The Mouth-Body Connection

Research has established that there exist strong connections between periodontal disease and many other chronic conditions including diabetes, heart disease and osteoporosis. Periodontal disease is characterized by inflammation of the gum tissue due to the presence of disease-causing bacteria. Overtime, infection can spread below the gum line into the bone. Infections and the bacteria that cause disease have effects throughout the body and can lead to a host of problematic health issues. Maintaining excellent oral hygiene and reducing the progression of periodontal disease through effective periodontal treatment will have benefits beyond preventing gum disease and jawbone loss. Periodontal care can also reduce your chance of developing other serious and possibly life threatening conditions.

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Periodontal Disease and Diabetes

Diabetes represents a serious and as yet, incurable disease characterized by high sugar (glucose) levels in the blood. Type II diabetes occurs when the body is unable to regulate insulin, meaning too much glucose stays in the blood. This is different from Type I diabetes where those affected are no longer able to produce insulin. Diabetes affects 1.5 million Canadians and has been shown to directly cause or contribute to a multiplicity of health issues including heart disease and stroke. This number is expected to rise due to the increasing rates of obesity.

Research has established that people with diabetes are more susceptible to periodontal disease than non-diabetics. Diabetic individuals with poor blood sugar control develop periodontal disease more frequently and with greater severity than those whose diabetes – blood sugar levels are well controlled.

The connection between diabetes and periodontal disease results from a variety of factors. Diabetics are more susceptible to all types of infection, including periodontal infections. One of the effects of diabetes is a slowing of the circulation which can allow bacteria to colonize. In addition, diabetes reduces the body’s immune system, thereby increasing the potential for gums to become infected.

As the severity of periodontal disease worsens, there is a commensurate elevation in sugar levels throughout the body. Diabetics with active periodontitis are more likely to experience difficulty keeping their blood sugar controlled. In addition, high sugar levels in saliva promote the growth of bacteria that then further exacerbates diabetes.

Blood vessel thickening is another concern for diabetics. Blood vessels function to bring nutrients and remove waste products from our body. When blood vessels become thickened by diabetes, these exchanges become more difficult. As a result, harmful waste can be left in the mouth thus weakening the resistance of gum tissue to infection and disease.

Smoking is detrimental to one’s oral and overall health, but is particularly harmful in diabetics. It has been established that diabetic smokers 45 and older, are 20 times more likely to develop periodontal disease than those who do no smoke.

Without question, it’s important for everyone to brush and floss their teeth effectively. It is essential however for diabetic patients in addition to practicing excellent daily oral hygiene, to present for preventive periodontal specialty care.

Periodontal Disease, Heart Disease and Stroke

Coronary heart disease occurs when fatty proteins, a substance referred to as arterial plaque builds up on the walls of our arteries. Overtime, a narrowing of the arteries can occur thus constricting the flow of blood. Oxygen travelling to the heart can become restricted which can result in shortness of breath, chest pain, and eventually, precipitate a heart attack.

The link between periodontal disease and heart disease is so apparent that patients with untreated oral periodontal infection are nearly twice as likely to suffer from coronary artery disease as those with healthy mouths. Periodontal disease has also been shown to exacerbate existing heart conditions. It has also been established that patients with periodontal disease are more susceptible to strokes. A stroke occurs when a blood clot prevents blood from reaching the brain.

The connection between periodontal disease and heart disease extends beyond oral bacteria merely entering the bloodstream to include the impact of these bacteria and their inflammatory by-products precipitating on blood vessel walls. As strands of periodontal bacteria enter the bloodstream and attach to fatty plaques in the arteries, this attachment leads to inflammation, clot formation and an increased risk of a heart attack.

Inflammation due to periodontal disease results in an increase in white blood cells and C-reactive protein (CRP). CRP is a protein that has long been associated with heart disease. As levels of CRP rise, there is a commensurate amplification in the body’s inflammatory response. Periodontal disease bacteria upon entering the bloodstream cause the liver to increase production of CRP. Over time, these changes lead to inflamed arteries and contribute to an increased risk of developing blood clots. Inflammation causes the arterial walls to become sticky thus promoting further atherosclerotic plaque formation. Narrowing of arterial vessel diameter and potential blockage has been shown to increase the risk of developing heart attacks and strokes.

Coronary and vascular artery disease represents the leading causes of death in Canada for both men and women. Effective periodontal specialty care can help control inflammation (CRP levels) thereby reducing your risk of developing coronary and vascular artery disease.

Periodontal Disease in Women and Pregnancy

Research has established that a pregnant mother with periodontal disease exposes her unborn child to a variety of risks and potential complications. The hormonal changes brought on by pregnancy affect women in a myriad of ways. To ensure the developing fetus is adequately nourished, increases in hormone (estrogen) levels promote the development of terminal blood vessels. From an oral health standpoint, gums represent a terminal blood element. It is typical during pregnancy for gums to become inflamed (gingivitis) and begin to bleed. In particular, increases in estrogen levels contribute to a shift in oral bacteria types to those that are more disease causing (pathogenic). Gum and jawbone (periodontal) infections have been linked to premature delivery (preeclampsia). The earlier – premature a baby is born and the lower the baby’s birth weight, the greater their health risks. Such effects don’t merely manifest during early development, but can persist throughout life. Fortunately, controlling inflammation and halting the progression of periodontal disease through periodontal specialty treatment tailored to the pregnant mother, coupled with improved in oral hygiene practices can help reduce the risk of periodontal disease related pregnancy complications by up to 50%.

There are a multitude of factors that contribute to the effects periodontal disease has on the mother and her unborn child. One factor relates to increases in prostaglandin levels in mothers with periodontal disease. Prostaglandin is a labor-inducing chemical that is also found in oral bacteria associated with periodontitis. Rising levels of prostaglandins can induce the mother to go into premature labor (preeclampsia) and deliver a low birth weight baby.

Another compound recently been linked to premature birth and the delivery of a low birth weight baby is C-reactive protein (CRP). CRP is a protein that has long-been associated with heart disease. Infection due to periodontal disease increases CRP levels, which turn has been shown to amplify the body’s natural inflammatory response. Bacteria associated with periodontal disease can enter the bloodstream causing the liver to produce additional CRP, which then leads to inflamed arteries and blood clots. Inflamed arteries are more susceptible to blockage, which can cause heart attacks or strokes. Although the exact reason why elevated CRP causes preeclampsia is not fully understood, studies overwhelmingly have established a linkage.

Finally, in a diseased mouth, bacteria that invade the gum can travel through the bloodstream to affect other parts of the body. Scientists have discovered these disease causing bacteria colonizing in the internal mammary glands and coronary arteries in pregnant women.

If you are pregnant, it is essential that you practice effective daily home care to reduce the impact of  those hormonal changes that predispose you to develop gum disease. Dr. Novack can assess your gum health and periodontal risk. Together we can then define a preventative program that best protects you and your baby’s health.

Periodontal Disease and Respiratory Disease

Respiratory disease can occur when fine droplets are inhaled from the mouth and throat into the lungs. Bacteria contained within those droplets can spread and multiply within the lungs to impair breathing. Recent research has also established that bacteria found in the mouth and throat can be drawn into the lungs (lower respiratory tract) and there cause infection or a worsening of an existing lung condition.

Should oral bacteria travel into the lungs, respiratory infections including pneumonia can occur. It has been well established that periodontal disease contributes to the development of bronchitis and emphysema. Chronic obstructive pulmonary disease (COPD), a respiratory condition characterized by airway blockage and often seen in people who smoke, tends to worsen in patients with active periodontal disease.

One explanation for the connection between respiratory problems and periodontal disease is low (reduced) immunity. Patients who experience respiratory problems generally have a reduced immunological response. In these individuals, oral bacteria can grow more easily and spread below the gum line into the jawbone often because of an ineffective immunological response. Once periodontal disease is established, it will progress and potentially, cause a worsening of respiratory issues.

Inflammation in the gums has also been linked to respiratory problems through the development of an increased systemic immunological response (CRP). Inflammation in the airways can reduce the volume of air that can pass freely into the lungs (asthma).

If you have been diagnosed with respiratory disease, Dr. Novack will work collaboratively with your physician (and/or respirologist) to plan how best to manage both conditions and reduce the potential for more serious complications.

Periodontal Disease and Osteoporosis

Osteoporosis, a condition characterized by thinning of the bones and loss of bone mineral density is common in older individuals, particularly women. Osteoporosis occurs when there is a disruption in the balance between new bone formation and the absorption of existing bone. Research has established that the drop in estrogen levels noted in menopausal women or the drop in testosterone levels among older men is a contributing factor in the development of osteoporosis. Individuals affected by osteoporosis must take extra precautions when performing their daily activities due to the increased risk of bone fracture.

Since both periodontal disease and osteoporosis result in a permanent loss of bone, these two diseases have been studied for possible connections. Research has discovered that post menopausal women who suffer from osteoporosis are 86% more likely to develop periodontal disease. In turn, periodontal disease in patients with osteoporosis results in an increased loss of jawbone which then can lead to tooth loss. In like fashion, inflammation due to periodontal disease accelerates the loss of a jawbone already weakened by osteoporosis. This explains why periodontal infection (periodontitis) is particularly destructive and rapidly progressive in patients with osteoporosis. Studies conducted over the past decade have also discovered that patients suffering from osteoporosis can significantly reduce tooth loss by controlling periodontal disease.

A decrease in estrogen levels represents another factor linking bone loss seen in both osteoporosis and periodontal disease. It has been established that an estrogen deficiency contributes to the progression of both oral and systemic bone loss. This condition also accelerates the breakdown in the tooth support apparatus (periodontal ligament). Tooth loss occurs when these supporting fibres are destroyed.

If you have been diagnosed with osteoporosis (or osteopenia), to protect your teeth and jawbones, it is essential that you take preventative measures to guard against periodontal disease.

Periodontal Disease & Aging

In Canada, it is estimated that nearly 800 people a day reach the age of 65 and those individuals 65 years and older will double from 3.5 million to more than 7 million in the coming years. What separates today’s aging boomers from those who preceded them is that now a day’s, people don’t merely wish to live longer. They also wish to live better with no boundaries on the functional ability or esthetics. As we all age, the undeniable impact of chronic diseases and the medications required to mitigate these diseases go hand in hand. Baby boomers may see themselves as ageless, but nearly epidemic proportions live with diabetes, cardiovascular disease, arthritis and other chronic inflammatory diseases associated with aging. The message however is clear is that loss of teeth is unacceptable for today’s aging boomers.

Periodontists possess advanced training and expertise in the fields of periodontal medicine and the management of chronic inflammatory periodontal diseases. In defining patient care, Dr. Novack adopts a holistic approach and evaluates each patient’s entire medical status and systemic conditions. He brings to each case, a wealth of knowledge and experience in the field of periodontal medicine and tissue regeneration. The philosophy of care in our office is to include a patient’s total health status in defining therapy. Patients are not truly healthy unless they are also periodontally healthy. Similarly, implant success relies on both periodontal and restorative principles. A cornerstone of Dr. Novack’s practice is the commitment to maintain each patient’s total health and this takes on an even greater role in the aging patient.

Periodontal Disease & Smoking

Most people today are familiar with the link between smoking (tobacco use), lung disease, cancer, and heart disease. Studies have also linked an increased risk of periodontal disease with tobacco usage.  Periodontal disease tends to be more severe and the treatment required, more extensive in smokers than those who don’t use tobacco. Research reports a greater incidence of tartar (calculus) formation on teeth, more serious infection (deeper pockets) between the teeth and gums and a greater loss of the bone and the fibres that support teeth in smokers.  In addition, the potential to develop oral cancer increases with the use of tobacco, even smokeless tobacco. Finally, the chemicals contained within tobacco such as nicotine and tar, have been shown to slow the rate of healing thus reducing the predictability of achieving success following periodontal treatment. Quitting smoking can unquestionably improve both your periodontal and general health.