gum disease and your health

Periodontal disease

Periodontal disease is a condition where you have millions of harmful bacteria that have multiplied under the gumline causing an infection. This condition starts as gingivitis or inflammation of the gingiva. It is characterized by a slight irritation and redness of the gums but is typically painless. The only symptom you may notice is bleeding while brushing or flossing. If your gums bleed, it is NOT normal. It is a sign that some type of inflammation exists and you should see a dental professional. Gingivitis progresses to periodontal disease (Periodontitis or Phyorrhea) if not treated. There are four stages of severity and they progress from moderate to severe and are characterized by the following in varying degrees:

• Bone destruction
• Tissue pulling away from the teeth causing “pockets” 
• Gum recession
• Bleeding gums
• Bad Breath
• Loosening of teeth and eventual loss of teeth
• Presence of harmful germs or bacteria
• Inflammatory response of the immune system and presence of C Reactive Protein in the blood (more on this later)

Mouth is a Mirror

As a dental student at The University of Pittsburgh I remember on the very first day of Pathology class our instructor saying that the mouth was a mirror to the overall health of the patient. As a dentist we often have the opportunity to examine a patient long before they see their physician and long before certain disease states become symptomatic. Dentists have long suspected a link between periodontal disease and other systemic diseases but it was thought to be related to the bacteria that cause periodontal disease.

Recent research has shown a definite link between gum disease and other diseases like heart disease, stroke, cardiovascular disease, Alzheimer’s and Diabetes but not for the reasons we once suspected. Periodontal disease is essentially a chronic inflammatory disease and we now know that is this inflammatory response that links periodontal disease with other disease states. This is not to say that the bacteria the cause periodontal disease are not harmful systemically but only to say that it is a combination of factors that are responsible for both oral and systemic conditions. In 2000 the Surgeon General released a report on oral health in America and said, “Oral health is Integral to general health.”

C Reactive Protein (CRP)

C Reactive protein is a protein that is found in the blood which rises during periods of inflammation. Generalized periods of inflammation can be brought about by such things as: cigarettes smoking, hypertension (high blood pressure) hyperglycemia (high blood sugar), atherogenic lipoproteins (the bad cholesterol in your blood) and Periodontal Disease. Dr. Steven of the bacher of the American Academy of Periodontolgy states, “Periodontal disease needs to be considered as a major contributor to increased levels of CRP by the medical community.” These increased levels of CRP in the blood directly increase an individual’s increased risk to such disease states such as Heart Disease, Atherosclerosis, Stroke, Pancreatic Cancer, Parkinson’s, Alzheimer’s, Diabetes and Osteoporosis.

Heart Disease, Stroke and Cardiovascular disease

In 2004 Heart Disease killed over 450,000 Americans taking the spot as America’s number one killer according to the American Heart Association. It is estimated that 85% of the population over the age of 65 have some form of gum disease and over 50% under the age of 65. While it is unclear how many lives could be saved by having good periodontal health it is clear that it would be a large number. According to Dr. Steven Offenbacher, a research professor at the University of North Carolina and member of the AAP the number would be in the “hundreds of thousands”.

Researchers have known for some time that increased CRP levels increase the risk for cardiovascular disease but a recent study in the New England journal of Medicine stated that increased levels of CRP in the blood is a better predictor of Heart attacks than cholesterol levels. It is now possible to test for elevated CRP levels and it is quite possible that this will be a routine screening in the very near future. In fact, new studies show a highly specific form of CRP is the best predictor in having a heart attack and a predictor of survivability and recurrence.

Conclusions

Good oral hygiene and plaque control are necessary not only to promote good oral health but also to promote good overall health as well. The presence of pathogenic oral bacteria can cause gingivitis and eventually Periodontitis or gum disease which will evoke an immune inflammatory response in an individual. This inflammatory response triggers the liver to produce a substance called C Reactive Protein which is also present is inflammatory responses of other risk factors for major diseases: Heart disease, cardiovascular Disease, Stroke, Diabetes, Alzheimer’s and Parkinson’s. To ensure the best chance of good overall health your best bet is to reduce your risk factors:

• Avoid smoking
• Exercise at least three times a week for 30 minutes
• Eat a balanced diet with moderate caloric intake
• Maintain healthy blood pressure
• Maintain your ideal weight
• Brush and floss daily
• See your dentist and hygienist twice a year
• Get a yearly physical by your physician

The relationship between periodontal disease and other diseases is well established. Because this disease is painless until it’s end stages it is important to visit your dentist regularly to be screened for periodontal conditions. If you have a family history of heart problems, cardiovascular problems, diabetes, Alzheimer’s, pancreatic cancer or are pregnant, it is important that you be screened by a dental professional. The damage in the mouth caused by gum disease can never be reversed but it can be treated and maintained. A healthy mouth can mean a Healthy life.