Periodontal Gum Disease
Periodontal gum disease is a serious infection of the mouth that, if left untreated, can lead to tooth loss and is known to be a contributing factor in developing numerous serious diseases. Research has shown that chronic oral infections are associated with, and may contribute to life-threatening health problems such as heart disease, strokes, diabetes, spontaneous pre-term births, and low-weight babies.
Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on everyone’s teeth) causes the gums to become infected and inflamed. In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene, especially lack of flossing and is reversible with professional treatment and good oral home care.
Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate and inflame the gums. The toxins stimulate a chronic inflammatory response in which the body, in essence, turns on itself and the gums, ligaments, and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue, ligaments and bone are broken down and destroyed. Initially, this destructive process has very mild symptoms and the patient may not be aware he has a serious infection and the damage it is causing below the gum line. Eventually, teeth can become loose and may be lost or have to be removed. This pernicious infection can be present for years and is believed to adversely affect the body’s immune system making it more susceptible to numerous serious diseases.
More than 300 different types of bacteria exist in the human mouth, either alone or in combination. This makes treating periodontal disease difficult, time-consuming and expensive as the periodontist tries various antibiotics and treatment modalities until an effective treatment plan is developed.
To add to the periodontist’s difficulty, the existing manual pick and probe methodology currently used to diagnose periodontal disease and monitor its treatment (described below) is disruptive to the healing process and very inaccurate so the treatment plan’s effectiveness may not be readily ascertainable. This can result in a trial and error approach that can last for many months and be very time consuming and expensive. In the meantime, as the patient’s immune system fights this chronic and perhaps serious infection, it creates an opportunity for other serious diseases to develop. Like any other serious infection, if not promptly treated with the proper types and amounts of antibiotics, periodontitis can result in severe systemic infection that can even become life-threatening.
The Mouth and Body Connection
In July of 1998, the American Academy of Periodontology launched an effort to educate the public about new findings which support what dental professionals had long suspected: Infections in the mouth can play havoc elsewhere in the body.
Periodontal disease is a bacterial infection, and all infections are cause for concern. Periodontal bacteria can enter the blood stream and travel to major organs and begin new infections. Research is suggesting that this may:
- Contribute to the development of heart disease, the nation’s leading cause of death.
- Increase the risk of stroke.
- Increase a woman’s risk of having a preterm, low birth weight baby.
- Pose a serious threat to people whose health is compromised by diabetes, respiratory disease, or osteoporosis.
Also see the sections on treatment, warning signs, and Don’t ignore your oral health.
Heart Disease and Stroke
Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.
Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries. Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease. Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your dentist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.
Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.
Preterm Low Birth Weight Births
For a long time we’ve known that risk factors such as smoking, alcohol use, and drug use contribute to mothers having babies that are born prematurely at a low birth weight. Now evidence is mounting that suggests a new risk factor – periodontal disease. Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small.
It appears that periodontal disease triggers increased levels of biological fluids that induce labor. Furthermore, data suggests that women whose periodontal condition worsens during pregnancy have an even higher risk of having a premature baby.
People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don’t have their diabetes under control are especially at risk.
A study in the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are. Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways – periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.
Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications. Thus, diabetics who have periodontal disease should be treated to eliminate the periodontal infection.
Bacterial respiratory infections are thought to be acquired through aspiration (inhaling) of fine droplets from the mouth and throat into the lungs. These droplets contain germs that can breed and multiply within the lungs to cause damage. Recent research suggests that bacteria found in the throat, as well as bacteria found in the mouth, can be drawn into the lower respiratory tract. This can cause infections or worsen existing lung conditions. People with respiratory diseases, such as chronic obstructive pulmonary disease, typically suffer from reduced protective systems, making it difficult to eliminate bacteria from the lungs.
Scientists have found that bacteria that grow in the oral cavity can be aspirated into the lung to cause respiratory diseases such as pneumonia, especially in people with periodontal disease. This discovery leads researchers to believe that these respiratory bacteria can travel from the oral cavity into the lungs to cause infection.
Chronic obstructive pulmonary diseases (COPD) cause persistent obstruction of the airways. The main cause of this disease is thought to be long-term smoking. Chemicals from smoke or air pollution irritate the airways to cause obstruction. Further damage to the tissue and working function of the lungs can be prevented, but already damaged tissue cannot be restored – untreated or undetected COPD can result in irreversible damage. Scientists believe that through the aspiration process, bacteria can cause frequent bouts of infection in patients with COPD. Studies are now in progress to learn to what extent oral hygiene and periodontal disease may be associated with more frequents bouts of respiratory disease in COPD patients.
Researchers have suggested that a link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation. However, hormone replacement therapy may offer some protection.
A study in the Journal of Periodontology concludes that estrogen supplementation in women within five years of menopause slows the progression of periodontal disease. Researchers have suspected that estrogen deficiency and osteopenia/osteoporosis speed the progression of oral bone loss following menopause, which could lead to tooth loss. The study concluded that estrogen supplementation may lower gingival inflammation and the rate of attachment loss (destruction of the fibers and bone that support the teeth) in women with signs of osteoporosis,thus helping to protect the teeth.
Some warning signs of gum disease include: tender, bleeding gums, persistent bad breath, receding gums, changes in your bite, and tooth movements such as migration and mobility.
We hope that this information was helpful in better understanding periodontal disease.
Treatment of Periodontal Disease
If you’re diagnosed with periodontal disease, your dentist may recommend periodontal surgery. Periodontal surgery is necessary when your dentist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. An alternative treatment option to conventional periodontal surgery is laser periodontal surgery.
In 2004, the PerioLase® Nd:YAG Laser received FDA approval to perform a procedure known as: Laser Assisted New Attachment procedure (LANAP) which has been shown in a university study to regenerate a new periodontal attachment.
Don’t Ignore Your Oral Health
If you value your oral as well as your overall health, a periodontal evaluation is a good idea. Sometimes the only way to detect periodontal disease is through a periodontal evaluation. A periodontal evaluation may be especially important if you:
- Notice any symptoms of periodontal disease (bleeding or receding gums, bad breath, etc.)
- Have heart disease, diabetes, respiratory disease or osteoporosis.
- Are thinking of becoming pregnant.
- Have a family member with periodontal disease. Research suggests that the bacteria that cause periodontal disease can pass through saliva. This means the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member.
- Have a sore or irritation in your mouth that does not get better within two weeks.
This was the key note speaker a Cardiologist that was voted by Time magazine as one of the 100 most influential people in the word.
Periodontal disease, according to The Guinness Book of world records, is the most common infectious disease affecting mankind. The Surgeon General has estimated that 80% of adult Americans have some form of gum disease. Healthcare costs could be reduced by focusing on the mouth. Medical insurance companies are saying we can save 4 to 1. That is, for every dollar invested in dental care they are saving $4 in medical costs.
The cost for treating diabetes is around $174 billion in the U.S. annually. Extrapolate what Columbia University and Aetna Medical found in their research that costs for diabetes care could be reduced by as much as 16 percent by treating gum disease. Take into consideration the Surgeon Generals estimate that gum disease affects approximately 80 percent of the U.S. population. Thus the potential savings by treating gum disease are approximately $22 billion.
This does not include the savings for cardiovascular disease, a probable savings of 11 percent, or another 9 percent for cerebral vascular disease or stroke. The same Aetna and Columbia University studies found that treating gum disease can reduce preterm low birth-weight babies by 50 percent. Preterm low birth-weight births account for more than 12 percent of all births, $13 billion annually in hospitalizations and uncounted social costs since babies born prematurely often require years of care. The whole total of dental expenditures in the U.S is approximately $75 billion annually. Only 3%, according to Dental Insurance statistics, is spent on periodontal disease. In other words, only $2 Billion is spent on gum disease annually.
The important thing to take from this is to know your periodontal score. Unfortunately, gum disease does not hurt. When you visit your dentist make sure your gum pockets are being measured. The dentist needs to take six measurements per tooth. This score has been shown to be more important to your general health than your cholesterol level, body mass index, or blood pressure.
Remember that your gums should never bleed when you brush and floss thoroughly, no more than your hands should bleed when you wash them. A new breakthrough in the treatment of Gum disease is Laser Assisted New Attachment Procedure LANAP. The Laser has been found to regenerate the attachment around the tooth.