Periodontal disease as major risk factor for systemic diseases (Part I)

The focus of recent studies in periodontics is on systemic connection between untreated periodontal disease and other health problems, including heart disease, stroke, obstructive pulmonary disease and diabetes. It has been shown a long time ago that some of these conditions (especially diabetes) worsen periodontal status of patients already affected by periodontitis and make them 2-5 times more susceptible to develop severe periodontal disease.

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 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. 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.

Chronic periodontal disease may contribute to diabetes according to a recent research review. While it has been established that people with diabetes are more prone to develop periodontal disease, new research is suggesting that periodontal disease may, in turn, be a risk factor for diabetes.

The research review was presented at an American Academy of Periodontology (AAP)/National Institute of Dental and Craniofacial Research (NIDCR) symposium on periodontal systemic connections in Bethesda, Md. Periodontal disease can cause bacteria to enter the bloodstream and activate immune cells. These activated cells produce inflammatory biological signals (cytokines) that have a destructive effect throughout the entire body. In the pancreas, the cells responsible for insulin production can be damaged or destroyed by the chronic high levels of cytokines. Once this happens, it may induce Type 2 diabetes, even in otherwise healthy individuals with no other risk factors for diabetes.

The next step to determine for sure whether or not periodontal disease can cause diabetes is to perform clinical studies and intervention trials, which answer the question, when periodontal disease is treated, does the risk for diabetes decrease? Until we have results from intervention studies to better understand the role periodontal disease may play in diabetes, as well as heart disease, preterm births and respiratory disease, the best advice is for people to take excellent care of their oral health to help ensure they keep their teeth as well as maintain overall health.

New research confirms findings that periodontal disease may increase a person's risk for the respiratory disorder Chronic Obstructive Pulmonary Disease (COPD), the sixth leading cause of mortality in the United States. The study, published in Journal of Periodontology, also noted a correlation between the amount of periodontal disease and lung capacity.

For this study, researchers analyzed the periodontal and respiratory health of 13,792 patients. Patients with periodontal disease, defined by mean periodontal attachment loss (MAL) of greater than 3 millimeters, were found to have nearly a one-and-a-half times greater risk of COPD. A distinct trend also was noted in that lung function seemed to diminish with increased periodontal attachment loss. This suggests that periodontal disease activity may promote the progression of COPD.

"Identification of potential risk factors that contribute to the development of chronic bronchitis or emphysema - respiratory diseases that comprise COPD - may suggest interventions that could prevent or delay the onset of the disease, or slow its progression," explained Frank A. Scannapieco, D.M.D., lead researcher of the study. "Based on these and previous research findings, it is conceivable that improved oral health may help prevent the progression of COPD. This is good news for the estimated 16 million Americans who suffer from it."

Scannapieco cautioned that research does not conclude that periodontal disease causes COPD. "We know that the onset and progression of COPD is dependent on smoking, and that repeated bacterial infections can worsen the lung disease. It is possible that periodontal bacteria could travel to the lungs through saliva or normal breathing and in some way promote lung infection. Another possibility is that the inflammation caused by periodontal disease may contribute to inflammation of the lining of the lung airway, which limits the amount of air that passes to and from the lungs."

For a long time we have known that people who smoke, are exposed to environmental pollution, or are genetically predisposed are at increased risk for development of COPD. Now mounting evidence suggests that periodontal disease may work in concert with these factors and contribute to the progression of this disease.

Prompt intervention and treatment of periodontal disease may mean breathing easier and living healthier and longer. Take action against silent periodontal disease to improve your health!