ORAL-SYSTEMIC LINK
How poor oral health can affect your general health and how certain medical conditions and gum disease go hand in hand.
There are new findings that support something that dental professionals have suspected for a long time. Infection and inflammation in the mouth can be linked with other parts of the body. Problems which may be caused or made worse by poor oral health include heart disease, strokes, respiratory disease, diabetes, rheumatoid arthritis, premature and low birth –weight babies and dementia Having one of these diseases can make the control of your periodontal disease more difficult. But a good periodontist or dentist who is aware of these problems can give you guidance on how to maintain your periodontal health.
Poor Oral Hygiene: leads to gingivitis and periodontitis (gum disease), both of which are inflammatory diseases. In recent studies, it has been established, that heart disease, diabetes, obesity and other systemic diseases, are inflammatory driven. They all add to the inflammatory burden of the body. This is fueled, by the inflammatory diseases of gingivitis and periodontitis.
Heart Disease: People with gum disease are almost twice as likely to have coronary artery (heart) disease than people without gum disease. When people have gum disease, it is thought that bacteria from the mouth can get into their bloodstream. The bacteria produce protein. This can then affect the heart by causing the platelets in the blood to stick together in the blood vessels of the heart. This can make clots more likely to form. Blood clots can reduce normal blood flow, so that the heart does not get all the nutrients and oxygen it needs. .If the blood flow is badly affected this could lead to a heart attack.
Strokes: Several studies have looked at the connection between mouth infections and strokes. They found that people who have had a stroke are most likely to have gum disease than people who have not had one.
Respiratory Disease: Bacterial chest infections are thought to be caused by breathing in droplets from the throat and mouth into the lungs. This can cause infections, such as pneumonia, or could make an existing condition worse. People with gum disease have more bacteria in their mouth and are therefore more likely to get chest infections. This particularly affects frail, elderly people who may die from pneumonia caused by breathing in bacteria into their mouth. Good oral hygiene is particularly important for this group of people.
Diabetes: People with diabetes are more likely to have gum disease than people without it. This is probably because diabetics are more likely to get infections in general. People who do not know they have diabetes, or whose diabetes is not under control, are especially at risk.If you have diabetes it is important that any gum disease is diagnosed, because it can increase your blood sugars. This would put you at risk of diabetic complications. Also, if you are a diabetic you may find that you heal more slowly.New research shows that you are more likely to develop diabetes if you have gum disease. If you have diabetes you have an increased risk of losing teeth.
Premature birth and low – weight babies: Pregnant women who have gum disease may be over three times more likely to have a baby that is premature and so have a low birth weight. There is a one in four chance that women with gum disease will give birth before 35 weeks. It is thought that gum disease may raise the levels of chemicals that bring on labour. Research also suggests that women whose gum disease gets worse during pregnancy have an even higher risk of having a premature baby.Having gum disease treated properly during pregnancy can reduce the risk of premature birth.
Rheumatoid Arthritis: Periodontal disease has also been associated with rheumatoid arthritis (RA), an autoimmune disease that inflames joints and causes destruction of cartilage, bone and ligaments. The two diseases share some basic characteristics: both diseased gingival tissues and joints affected by RA produce similar cytokines and growth factors. These chemicals promote the dissolution of bone, a problem shared by both diseases. This suggests the presence of a common underlying inflammatory mechanism. Levels of anti-CCP antibodies (anti-cyclic citrullinated peptide antibody) are considerably higher in RA patients with periodontal disease, suggesting that periodontitis may be a contributing factor in the pathogenesis of RA. Coincidently, P.gingivalis produces an enzyme that induces citrullination of various autoantigens. Patients with RA are likely to benefit from increased periodontal care.
Dementia: Recently, there has been much interest in the possible connection between poor oral health and the onset of dementia in later life. The inflammatory hypothesis of various neurodegenerative diseases such as Alzheimer disease and Parkinson disease best be characterized as a neuroinflammatory process. Recent evidence suggests that systemic inflammation is associated with signals that pass from the blood to the brain. The resultant neuroinflammatory responses include secretion of neurotoxic factors causing cell injury and death throughout the central nervous system. Over a period of years, this smouldering inflammation in the brain may destroy sufficient amounts of neurons to cause the clinical signs of Alzheimer or Parkinson dementia. These interactions suggest that systemic infections, or indeed any systemic challenge that promotes a systemic inflammatory response, may contribute to the outcome or progression of chronic neurodegenerative disease. This scenario provides a potential link between periodontitis-induced bacteremia or endotoxemia and subsequent neuronal injury. Some recent studies have examined oral disease as a potential risk factor in the development of dementia. One of the most interesting of these is the Nun study, a longitudinal study of aging and Alzheimer disease in 144 participants aged 75–98 years old. The study used 40 years of dental data and 12 years of findings from annual cognitive assessments and brain autopsies, which provided an unparalleled opportunity to study dental health, dementia and neuropathology. The findings demonstrated for the first time an association between a history of oral disease and the development of dementia in a longitudinal population-based design. Participants with the most tooth loss due to periodontal disease had the highest risk of prevalence and incidence of dementia (overall risk for dementia increased by 120%).
Always tell us about any changes to your general health. It is especially important to tell us if you are pregnant, have heart disease, lung disease, have respitorary disease or have ever had a stroke. You also need to tell us about any medications you are taking. Certain medications can directly affect your gums, causing you to become more susceptible to gum disease.
Are you more at risk of Periodontal Disease?
There are many factors that can make you more susceptible to gum disease.
The main causing factor is the bacterial plaque which is naturally present in our mouths. Other main factors includes oral habits, genetics, smokers, teeth that are crowded or malaigned. stress, hormones. Certain medical conditions and medications can have a direct impact on your gums and therefore make you more at risk of gum disease. They include other diseases, medicines and oral habits. These factors can increase your risk of gum disease or make it worse once the infection has set in.
Genes: Some people are more likely than others to get periodontal disease because of their genes. But your genes do not make gum disease inevitable. Even people who are highly prone to periodontal disease can prevent or control the disease with good oral care.
Smoking and tobacco use:Smoking increases the risk of periodontal disease. The longer you smoke, and the more you smoke, the higher the risk. If you have periodontal disease, smoking makes it more severe. Smoking is a major reason that some cases of periodontal disease are resistant to treatment. Smokers tend to collect more tartar on their teeth. They often develop deeper periodontal pockets once they have gum disease. They also are likely to lose more bone as the disease gets worse. Unlike many other factors that affect the health of your gums, the decision to smoke or not is under your control. Quitting smoking can play a major role in bringing periodontal disease under control.
Misaligned or crowded teeth, braces or any plaque trap:Anything that makes it more difficult to brush or floss your teeth is likely to enhance plaque and tartar formation. The more plaque and tartar you have, the greater your chance of developing gum disease. Dentists and periodontists can show you the best ways to clean your teeth, even if they are hard to clean. For example, you can use special tools and ways of threading floss to clean around bridgework or slide under braces. If overcrowded or crooked teeth are a problem, your dentist might recommend orthodontics. This could straighten out your smile and give you a better chance of preventing disease.
Grinding, gritting or clenching of teeth: These habits won’t cause periodontal disease. However, they can lead to more severe disease if your gums are already inflamed. These habits exert excess force on the teeth. This pressure appears to speed up the breakdown of the periodontal ligament and bone. In many cases, people can learn to stop this habit simply by recognizing when it is happening and then relaxing. If these efforts don’t work, your dentist or periodontist can create a custom guard appliance to help reduce the pressure of clenching or grinding on the teeth. This device is sometimes called an occlusal guard, night guard, mouth guard or bite guard.
Stress:Stress can make periodontal disease worse and harder to treat. Stress weakens your body’s immune system. This makes it harder for your body to fight off infection, including periodontal disease.
Fluctuating hormones:Whenever hormone levels go up and down in the body, changes can occur in the mouth. Puberty and pregnancy can temporarily increase the risk and severity of gum disease. So can menopause.
Medicines:Several types of medicines can cause dry mouth, or xerostomia. Examples include certain drugs for depression and high blood pressure. If you don’t have enough saliva, plaque is more likely to form. This may lead to tooth decay (cavities). Other medicines may cause the gums to enlarge. This makes them more likely to trap plaque. These medicines include:
Phenytoin (Dilantin and other brand names), used to control seizures
Cyclosporine (Neoral, Sandimmune), used to suppress the immune system in people who have had organ transplants
Nifedipine (Adalat, Cardizem and others) and other calcium channel blockers, used to treat high blood pressure, chest pain (angina) or heart arrhythmia
Poor nutrition:Nutrition is important for overall good health, including a working immune system and healthy gums and mouth. Severe vitamin C deficiency (scurvy) can cause bleeding gums.
