetics are unable to regulate insulin levels which means excess glucose stays in the blood.  Type I diabetics do not produce any insulin at all.  Diabetes is a serious condition which can lead to heart disease and stroke.

Whats the Connection Between Heart Disease and Stroke? 

Experts suggest the relationship between diabetes and periodontal disease can worsen both conditions if either condition is not properly controlled.

Here are ways in which diabetes and periodontal disease are linked:

• Increased blood sugar – Moderate and severe periodontal disease elevates sugar levels in the body, increasing the amount of time the body has to function with high blood sugar.  This is why diabetics with periodontitis have difficulty keeping control of their blood sugar.  In addition, the higher sugar levels found in the mouth of diabetics provide food for the very bacteria that worsen periodontal infections.
  
  
• Blood vessel thickening – The thickening of the blood vessels is one of the other major concerns for diabetes sufferers.  The blood vessels normally serve a vital function for tissues by delivering nutrients and removing waste products.  With diabetes, the blood vessels become too thick for these exchanges to occur.  This means that harmful waste is left in the mouth and can weaken the resistance of gum tissue, which can lead to infection and gum disease.
  
  
• Smoking – Tobacco use does a great deal of damage in the oral region.  Not only does tobacco use slow the healing process, it also vastly increases the chances of an individual developing periodontal disease.  For diabetics who smoke, the risk is exponentially greater.  In fact, diabetic smokers aged 45 and over are twenty times more likely to develop periodontal disease.
  
  
• Poor oral hygiene – It is essential for diabetics to maintain excellent levels of oral health.  When daily brushing and flossing does not occur, the harmful oral bacteria can ingest the excess sugar between the teeth and colonize more freely below the gum line.  This exacerbates the metabolic problems that diabetes sufferers experience.

How can treatment help Treatment 

It is of paramount importance for people suffering from any type of diabetes to see the dentist at least twice yearly for checkups and professional cleanings.  Studies have shown that simple non-surgical periodontal treatments can lower the HbA1c (hemoglobin molecule blood test) count by as much as 20% in a six month period.

The dentist will use medical history, family history and dental X-rays to assess the risk factors for periodontal disease and determine the exact condition of the gums, teeth and underlying jawbone.  If necessary the dentist will work in conjunction with other doctors to ensure that both the diabetes and the gum disease are being managed and controlled as effectively as possible.

Non-surgical procedures performed by the dentist and dental hygienist include deep scaling, where calculus (tartar) will be removed from the teeth above and below the gumline, and root planing, where the root of the tooth is smoothed down to eliminate any remaining bacteria.  Antibiotics may be applied to the gum pockets to promote healing.

Before and after periodontal treatment, the dentist and hygienist will recommend proper home care and oral maintenance as well as prescribing prescription mouthwashes which serve to deter further bacteria colonization.

If you have questions or concerns about diabetes or periodontal disease, please contact our office.

CALL US: (508) 481-3663 REQUEST APPOINTMENT

Periodontal Disease and Heart Disease

Periodontal disease, heart disease and stroke may seem to be unlikely bedfellows, but researchers have found that gum disease sufferers are nearly twice as likely to also suffer from coronary heart disease.  In addition, research studies have discovered that oral infection is indeed a risk factor for stroke.  People diagnosed with acute cerebrovascular ischemia were more likely to also be experiencing some degree of periodontal disease.

Periodontal disease is a progressive condition in which the gingival tissue surrounding the teeth is infected by the colonization of bacteria.  Bacteria found in plaque colonize first above, then below the gumline, causing the tissue to pull away from the teeth.  If periodontal disease is left untreated, deep pockets form between the gums and the teeth and the tissue of the underlying jawbone is also destroyed.  The destruction of bone tissue causes the teeth to shift, wobble or completely detach from the bone.

Coronary heart disease occurs when the walls of the coronary arteries become progressively thicker due to the buildup of fatty proteins.  The heart then suffers from a lack of oxygen and must labor significantly harder to pump blood to the rest of the body.  Coronary heart disease sufferers sometimes experience blood clots which obstruct normal blood flow and reduce the amount of vital nutrients and oxygen the heart needs to function properly.  This phenomenon often leads to heart attacks.

Reasons for the Connection

There is little doubt that the presence of periodontal disease can exacerbate existing heart conditions.  The periodontist and cardiologist generally work as a team in order to treat individuals experiencing both conditions.

There are several theories which may explain the link between heart disease, stroke and periodontal disease, which include the following:

• Oral bacteria affect the heart – There are many different strains of periodontal bacteria.  Researchers assert that some of these strains of bacteria enter the bloodstream and attach to the fatty plaques in the heart blood vessels (coronary arteries).  This attachment then contributes to clot formation causing grave danger to the individual.
  
  
• Inflammation – Periodontal disease causes severe inflammation in the gum tissue which elevates the white blood cell count and also the high sensitivity C-reactive protein levels.  Research studies have shown that elevated levels of C-reactive proteins have been linked to heart disease.
  
  
• Infectious susceptibility – Individuals who experience particularly high levels of oral bacteria may have weaker immune systems and an inadequate host inflammatory response.  These factors may induce specific vascular effects which have previously been shown to contribute in the onset of certain forms of heart disease.

Diagnosis and Treatment

Since periodontal disease appears to be a risk factor for both heart attack and stroke, it is extremely important to seek immediate treatment.  Initially, the periodontist will conduct thorough examinations to assess the exact condition of the teeth, gums and jawbone.  X-rays can be helpful in determining whether bone loss is prevalent in the upper and lower jaw.

The dentist is able to conduct deep cleaning treatments such as scaling and root planing to remove hardened calculus (tartar) deposits from the gum pockets.  An antibiotic may be prescribed to ensure that the bacterium is completely destroyed and the periodontal infection does not spread.  In most cases, periodontal disease can be prevented with regular cleanings and proper home care.

If you have questions or concerns about periodontal disease and its relation to heart disease and stroke, please contact our office.

CALL US: (508) 481-3663 REQUEST APPOINTMENT

Periodontal Disease and Pregnancy

Researchers have shown that periodontal disease in expectant mothers actually exposes their unborn child to many different risks, particularly if they also happen to be diabetes sufferers.

Periodontal disease generally begins with a bacterial infection in the gum (gingival) tissue, which progressively destroys the tissue and the underlying bone.  If left untreated, the bacterial infection causes an inflammatory reaction in the body, which can significantly deepen the gum pockets (space between the teeth and gums), and forces the gum and jawbone to recede.  Eventually, the progressive nature of periodontal disease causes the teeth to become loose and unstable, and eventually fall out.

Pregnancy causes many hormonal changes which increase the risk of the expectant mother to develop gingivitis (inflammation of the gum tissue) and periodontal disease.  These oral problems have been linked in many research studies to preeclampsia, low birth weight of the baby and premature birth.  Expectant women should seek immediate treatment for periodontal disease in order to reduce the risk of pre-natal and post-natal complications.

Reasons for the Connection

There are many different reasons why periodontal disease may affect the health of the mother and her unborn child:

• Prostaglandin – Periodontal disease appears to elevate levels of prostaglandin in mothers who are suffering from the more advanced forms of the condition.  Prostaglandin is a labor-inducing compound found in one of the oral bacteria strains associated with periodontitis.  Elevated levels of prostaglandin can cause the mother to give birth prematurely and deliver a baby with a low birth weight.
  
  
• C - reactive protein (CRP) – This protein, which has been previously linked to heart disease, has now been associated with adverse pregnancy outcomes including preeclampsia and premature birth.  Periodontal infections elevate C-reactive protein levels and amplify the body’s natural inflammatory response.  Periodontal bacteria may enter the bloodstream causing the liver to produce CRP which leads to inflamed arteries as well as possible blood clots.  These inflammatory effects can then lead to blocked arteries causing strokes or heart attacks.
  
  
• Bacteria spread – The bacteria which colonize in the gum pockets can readily travel through the bloodstream and affect other parts of the body.  In pregnant women, research has found that oral bacteria and associated pathogens have colonized in the internal mammary glands and coronary arteries.

Diagnosis and Treatment

There are many safe, non surgical treatment options available for pregnant women.  It is of paramount importance to halt the progress of periodontal disease in order to increase the chances of a safe and healthy delivery.

Initially, the dentist will assess the exact condition of the gums and jawbone in order to make a precise diagnosis.  Scaling and root planing are two common non-surgical procedures used to rid the tooth-root surfaces of calculus (tartar) and remove the bacterial toxins from the gum pockets.

With treatment, the risks of pregnancy complications caused by periodontal disease are reduced by as much as 50%, and these treatments will alleviate many unpleasant and harmful effects associated with gingivitis and periodontal infection.

Dentists can provide education and recommendations to pregnant women about effective home care which can reduce risks that may affect her and/or her child’s health. Risks of periodontal disease can be vastly reduced by proper home care, smoking cessation, dietary changes, and the ingestion of supplementary vitamins.

If you have any questions or concerns about periodontal disease and its affect on pregnancy, please contact our practice.

CALL US: (508) 481-3663 REQUEST APPOINTMENT

Periodontal Disease and Osteoporosis

Periodontal disease is characterized by a progressive loss of supportive gingival tissue in the gums and jawbone.  It is the number one cause of tooth loss among adults in the developed world.  Periodontal disease occurs when toxins found in oral plaque inflame and irritate the soft tissues surrounding the teeth.  If left untreated, bacteria colonies initially cause the systematic destruction of gum tissue, and then proceed to destroy the underlying bone tissue.

Osteoporosis is a common metabolic bone disease which frequently occurs in postmenopausal women, and occurs less frequently in men.  Osteoporosis is characterized by bone fragility, low bone mass and a decrease in bone mineral density.  Many studies have explored and identified a connection between periodontal disease and osteoporosis.

A study conducted at the University of New York at Buffalo in 1995 concluded that post-menopausal women who suffered from osteoporosis were 86% more likely to also develop periodontal disease.

Reasons for the Connection

Though studies are still being conducted in order to further assess the extent of the relationship between osteoporosis and periodontal disease, the researchers have thus far made the following connections:

• Estrogen deficiency – Estrogen deficiency accompanies menopause and also speeds up the progression of oral bone loss.  The lack of estrogen accelerates the rate of attachment loss (fibers and tissues which keep the teeth stable are destroyed).
  
  
• Low mineral bone density – This is thought to be one of several causes of osteoporosis, and the inflammation from periodontal disease makes weakened bones more prone to break down.  This is why periodontitis can be more progressive in patients with osteoporosis.

Diagnosis and Treatment

Osteoporosis and periodontal disease are much less dangerous if they are diagnosed in the early stages.  Once a diagnosis has been made, the dentist will generally work with the patient’s doctor to ensure that both diseases are effectively controlled.

Here are some methods commonly used to diagnose and treat the diseases:

• Routine dental X-rays – X-rays can be effectively used to screen for bone loss in the upper and lower jaw, and the dentist can provide interventions for preventing and treating periodontal disease.  It is believed that minimizing periodontal disease will help treat osteoporosis.
  
  
• Estrogen supplements – Providing post-menopausal women with estrogen supplements lowers the rate of attachment loss and also lowers gingival inflammation, which in turn protects the teeth from periodontal disease.
  
  
• Assessment of risk factors – Dentists and doctors are able to closely monitor the patients that are at an increased risk of developing both diseases by assessing family history, medical history, X-ray results, current medications and modifiable risk factors.  Tobacco use, obesity, poor diet and estrogen deficiency can all be managed using a combination of education, support and prescription medications.

If you have any questions about periodontal disease and its connection with osteoporosis, please contact our practice.

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Periodontal Disease and Respiratory Diseases

Periodontal disease (also called periodontitis and gum disease) has been linked to respiratory disease through recent research studies.  Researchers have concluded that periodontal disease can worsen conditions such as chronic obstructive pulmonary disease (COPD) and may actually play a causal role in the contraction of pneumonia, bronchitis and emphysema.

Periodontal disease is a progressive condition which generally begins with a bacterial infection.  The bacteria found in plaque begin to colonize in gingival tissue, causing an inflammatory response in which the body destroys both gum and bone tissue.  The sufferer may notice the teeth “lengthening” as the gums recede while the disease progresses.  If left untreated, erosion of the bone tissue brings about a less stable base for the teeth, meaning loose, shifting or complete tooth loss.

There are a number of different respiratory diseases linked to periodontal disease.  Pneumonia, COPD, and bronchitis are among the most common.  Generally, bacterial respiratory infections occur due to the inhalation of fine droplets from the mouth into the lungs. COPD is a leading cause of death and should be taken very seriously.

Reasons for the Connection

The fact that respiratory disease and periodontal disease are linked may seem far-fetched, but there is plenty of evidence to support it.

Here are some of the reasons for the link between periodontal disease and respiratory disease:

• Bacterial spread – The specific type of oral bacterium that causes periodontal disease can easily be drawn into the lower respiratory tract.  Once the bacteria colonize in the lungs, it can cause pneumonia and exacerbate serious conditions such as COPD.
  
  
• Low immunity – It has been well-documented that most people who experience chronic or persistent respiratory problems suffer from low immunity.  This low immunity allows oral bacteria to embed itself above and below the gum line without being challenged by the body’s immune system.  Not only does this accelerate the progression of periodontal disease, it also puts the sufferer at increased risk of developing emphysema, pneumonia and COPD.
  
  
• Modifiable factors – Smoking is thought to be the leading cause of COPD and other chronic respiratory conditions.  Tobacco use also damages the gingiva and compromises the good health of the oral cavity in its entirety.  Tobacco use slows the healing process, causes gum pockets to grow deeper and also accelerates attachment loss.  Smoking is not the sole cause of periodontal disease, but it is certainly a cofactor to avoid.
  
  
• Inflammation – Periodontal disease causes the inflammation and irritation of oral tissue.  It is possible that the oral bacteria causing the irritation could contribute to inflammation of the lung lining, thus limiting the amount of air that can freely pass to and from the lungs.

Diagnosis and Treatment

When respiratory disease and periodontal disease are both diagnosed in one individual, it is important for the dentist and doctor to function as a team to control both conditions.  There are many non-surgical and surgical options available, depending on the specific condition of the teeth, gums and jaw.

The dentist is able to assess the extent of the inflammation and tissue loss and can treat the bacterial infection easily.  Scaling procedures cleanse the pockets of debris and root planing smoothes the tooth root to eliminate any remaining bacteria.  The dentist generally places antibiotics into the pockets after cleaning to promote good healing and reduce the risk of the infection returning.

Whichever treatment is deemed the most suitable, the benefits of controlling periodontal disease are two-fold.  Firstly, any discomfort in the oral region will be reduced and the gums will be much healthier.  Secondly, the frequent, unpleasant respiratory infections associated with COPD and other common respiratory problems will reduce in number.

If you have questions or concerns about respiratory disease or periodontal disease, please ask your dentist.

CALL US: (508) 481-3663 REQUEST APPOINTMENT