OPEN WIDE Once again, Mom was right.
For years she hounded you to brush and floss regularly to help keep your teeth and gums healthy. Little did she or anyone else know then that following her oral hygiene advice may also protect you from serious illness and disease. There’s growing evidence that gum or periodontal disease may put you at increased risk for heart attacks, stroke, diabetes and some cancers.
In March, a study published in the New England Journal of Medicine found that treating severe gum disease can improve the function of blood vessel walls, improving heart health.
The April issue of the Journal of Periodontology published studies that found periodontal bacteria in the arteries of people with heart disease and in the placentas of pregnant women with high blood pressure. Another study in that journal found that gum disease may predispose some people to developing early signs of diabetes. And earlier this year, a Harvard School of Public Health study of more than 50,000 men showed that those who had gum disease had double the risk of getting pancreatic cancer than those without gum disease.
GUM DISEASE “Although the cause and effect of periodontal disease linked to other diseases is not absolutely proven, the data is starting to pile up,” says Dr. David Richards, a San Diego periodontist who emphasized that it’s more important than ever to “take aggressive action against periodontal disease.”
An estimated 80 percent of American adults have some form of periodontal disease, according to the National Institute of Dental and Craniofacial Research at the National Institutes of Health.
The main cause of gum disease is bacteria, which is found in plaque, a sticky, colorless film that constantly forms on the teeth and tongue. Daily brushing, flossing, tongue scraping and other forms of interdental cleaning usually remove plaque to keep the gums healthy. But it doesn’t take long for sloppy brushing and haphazard flossing to lead to gingivitis, the early stage of periodontal disease. Characterized by swollen and bleeding gums, it’s reversible with professional treatment and diligent home oral care.
Left untreated, however, gingivitis can develop into periodontitis, advanced gum disease.
As tartar and plaque continue to build up, pockets form between the teeth and gums and the gums may begin to recede. As the pockets become deeper, the disease destroys more gum tissue and progresses to the bone, which can eventually cause teeth to become loose or fall out.
The dentist, periodontist or dental hygienist can remove plaque through deep cleanings called scaling and root planing. If inflammation and deep pockets remain after cleaning and medication, it may be necessary to do flap surgery, which involves lifting back the gums and removing the tartar. Your periodontist may also suggest bone and tissue grafts to help replace or encourage new growth of bone or gum tissue destroyed by the disease.
About three of every 10 adults over age 65 have lost all of their teeth because of cavities and gum disease, according to the U.S. Centers for Disease Control and Prevention.
“A lot of people go untreated for periodontal disease because most of the time it doesn’t hurt. By the time they feel or notice anything, it’s too late. The bacteria has already eaten away at the bone and tissue,” says Dr. Irvin Silverstein, another San Diego area periodontist. “If periodontal disease hurt as much as an infected finger, they’d get themselves treated early.”
A number of studies indicate that the unchecked inflammation and bacteria in the mouth may be at the root of many problems throughout the body. The bacteria in plaque produce toxins that trigger an immune response and the release of chemicals called cytokines to wall off and kill the bacteria. The problem is, when too many cytokines are released, inflammation increases, damaging tissues in all areas of the body and causing increased blood pressure levels, high cholesterol levels and increased blood clotting, which can lead to potentially fatal heart attacks and strokes.
“Inflammation is a very important phenomenon in the spectrum of all kinds of diseases,” Richards says. “The inflammatory messengers sent out by diseased gums are taken by the bloodstream to distant sites in the body and can affect overall health.”
Some researchers also believe that when periodontal bacteria travel from the mouth through the bloodstream, they may lodge in the blood vessel walls, triggering inflammation and causing the walls to thicken. A thickened blood vessel wall can increase a person’s risk of heart disease and heart attack.
To save your teeth and your general health, stopping periodontal disease before it starts is critical, periodontists say, because you’re never cured.
“Just like with diabetes, you will always be stuck with periodontal disease once you have it. But, you can manage it,” Richards says. “You will have to be more vigilant (about oral hygiene) than the next person who doesn’t have any deep pockets. And you may need to get your teeth cleaned four times a year and use special mouth rinses. But, if you work at it, you can control it.”
Even some of the insurance companies are figuring out that keeping the gums healthy can save them big bucks. Don’t be surprised if your MEDICAL insurance urges you or even forces you to show at least an attempt at getting gums healthy. Smarter companies like Aetna and Blue Cross seem to be moving toward providing benefits to encourage better gum health.
Some physicians, like doctors of the joints are requiring patients to get a dental clearance before performing surgeries like hip or knee replacements.
ScienceDaily (Nov. 28, 2007) — A new study
found that prevention of periodontal diseases
may lead to savings on not only dental costs,
but also medical care costs. Periodontal, or
gum diseases have been linked to systemic
health conditions including diabetes,
cardiovascular disease, and respiratory
The study, conducted in Japan, examined the
effect of periodontal diseases on medical and
dental costs in 4,285 patients over a 3.5
year time span. The patients were between the
ages of 40-59. Researchers found that
cumulative health care costs were 21% higher
for those patients with severe periodontal
disease than those with no periodontal
disease. Severe periodontal disease, or
periodontitis, involves bone loss and
diminished attachment around the teeth.
“While previous studies have evaluated the
potential link between periodontal diseases
and other systemic conditions, this study
provides an interesting analysis of total
health care costs and the financial impact of
having periodontal diseases,” explained JOP
editor Kenneth Kornman, DDS. “The research
suggests that patients with sever periodontal
diseases incur higher overall health care
expenses as compared to those patients with
no periodontal disease. Prevention of
periodontal disease may be very important in
overall health, and this study suggests that
it may also indirectly translate into lower
total health care costs.”
“Everyone is looking for ways to reduce
health care costs,” said Susan Karabin, DDS,
President of the American Academy of
Periodontology. “Especially those who are in
an age category where they are more
susceptible to periodontal diseases. Because
of the relationship between the mouth and the
rest of the body, treating periodontal
disease may be one simple way to decrease
total health care costs. If caught early,
periodontal diseases can be treated using
simple non-surgical techniques which can
restore your mouth to a healthy state.”
Journal of Periodontology article: “The
effect of periodontal disease on medical and
dental costs in a middle-aged Japanese
population: A longitudinal worksite study,”