What is Periodontal Disease?
Periodontal disease is an infection that breaks down the connective tissues that hold the teeth, gums, and bones together. As the disease progresses, pockets begin to form in the gums as they begin to recede and pull away from the teeth. If the disease is left unchecked, it can eventually lead to tooth loss.
If you have red, swollen gums or experience bleeding when brushing or flossing, you may have some form of gum disease.
Why the health of your gums is vital to your overall wellbeing
Treating gum disease isn’t just about keeping your mouth healthy. There are a number of serious health conditions that have been connected with periodontal disease, including heart disease, stroke, diabetes, osteoporosis, respiratory disease such as pneumonia, and some forms of cancer.
Though experts are still exploring the details, it’s becoming clear that your oral health has a significant impact on the health of your entire body. Treating inflammation of the gums can help with inflammatory conditions elsewhere. The infographic below highlights some of the known connections between gum disease and these conditions.
What Is the Oral-Systemic Link?
It’s frequently said that the mouth is the gateway to the body. More and more, medical professionals have been discovering just how true this really is. This is referred to as the oral-systemic link.
Dentists are often the first to detect conditions such as Crohn’s disease, diabetes, or cancer because the early symptoms may first show up in the mouth. Going in the other direction, we’re learning more and more how what happens in your mouth affects the health of the rest of your body.
The brain has the blood-brain barrier which protects it from toxins in the blood. In our mouths, there is a barrier between our gums and teeth and the rest of our bodies as well. In the case of periodontal disease, this barrier can break down and may cause disease or other problems in the rest of the body. Previously, it was thought that bacteria were the main factor in this, but more recent research has been indicating that inflammation may play a bigger role.
While the details of this connection between oral health and the health of the rest of the body are still being explored, it’s becoming increasingly clear that treating the inflammation of periodontal disease can help with the treatment of other inflammatory conditions (and, in some cases, vice versa).
Diseases with Oral Connections
Some conditions with strong connections to oral health include:
- Diabetes – Gum disease can make diabetes harder to control, and diabetes can exacerbate gum disease.
- Heart disease and stroke – Conditions causing chronic inflammation, such as periodontal disease, have connections to the likelihood of heart disease and stroke.
- Respiratory disease – The bacteria that grow in the mouth can find its way into the lungs as well. Respiratory diseases, such as pneumonia, can be caused by the same bacteria responsible for periodontal disease.
- Cancer – According to the American Academy of Periodontology, those with periodontal disease were more likely to develop cancer than those without:
- 54% more likely to develop pancreatic cancer
- 49% more likely to develop kidney cancer
- 30% more likely to develop blood cancers
Other diseases that may be caused or complicated by oral infections include:
- Breast cancer
- Prostate cancer
- Weight gain
- Alzheimer’s and dementia
- Low birth weight and premature birth
- Rheumatoid arthritis
Some diseases can influence your oral health, as well, such as osteoporosis. Osteoporosis can lead to bone loss in the jaw which, in turn, can result in tooth loss, as there is no longer sufficient bone to support the teeth.
It’s critical to understand how important oral health truly is to our wellbeing, and to take it seriously in order to help prevent, or reduce the effects of other conditions.
Diabetes & Periodontal Disease
The health of your mouth and the rest of your body are linked, and there’s an especially strong connection when it comes to diabetes and periodontal disease. For those who are suffering from diabetes, gum disease is often more likely and cases can be more severe.
How is diabetes linked to gum disease?
Diabetes is a disease that occurs when the amount of glucose, or blood sugar, in the body is too high. A hormone known as insulin is responsible for helping the cells in your body to use this glucose for energy. For those with diabetes, the body doesn’t produce enough insulin, so too much glucose stays in the bloodstream.
Inflammation in the mouth, such as the type responsible for periodontal disease, have an impact on the body’s ability to regulate blood sugar levels as well. This means that people with diabetes, whose bodies are already struggling with processing sugar, can find themselves having an even harder time if they are suffering from gum disease.
This link can go both ways, too, as high blood sugar levels provide an environment that can make gum infections more likely,
Heart Disease/Stroke & Periodontal Disease
The potential links between periodontal disease and heart disease and stroke have been the subject of medical research in recent years. While a clear cause-and-effect relationship has yet to be established, findings lend a lot of credibility to the connection between oral inflammation and cardiovascular disease.
Researchers have found that chronic inflammation in the body is a major contributor to health problems in the body. This means that long-term inflammation, such as that in gum disease, may lead to narrowing or blockages in blood vessels—a situation that can lead to a heart attack or stroke.
In an article that looked at a number of related studies, it was found that having periodontal disease increases a person’s risk of cardiovascular disease by around 20%. One stroke expert reported that periodontal disease could make a person almost twice as likely to experience a stroke.
While research is still ongoing, what’s already been discovered should only put more emphasis on the need for a healthy mouth and gums.
If you have any concerns about the health of your mouth, or if you haven’t had a dental appointment in a while, make sure to get in touch to schedule your next visit.
Cancer & Periodontal Disease
Links have been established between gum disease and many types of cancers.
Studies performed at Brown University, Harvard, New York University and others have looked into the link between gum disease and pancreatic cancer. Pancreatic cancer is extremely hard to detect and causes death within six months of diagnosis. It is approximated that pancreatic cancer is responsible for nearly 40,000 deaths per year in the US. So, what is the connection between gum disease and pancreatic cancer?
The connection comes from changes in the microbial mix in your mouth. Those who have porphyromonas gingivalis in their mouth were at a 59% higher risk of developing pancreatic cancer. In addition to prophyromonas gingivalis, those who had aggregatibacter actinomycetemcomitans were 50% more likely to develop pancreatic cancer.
While the names may not mean much to the average person, the important thing to understand is that both of these types of bacteria have been tied to gum disease.
Unfortunately, the majority of Americans do not take proper care of their gums. It is reported that nearly half of American adults over the age of 30 have some form of periodontal disease. If you look at Americans over the age of 65, the percentage suffering from periodontal disease increases to 65%. Although not nearly as talked about, gum disease is almost 2.5 times more common than diabetes.
However, there is some good news! Gum disease responds extremely well to treatment and can easily be reversed after detected by your dentist.
A study done by the Federal University of Santa Maria Dental School in Brazil found that women with periodontitis are 2-3x more likely to develop breast cancer. In this instance, the researchers believe that breast cancer may be triggered due to systemic inflammation resulting from gum disease.
The study was based on 67 women who have been diagnosed with breast cancer and 134 controls from 2013 to 2015. It is important to remember that this study has not proven that gum disease causes breast cancer, but the findings do provide further support for the idea that oral health is vital to our overall wellbeing.
In the United States, for every 100,000 women, there are 124.9 new cases of breast cancer. Breast cancer continues to be studied, and this possible connection to oral health provides another avenue to be explored when learning to treat this type of cancer.
A 10-year study performed by NYU Langone Health’s Perlmutter Cancer Center has found that two types of bacteria that are present in individuals with gum disease can increase the chances of being affected by esophageal cancer.
The eight most common type of cancer in the world, esophageal cancer can be highly fatal and is the sixth most common cause of cancer-related deaths. In the US, it affects around 1 in 125 men and 1 in 417 women. The American Cancer Society says that currently, only around 20% of those diagnosed with this form of cancer will live for more than five years following diagnosis.
The study by NYU Langone found that bacteria associated with periodontal (gum) disease can find its way into the upper digestive tract, and in the case of one of the types of bacteria in the study, tannerella forsythia, its presence may increase the chances of this kind of cancer by 21%.
It is important to note that while the bacteria involved demonstrates a link between gum disease and esophageal cancer, it has not yet been proven that periodontal disease directly causes cancer. However, the connection should be reason enough to reinforce the importance of proper oral hygiene and treatment of gum disease.
How Is Rheumatoid Arthritis Linked to Gum Disease?
A November 2020 study found more evidence of connections between rheumatoid arthritis and periodontal (gum) disease.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis a chronic inflammatory and autoimmune disease, which causes the immune system to mistakenly attack healthy cells of the body. It results in painful swelling of the affected tissues. While RA primarily affects the joints of the body, it can also damage the skin, lungs, heart, blood vessels, and eyes.
How Is Rheumatoid Arthritis Connected to Gum Disease?
Although there’s still more to learn about whether or not one condition could be a cause of the other, past studies have found that people with RA are 8 times more likely to develop gum disease than those without RA. It’s also been found that the type of bacteria that causes periodontal disease, porphyromonas gingivalis, can lead to an earlier onset of RA and make it more severe.
Connections With Cardiovascular Disease
People with rheumatoid arthritis also face elevated risks for cardiovascular disease, which itself has links to periodontal disease.
The November 2020 study in Arthritis & Rheumatology found that a pathogen related to periodontal disease, called aggregatibacter actinomycetemcomitans, “had the strongest associations with atherosclerosis in the patients with rheumatoid arthritis that we studied,” according to Jon T. Giles, MD, MPH, of Columbia University.
While research into the connections between periodontal disease and other diseases continues, this should further reinforce the importance of a healthy mouth. Preventing or treating gum disease may very well prevent or lessen the impact of ailments such as rheumatoid arthritis.
Gum Disease and Reproductive Health
It can’t be overstated how much the health of the body is connected to oral health. Research has found that gum health is even linked to sexual and reproductive health.
The plaque that develops as a biofilm in our mouths is made up of bacteria, including these:
- Porphyromonas ginigvalis
- Tannerela forsynthia
- Prevotella intermedia
- Aggregatibacter actinimucentemcomitans
- Treponema denticola
Periodontal disease allows these pathogens, which originate in the mouth, to be introduced into the bloodstream. The presence of some of these types of bacteria in the bloodstream is where many of the links between oral health of various other ailments have been discovered. And it isn’t just the bacteria itself, but the resulting inflammatory response and waste products of the bacteria that can cause problems.
Pregnancy and Oral Health
In the case of pregnancy, it’s believed that these pathogens can cause negative outcomes such as low birth weight or premature birth. A few studies have suggested that women suffering from chronic periodontitis may be 4 to 7 times more likely to give birth prematurely.
Women who become pregnant should be aware that hormonal changes make them more susceptible to getting gum disease as well. Gum disease has been linked with preeclampsia, a condition which can damage internal organs such as the kidneys and liver of both the baby and the mother.
Fertility and Periodontal Disease
Along with the impacts on pregnancy, studies have found that gum disease can play a role in fertility, with both male and female fertility being impacted.
One study in Australia found that women with periodontal disease may require two more months to conceive than those without. In men, the bacteria related to gum disease lead to low sperm count, poor sperm motility. There appears to be a connection with erectile dysfunction as well, with men who have gum disease being more likely to suffer from ED.
Gum Disease and Dementia
How Is Gum Disease Connected to Dementia?
According to the National Institutes of Aging, the bacteria responsible for periodontal disease are also associated with the development of dementia (particularly vascular dementia) and Alzheimer’s disease.
We frequently emphasize the importance of oral health and treatment of periodontal/gum disease, as this infection of the tissues surrounding the gums allows bacteria from the mouth to enter the bloodstream and affect other parts of the body.
Using data from the National Health and Nutrition Examination Survey along with blood tests, the National Institutes of Aging researchers looked at a group of more than 6,000 people to find if the oral bacteria in gum disease could be linked with diagnoses of dementia.
They looked for nineteen different types of oral bacteria, including Porphyromonas gingivalis, which is the most typical type of bacteria found in gum disease. In those who are afflicted by Alzheimer’s, it’s been found that beta-amyloid proteins can clump together to form plaques. A previous study has suggested that these plaques may actually be produced in the body as a response to Porphyromonas gingivalis.
One of the findings was that older adults with gum disease at the start of the study were more likely to develop Alzheimer’s during the course of the study than those who did not have signs of gum infections.
While it appears to be clear that there are connections between dementia and the bacteria found in periodontal disease, researchers are looking into more long-term studies to learn more about this association. The current findings suggest that gum disease may precede cases of dementia, but it’s also known that dementia makes it harder for patients to properly care for their teeth and gums. Further research needs to be done into whether or not treatment of infections of gingivalis can have an impact on Alzheimer’s disease.
Periodontal Disease and Colon Cancer
Gum disease provides a way for oral bacteria to find their way to other parts of the body. According to research done by Virginia tech, this bacteria may facilitate the spread of colon cancer and other types of cancer to other parts of the body.
The bacteria of interest in the study was Fusobacterium nucleatum, which is common in the mouth and has been found to invade tumors in the colon. Daniel Slade, Ph.D., an assistant professor in the Virginia Tech Department of Biochemistry explains the importance of the discovery that this type of bacteria may responsible for the spread of cancer in the body: “This is vital information because 90% of cancer-related deaths result from nonprimary tumors or sites that have metastasized to somewhere else in the body.”
In a 2017 study performed on mice, researchers found their first evidence that F nucleatum could be directly responsible for causes cancer in the colon to spread to the liver.
The research team has made examining the role this bacteria plays in the spread of cancer a focus on their treatment. Understanding the process by which this works can help medical experts find a way to inhibit the spread of cancer from one organ to another.
The team’s latest study, “Fusobacterium Nucleatum Host-Cell Binding and Invasion Induces IL-8 and CXCL1 Secretion That Drives Colorectal Cancer Cell Migration” was published in Science Signaling.
While promising for future research into the treatment of cancer, these findings also further highlight the importance of treating gum disease, in order to minimize the presence of oral bacteria in the rest of the body.
Can You Die From Periodontitis?
The link between the health of the mouth and the overall health of the body is not something to be overlooked. Researchers have uncovered significant relationships between the health of the mouth and diabetes, heart disease, and cancer. Types of bacteria found in the mouth can affect respiratory problems, also.
A 3-month study was performed in Germany that followed patients who had been hospitalized with COVID-19. The study discovered that patients with periodontal disease had a significantly greater chance of life-threatening respiratory failure than those who had healthy mouths.
This respiratory condition is likely caused by IL-6 (interleukin), a harmful protein that is produced by periodontitis. Interleukin moves from the gum tissue to the lungs where it can cause respiratory issues.
According to Shervin Molayem, DDS, founder of the UCLA Dental Research Journal, “Gum disease has been linked to other breathing ailments, including pneumonia and chronic obstructive pulmonary disease, so we weren’t surprised to find a link to respiratory problems with COVID-19.”
He continued with, “what shocked us was the discovery of the protein’s devastating, life-threatening impact on patients once they’re hospitalized. One tiny, inflammatory protein robbed them of their ability to breathe.”
The California Dental Association has released an article called The Mouth-COVID Connection in which you can learn more about these findings.
Now, more than ever, having good oral health is critical. Make sure you have your six-month exam and cleaning scheduled and contact us if you notice any of the signs of gum disease.
More research has been done on this topic, including a study published in the European Federation of Periodontology’s Journal of Clinical Periodontology.
The team performing the study in Qatar looked at 568 patients who had been diagnosed with COVID-19 between February and July of 2020. Of the patients in the study, 40 had suffered complications, which consisted of being put in intensive care, placed on a ventilator, or dying. The study looked at a number of factors for their connection with COVID-19, including heart disease, asthma, diabetes, body mass index, blood pressure, smoking, and others.
The study found that COVID-19 patients who were suffering from periodontal disease were nearly nine (8.81) times more likely to die than those without.
COVID patients with gum disease were 4.5 times more likely to need a ventilator and were 3.5 times more likely to be admitted to intensive care.
Those with periodontal disease were more likely to develop COVID-19 complications (around 12.8%) than those without (about 2.3%).
One of the study’s co-authors, Professor Lior Shapira of the Hebrew University, said, “The results of the study suggest that the inflammation in the oral cavity may open the door to the coronavirus becoming more violent. Oral care should be part of the health recommendations to reduce the risk for severe COVID-19 outcomes.”
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Regular visits with Dr. Williams to assess and maintain your oral health is likely more important to your health than you may have thought.