Good Oral Health Leads to Better Health Overall
Good Oral Health Leads to Better Health Overall
Untreated Gum Disease Can Allow Other Diseases to Flourish
More and more, scientific studies are showing that how well you care for your teeth and gums affects other parts of your body — and vice versa. In other words, the benefits of proper oral health care extend way beyond a pretty smile!
There’s a growing appreciation for the delicate balance that exists between the various organ systems. One subject of particular focus is the relationship between periodontal (gum) disease and other health conditions.
Periodontal disease (“peri” – around; “odont” – tooth) is actually a group of disorders that affect the gums, the bone beneath them, and other surrounding tissues — in short, everything that connects us to our teeth. They are caused by dental bacterial plaque (biofilm) that collects at the gum line in the absence of effective daily oral hygiene. In severe cases, the resulting breakdown of periodontal tissues can be equal to an ulcer the size of an adult palm. But, since the ulceration is within the gum tissues, you can’t see it. Yet it makes it easy for bacteria and toxins to enter the bloodstream, where they have systemic (whole-body) effects. When you consider that nearly half of all American adults suffer from some form of gum disease and 13% have significant periodontal breakdown, you may begin to see how periodontal disease can affect systemic conditions and vice versa.
In fact, ailments as wide-ranging as cardiovascular disease and diabetes are increasingly being linked to gum disease. There is also evidence that giving birth to preterm, low-weight babies may also be tied to oral health problems.
Presently, direct cause-and-effect relationships between periodontal disease and these other maladies are not always clear. However, evidence from epidemiological studies, which measure the distribution of diseases in large population groups, reveal probable connections. Let’s take a closer look.
Insulin is a critically important hormone that helps turn sugars (carbohydrates) into energy that can be used by the body’s cells. When the pancreas does not produce enough insulin, or the body does not respond normally to the insulin that is produced, a condition known as diabetes develops. High levels of sugar accumulate in the blood, which can have increasingly serious health consequences primarily affecting blood vessels and therefore many systems of the body. About 26 million people, or a little over 8% of the U.S. population, suffer from various forms of the disease.
Studies have found evidence to support a clear association between diabetes and periodontal disease. One common factor they share is inflammation. This is normally a protective reaction but in this case it is not; on the contrary, it can make both conditions worse. For example, poorly controlled diabetic patients appear more susceptible to infectious diseases, including periodontal disease. Additionally, they have an exaggerated inflammatory response to the bacteria that produce periodontitis. Evidence also suggests that uncontrolled periodontitis can worsen blood sugar levels. The good news is that treatment of periodontal disease, by and large, has been shown to have beneficial effects on blood sugar control, which is how doctors measure diabetes treatment effectiveness. For example, a 2012 joint European-American periodontal workshop found that basic mechanical periodontal therapy (good oral hygiene and professional cleaning) improved blood sugar control to the same extent that adding a second drug would have.
Conditions collectively grouped together as cardiovascular (“cardio” – heart; “vascular” – blood vessel) disease, which leads to heart attacks and strokes, is the major cause of death worldwide. Cardiovascular disease includes peripheral vascular disease (high blood pressure); ischemic heart disease (restriction of blood flow); and cerebrovascular disease that affects the brain. Like periodontal disease, they are progressive, chronic, caused by a range of factors (including some common to both), and widespread. Cardiovascular and periodontal diseases leave similar “markers” in the blood that can serve as early indicators of these conditions. Specific types of invasive bacteria associated with periodontal disease can contribute to higher risk for cardiovascular disease.
Analysis of data suggests that those suffering from periodontal disease have a far greater risk of either developing or having cardiovascular disease. The American Heart Association, recognizing that more study is needed in order for a link to be validated, has called for additional research in this area. Some researchers, however, question this cautiousness, since at least some evidence already points to associations between gum disease and some forms of cardiovascular disease.
Proper oral care must be part of any mother-to-be’s health regimen. It has been shown that acute oral infections, chronic abscesses, and similar potential sources of toxins have the capacity to harm the developing baby. Therefore, prompt and thorough treatment of periodontal disease is critical at any stage of pregnancy. Fluctuating hormonal levels can compromise the body’s ability to resist disease and make women more sensitive to the effects of oral bacteria, which is why so many (estimates range from 30% to 100%) experience “pregnancy gingivitis” — an inflammation of the gum tissue.
For these reasons, there is widespread acceptance that the presence of periodontal disease during pregnancy can lead to an increased health risk to both mother and developing baby. Studies have further shown that women with severe periodontal disease during pregnancy can increase the possibility of very early, preterm birth even in an otherwise healthy mother. Unfortunately, even proper treatment of gum disease may not prevent problems at birth. Periodontal therapy, however, is highly recommended. Efforts to prevent inflammation should begin as soon as a woman reaches her childbearing years. Careful attention to education and maintenance of oral health must be emphasized, particularly if a woman is or wants to become pregnant.
Both osteoporosis (“osteo” – bone; “porosis” – sieve-like) and periodontitis involve bone loss to a significant degree. In osteoporosis, which is hormonally induced, bone density is diminished. In periodontal disease, bone is lost due to bacterially induced inflammation and infection. While some studies support the notion of a link between decreasing bone mineral density (BMD) in postmenopausal women with periodontitis and related conditions, other studies show no such support, or only a weak association. Interestingly, studies of postmenopausal women treated for osteoporosis have indicated that possible side benefits of the therapy included reductions in some of the conditions associated with periodontal disease. For example, low doses of the antibiotic doxycycline have been shown to have positive effects on osteoporosis as well as bone loss associated specifically with periodontal disease.
There is one possible connection between osteoporosis and periodontal health. A class of drugs called bisphosphonates may affect the success of bone regeneration after tooth extractions, and therefore tooth-replacement with implants. The impact of this class of medication varies among individuals. The length of time on the particular bisphosphonate, other medications, i.e. steroids, and overall health status may impact bone healing. Decision-making regarding placement of a dental implant, oral surgery or periodontal therapy may be impacted when there is a history of bisphosphonate use.
Because so much of the air we breathe passes through the mouth, it is easy to understand how easily potentially harmful oral bacteria can enter the lungs. This is of special concern in nosocomial pneumonia, a type of pneumonia that is acquired by high-risk patients during a stay in the hospital. The problem is made worse in situations where individuals have increased oral biofilm buildup, such as in intensive care units and nursing homes. Simple improvements in oral care have been shown to significantly lower the occurrence of lung disease.
Similarly, improved oral hygiene is effective in the treatment of bacterial pneumonia that is not acquired in a hospital setting. Additionally, it appears likely that improvements in oral care can contribute to a decreased incidence of chronic obstructive pulmonary disease (COPD).
Rheumatoid arthritis (RA) is a disabling and painful condition that can lead to substantial loss of mobility if not properly treated. An autoimmune disease (in which the body’s defense system is no longer protective, and is in fact destructive), RA may affect many tissues and organs throughout the body, but it principally attacks flexible joints. There are an estimated 1.5 million U.S. adults who have been diagnosed with RA.
The belief that there may be a link between RA and oral infections was first raised nearly two centuries ago. There are three phases of RA as the disease develops, and their progression is quite similar to what we see with periodontal disease. Patients newly diagnosed with RA have also been found to exhibit a high prevalence of periodontal disease, even at a young age. However, there is no evidence that treating periodontal disease has a positive effect on RA disease activity and more work is needed to determine the extent — if any — to which RA and periodontal disease are related.
A Healthy Future
Clearly, there is evidence that relationships exist between a number of well-known diseases and periodontitis. While further research is needed to reveal the exact nature of the connection, inflammation is a common feature. It is eventually hoped that by increased adoption of something as relatively simple, low in risk, and inexpensive as improved oral care, a number of highly prevalent and serious conditions can be better managed, and, perhaps, more effectively treated.
In the meantime, it is unquestionable that early diagnosis and treatment of periodontal disease and other oral infections will help ensure your overall health. As one former Surgeon General said, “You can’t have general health without oral health.