Systemic / Health Relationship
Perio Disease and Coronary Artery Disease
Periodontal Disease Link to Diabetes
Perio Disease Associated Womens Health
Adults over the age of 35 lose more teeth to gum diseases than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and Periodontal Diseases is by performing daily thorough tooth brushing and flossing techniques and regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.
Other important factors affecting the health of your gums include:
- Tobacco usage
- Clenching and grinding teeth
- Poor nutrition
Periodontal Disease & Tobacco
You are probably familiar with the links between tobacco use and lung disease, cancer, and heart disease.
Current studies have now linked periodontal disease with tobacco usage. These cases may be even more severe than those of non-users of tobacco. There is a greater incidence of calculus formation on teeth, deeper pockets between gums and teeth as well as greater loss of the bone and fibers that hold teeth in your mouth. In addition, your chance of developing oral cancer increases with the use of smokeless tobacco.
Chemicals in tobacco such as nicotine and tar slow down healing and the predictability of success following periodontal treatment.
Problems caused by tobacco include:
Lung disease, heart disease, cancer, mouth sores, gum recession, loss of bone and teeth, bad breath, tooth staining, less success with periodontal treatment and with dental implants.
Quitting tobacco will reduce the chance of developing the above problems.
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Periodontal Disease & Coronary Artery Disease
Researchers have found that people with periodontal disease are almost twice (2x) as likely to suffer from coronary artery disease than those without periodontal disease. Scientists theorize that the bacteria that cause periodontal disease can trigger white blood cells to release pro-inflammatory mediators that may lead to heart disease and stroke. Another theory is that bacteria from the mouth attach to fatty acid plaques in the coronary arteries and contribute to clot formation. These clots can obstruct normal blood flow and lead to heart attacks.
Diabetes & Oral Health
Individuals suffering from diabetes, especially uncontrolled diabetics, have a higher risk of developing bacterial infections of the mouth. These infections may impair your ability to process insulin, resulting in greater difficulty with controlling diabetes. Periodontal diseases will be more severe than those of a non-diabetic and treatment more difficult. However, well-controlled diabetics have a lower incidence of cavities.
Periodontal disease is often considered the sixth complication of diabetes – to the extent that people with non insulin-dependent diabetes are three (3x) times more likely to develop periodontal disease than are people without diabetes. Research supports a relationship between periodontal disease and diabetes as bi-directional – i.e., because acute bacterial infections are known to cause insulin resistance, it is theorized that periodontal disease may make it more difficult for people who have diabetes to control their blood sugar level. That is why it is critical that people with diabetes be treated to eliminate periodontal infection.
Steps to prevent periodontal disease include daily brushing and flossing to remove plaque from your teeth and gums, regular dental visits for professional cleaning, and regular periodontal evaluation. Your health professional must also be told of your history and the current status of your condition. And finally, you can help resist periodontal infection by maintaining control of your blood sugar levels.
Women & Periodontal Health
Throughout a womans life, hormonal changes affect tissues throughout the body. Fluctuations in levels occur during puberty, pregnancy and menopause. At these times, the chance of periodontal disease may increase, requiring special care of your oral health.
During puberty, there is increased production of sex hormones. These higher levels increase gum sensitivity and lead to greater irritations from plaque and food particles. The gums can become swollen, turn red, and feel tender.
Similar symptoms occasionally appear several days before menstruation. There can be bleeding of the gums, bright red swelling between the teeth and gum, or sores on the inside of the cheek. The symptoms clear up once the period has started. As the amount of sex hormones decrease, so do these problems.
Your gums and teeth are also affected during pregnancy. Between the second and eighth month, your gums may also swell, bleed, and become red or tender. Large lumps may appear as a reaction to local irritants. However, these growths are generally painless and not cancerous. They may require professional removal, but usually disappear after pregnancy.
Periodontal health should be part of your prenatal care. Any infections during pregnancy, including periodontal infections, can place a babys health at risk.
Scientists have also found that oral pathogens can release toxins that enter the human placenta via the mother’s blood circulation, interfering with normal fetal development. This process is thought to abnormally accelerate the production of inflammatory mediators that normally build to a threshold level throughout pregnancy, then cue the onset of labor. Instead, the elevated levels of these inflammatory mediators trigger premature delivery. In fact, there is growing evidence that pregnant women with periodontal disease may be seven (7x) times more likely to have a premature birth. The hormonal changes that occur cause a more sensitive reaction to dental plaque, resulting in increased gingival swelling, bleeding and redness.
Swelling, bleeding, and tenderness of the gums may also occur when you are taking oral contraceptives, which are synthetic hormones.
You must mention any prescriptions you are taking, including oral contraceptives, prior to medical or dental treatment. This will help eliminate the risk of drug interactions, such as antibiotics with oral contraceptives where the effectiveness of the contraceptive can be lessened or become ineffective.
Changes in the look and feel of your mouth may occur if you are menopausal or post-menopausal. They include feeling pain and burning in your gum tissue and salty, peppery, or sour tastes.
Careful oral hygiene at home and professional cleaning may relieve these symptoms. There are also saliva substitutes to treat the effects of dry mouth.
Periodontal Disease and Respiratory Diseases
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 cam 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.
Periodontal Disease and Osteoporosis
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.
One study published in the June 2007 Journal of Periodontology (JOP) examined 1,256 postmenopausal women and looked for a potential association between periodontal bacteria and bone loss in the oral cavity. The study results showed that women with periodontal bacteria in their mouths were also more likely to have bone loss in the oral cavity, which can lead to tooth loss if not treated.
A study of 106 postmenopausal women over more than 10 years concluded they could significantly reduce tooth loss by controlling their periodontal disease.
Another JOP study published in August 1999 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.
Bisphosphonates: Implications for Your Periodontal Therapy
Recently, there has been information in the news about taking bisphosphonates and the implications on your periodontal health. Below are some questions and answers about taking bisphosphonates, osteoporosis, and osteonecrosis of the jaw (the condition associated with taking bisphosphonates). It also links to helpful resources available online.
What are bisphosphonates?
Bisphosphonates, also known as bone-sparing drugs, are commonly used in the treatment of osteoporosis and cancer that has spread to the bone. Doctors prescribe intravenous bisphosphonate therapy for patients with cancer that has spread to the bone to help decrease associated pain and fractures. This intravenous therapy was the subject of precautions set out by the FDA. In addition, emerging research is exploring the ability of intravenous bisphosphonate therapy to inhibit the spread of some cancers to the bone.
What is osteonecrosis of the jaw (ONJ)?
This condition has been observed in individuals with cancer who undergo invasive dental procedures such as dental implants or tooth extractions while receiving treatment with intravenous bisphosphonates. ONJ can cause severe, irreversible and often debilitating damage to the jaw.
Who can develop ONJ?
The FDA recognizes additional risk factors associated with the development of osteonecrosis (not limited to the jaw) in cancer patients, such as female sex, advanced age, edentulous regions, combination cancer therapy, blood dyscrasias/metastatic disease, anemia coagulopathy, surgical dental procedures, and prior infection.
What is osteoporosis?
People diagnosed with osteoporosis have low or decreasing bone mass and must take extra care in performing day-to-day activities because they are at increased risk for bone fractures. Because bone loss is associated with both osteoporosis and periodontal disease, it is questioned whether the two are related. The association has been difficult to prove because of the many similar risk factors for these two diseases, including smoking, age, medications, and systemic diseases.