MEDICAL IMPLICATIONS OF PERIODONTAL DISEASE

Dental scientists have been very busy in the past few years. They have focused efforts on periodontal diseases. The Good News is that there are many new ways to treat gum diseases. Advances have been made in both Surgical and Non-Surgical treatments. In 1998  the  FDA approved three new drug-based treatments. These treatments may help some patients avoid surgery and improve results of treatment. The Bad News is that Gum Diseases are now thought to be factor in the development of many serious health problems. This makes it ever more important to have the proper treatment and continuing maintenance. This issue has received much attention in the media.

GUM DISEASE IS A RISK FACTOR FOR MANY DISEASES

New research has show that dental problems can influence your general health much more than was previously thought. The strongest influences come from periodontal disease. These discoveries implicate periodontal and dental disease as a risk factor in: Blood Infections, Heart infections, Cardiovascular Disease, Atherosclerosis, Diabetes, Respiratory Disease, Premature Low Weight Babies and Mental Health

Blood  Infections

It is a common event for oral bacteria to get into the blood stream from gum infections. This is the basic way it can affect your health. The extent that this occurs seems related to the severity of gum inflammation. Chewing and some oral hygiene efforts can cause releases of bacteria.

Heart Infections

It is generally accepted that dental procedures predispose some patients with pre-existing heart damage to Infective Endocarditis, a serious heart infection. This disease is usually fatal unless interrupted by antibiotic treatment. The usual cause is oral streptococci in dental plaque with an affinity to deposit on heart valves. Reduction of plaque through personal and professional care is essential for patients with valve problems who are predisposed to this condition.

Cardiovascular Disease and Atherosclerosis

More evidence has developed that links gum infection to clogged arteries and heart attacks. A number of studies have found an increased risk of Coronary Heart Disease ranging from 20-180% in patients with periodontitis. They show the risk of incurring fatal heart disease is 1.5 to 2.0 times greater for patients with periodontal disease. Dental infections increase the risk of coronary artery disease in a manner similar to the other classic risk factors, such as smoking, diabetes, hypertension, etc. Similar findings have been noted between dental infections and strokes. The exact mechanism for this association is unknown at this time.

Diabetes

It has been well documented that periodontal disease is more prevalent in patients with Type 1 and Type 2 diabetes. Recently attention has focused on the possible role of periodontitis as a predisposing factor in the development of diabetes. Numerous research findings indicate that severe periodontitis may be an important risk factor in the progression of diabetes. Diabetic patients should be treated to eliminate periodontal infections.

Respiratory Disease

The development of bacterial pneumonia can involve movement of oral bacteria into the lungs. Studies have shown 10-25% of pneumonia could be attributed to bacteria of possible oral origin. It is thought that chronic bronchitis may also be influenced by oral conditions.

Premature  Low Weight Babies

Recent research shows that the children of mothers with untreated periodontal disease have a significantly increased risk of being born both prematurely and underweight. These children often develop health problems from this well into later life.

Mental Health

There is a relationship between oral health and self-perception of well being. Oral disease can lead to pain and malaise with subsequent impact on psychosocial health. Poor oral function interferes with eating and speaking this can lead to loss of self-satisfaction and embarrassment. Poor oral appearance can degrade feelings of self-worth. Additionally, ill or depressed individuals tend to be less conscientious with their oral hygiene leading to decreased oral health.

Other Diseases

Oral bacteria released in the bloodstream can cause abscesses in various organs. Although rare, brain abscesses have been reported a number of times. It has also been reported that there may be an association between an unusual oral microorganism and Crohn's disease (ulcerative colitis).  Parallels between treatment and the mechanism of development of arthritis and periodontal disease have been noted; despite these similarities the evidence of an association remains unclear.

What To Do

There are many studies that suggest gum (periodontal) infections are a potential contributing factor to a wide range of systemic conditions. Most of these studies are preliminary and further research is needed. This means it is unwise to panic at this stage of knowledge.

If you have any of the conditions mentioned here or have a family history of these problems, it would be wise to have a medical and periodontal checkup. In some cases it will be recommended to have your periodontist and physician jointly discuss your case to minimize risks.

Dentists primarily treat periodontal disease to preserve natural teeth. If cause and effect associations with medical diseases are demonstrated, dental emphasis may shift. As the public becomes aware, these issues become powerful motivating factors for treatment

Periodontitis most likely will be borne out as a risk indicator for cardiovascular disease. Diabetic control is important in the management of periodontitis in diabetics.

Beyond these conditions the associations remain largely theoretical, making it too soon to act. Additional research is needed to clarify these issues. In my mind, an important perspective to take is that periodontal disease is a chronic infection that has all the negative ramifications of other medical infections on the your health. All chronic infections need definitive treatment.

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