The Mouth-Body Relationship

Periodontics is one of the most heavily researched disciplines in dentistry. The American Academy of Periodontology (AAP) has produced a series of clinical and scientific papers which summarize their statements, positions, parameters of care, and reviews on important topics in periodontics (Link to AAP). Periodontology 2000 is a well-recognized periodontal journal that produces in-depth review articles on every topic within the periodontal specialty (Link to Periodontology 2000).

The prevalence of periodontal disease among people 30 years of age or older is 47.2% with 8.7% having mild, 30% having moderate, and 8.5% having severe disease.1 There is a strong relationship between periodontal disease and systemic conditions such as cardiovascular disease, diabetes, and osteoporosis. This is because periodontal infections have the potential to spread to the bloodstream and cause multiple systemic issues. The collective research provides enough evidence to indicate that both the prevention and treatment of periodontal disease may reduce our chances of experiencing other health problems.

Cardiovascular Disease

Patients with periodontal disease are about 1.2x more likely than those with healthy gums to develop coronary artery disease.2 Periodontal bacteria have the ability to invade the cells of our gums and blood vessels. They may then gain access to our bloodstream, and cause inflammation within distant sites, including arteries. Some bacteria may attach to fatty plaques, which build up on artery walls, causing them to narrow. This constricts blood flow. Oxygen may then become restricted from reaching the heart, which may lead to heart failure.3

1 in 12, or 8% of Canadian adults 20 years of age or older live with diagnosed heart disease. Coronary artery disease is the most common type of heart disease. Heart disease is the 2nd leading cause of death in the Canada.4 Obtaining treatment for periodontal problems can help prevent us from developing this unfortunate condition. Professional treatment must be combined with proper home oral hygiene techniques and frequency, and regular professional hygiene maintenance visits with a dental hygienist.

Diabetes

Patients with diabetes are 2.8x more likely to have periodontal disease than patients with normal glycemic control, even after controlling for confounding variables such as age and oral hygiene measures. Diabetes causes blood vessel walls to thicken due to excess collagen formation. Circulation within our gums is slowed down, allowing periodontal disease-causing bacteria to thrive and colonize, unchecked by our immune system. This results in periodontal infections.5

1 in 10, or 10% of Canadian adults 20 years of age or older live with diagnosed diabetes. Type 2 diabetes is the most common type of diabetes. If left uncontrolled, diabetes results in consistently high blood sugar levels (hyperglycemia), which can lead to many serious complications, such as heart disease.6 Proper home oral hygiene measures, including daily brushing and flossing, as well as regular visits with the dentist for dental cleanings are important for everyone, but these measures are especially essential for diabetics.

Respiratory Disease

Patients with periodontal disease are about 1.2x more likely than those with healthy gums to develop lung cancer. Inflammation is a critical part of cancer progression. Periodontal disease, in and of itself, is a chronic inflammatory disease. The oral cavity has a close anatomic proximity to the lungs.7

Lung cancer is the most common cancer in Canada. 1 in 11 men (9%) and 1 in 14 women (7%) will be diagnosed with lung cancer in their lifetime. 98% of lung cancers occur in adults 50 years of age or older.8 Obtaining treatment for periodontal problems can help prevent us from developing this unfortunate condition.

Osteoporosis

Patients with periodontal disease are about 1.5x more likely than those with healthy gums to develop osteoporosis. Chronic inflammation again provides the connection. Our immune system responds to periodontal pathogens and in an effort to protect our gums from bacterial invasion, it may also cause bone loss to occur around our teeth by activating osteoclasts, which break down bone. An excess of these osteoclasts in our bloodstream may lead to an excess of the break down of our skeletal bone.9

1 in 10, or 10% of Canadian adults 40 years of age or older have osteoporosis. Women are 4x more likely to have osteoporosis than men. One possible explanation for this is that women start with lower bone density and they lose bone mass more quickly as they age, due to a drop in estrogen during menopause.10 Obtaining treatment for periodontal problems can help prevent us from developing this unfortunate condition.

Pregnancy

Pregnant female patients with periodontal disease are about 2.1x more likely than those with healthy gums to develop pre-term birth, less than 37 weeks.11 A normal gestation period is 37-41 weeks. Babies born pre-term are at a higher risk of various medical problems such as respiratory distress syndrome, chronic lung disease, cardiovascular disorder, asthma, as well as hearing and vision loss.12 Similar to the other mechanisms discussed, it has been proposed that the chronic inflammatory state in the oral cavity, produced by the presence of periodontal pathogens, leads to increased levels of pro-inflammatory prostaglandins and cytokines in our bloodstream, which act in a complex manner that leads to pre-term birth.13

7 in 100, or 7% of all births in Canada are pre-term.12 The question of whether or not periodontal treatment during pregnancy reduces this event from occurring has been heavily researched. A recent comprehensive review of all studies available has failed to show a clear benefit of periodontal treatment on reducing the chances of pre-term birth.13 Research on this topic is still ongoing. If you are pregnant, it is important to practice effective home oral hygiene care for preventing gum disease. Obtaining treatment for periodontal problems during pregnancy may still help to prevent pregnant patients from encountering this unfortunate event.

References

1. Genco R, et al. Risk factors for periodontal disease. Periodontology 2000. 2013; 62: 59-94.

2. Leng W, et al. Periodontal disease and risk of coronary heart disease: An updated meta-analysis of prospective cohort studies. International Journal of Cardiology. 2015: 469-472.

3. Scannapieco F, et al. Oral inflammation and infection, and chronic medical diseases: implications for the elderly. Periodontology 2000. 2016; 72: 153-175.

4. Public Health Agency of Canada. 2017, February 9. Heart Disease in Canada.

5. Mealy B, et al. Diabetes Mellitus and Periodontal Diseases. Journal of Periodontology. 2006; 77: 1289-1303.

6. Public Health Agency of Canada. 2017, November 14. Diabetes in Canada.

7. Zeng X, et al. Periodontal disease and incident lung cancer risk: a meta-analysis of cohort studies. Journal of Periodontology. 2016; 87: 1158-1164.

8. Public Health Agency of Canada. 2017, June. Lung cancer in Canada.

9. Mau L, et al. Patients with chronic periodontitis present increased risk for osteoporosis: A population-based cohort study in Taiwan. Journal of Periodontal Research. 2017; 52: 922-929.

10. Public Health Agency of Canada. 2018, January 12. Osteoporosis.

11. Xiong X, et al. Periodontal disease and adverse pregnancy outcomes: a systematic review. British Journal of Obstetrics and Gynaecology. 2006; 113: 135-143.

12. Statistics Canada. 2016, October 26. Health Fact Sheets – Preterm live births in Canada, 2000 – 2013.

13. Iheozor-Ejiofor Z, et al. Treating periodontal disease for preventing adverse birth outcomes in pregnant women (Review). Cochrane Database of Systematic Reviews. 2017: 1-84.