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Growing evidence shows that gum disease can be serious … even fatal


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."

SIDEBAR

How to keep those gums in the pink

By R.J. Ignelzi

Copley News Service

The best way to prevent serious periodontal disease is to get serious about your oral hygiene. And the sooner you start, the better. Gum disease can begin in the adolescent or teenage years, when "they rarely floss for weeks, months, sometimes years at a time," says Dr. Gary Sigafoos, a San Diego periodontist. "Food and bacteria get stuck between the teeth and are never removed and break down by nature. Parents need to remind their children to floss in the early years so it becomes an ingrained habit."

But it's never too late to start taking care of your teeth and gums. The following factors may increase your risk of developing periodontal disease. Periodontists offer tips on how to counter them and save your teeth and your health.

- Inadequate oral hygiene

Most dental experts recommend brushing at least twice a day, morning and night, and flossing at least once a day, preferably before bed. Have your teeth professionally checked and cleaned at least every six months.

- Smoking

Because tobacco can dull the immune response and decrease the amount of oxygen in the mouth, smokers are two to seven times more likely to develop periodontitis than nonsmokers, says the American Academy of Periodontology.

"When you smoke, the first biological tissue the hot (tobacco) gasses come in contact with are the gums," says periodontist Dr. David Richards, who advises everyone to quit smoking.

- Genetics

Up to 30 percent of the population may be genetically susceptible to gum disease, the academy says. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. If your parents have had gum disease, tell your dentist and hygienist, who may recommend more frequent cleanings and special mouth rinses to reduce the plaque.

- Diabetes

People who have diabetes tend to have more severe gum disease and get it earlier than non-diabetics.

Gum infections can impair a diabetic's ability to process and/or use insulin, which may cause the diabetes to be more difficult to control and the periodontal infection to be more severe, resulting in a greater loss of bone and connective tissue.

Diabetics need to tell their dentist and hygienist about their condition and be vigilant about oral care and blood sugar management.

- Hormonal changes

During puberty, pregnancy and menopause hormones are changing, and these changes can affect tissues in the body, including gums, which can make them more susceptible to gum disease. "With hormone change, the tissues overreact to plaque and can cause more gingivitis, more puffiness and bleeding of the gums," says Sigafoos, who notes the problem can be controlled with good home oral care and professional cleanings.

- Stress

Research shows that stress can make it more difficult for the body to fight off infection, including periodontal disease. "Stress can affect your gums big time," Sigafoos says. "With stress there's often a lack of sleep and poor diet and (when that happens) the tissues are more sensitive to plaque and there's often more bleeding (of the gums)."

- Teeth grinding

"Grinding or clenching the teeth softens the bone around the neck of the tooth, and it's easier for the infection to spread and the bone and ligaments to be injured," Sigafoos says. If you know you grind your teeth, talk to your dentist about getting a mouth guard to wear when you sleep.

- Medications

Some drugs - including oral contraceptives, anti-depressants and a few epilepsy and heart medicines - can affect your oral health. Tell your dentist or periodontist about all medications you're taking.

- Poor nutrition

A diet lacking important nutrients can compromise the body's immune system and make it harder to fight off infection, including periodontal disease.

- Kissing or sharing eating utensils

According to the American Academy of Periodontology, 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 gum disease of another family member.

"Gum disease is communicable if the person you're giving it to has deep enough pockets (between the teeth and gums) to harbor bacteria," Sigafoos says.
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