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Information for Our Patients
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Information on major subjects in periodontal health is provided for our patients in an overview of the following topics.
Topics: Heart Disease, Respitory Disease, Pre-term Birth and Cigarette Smoking in relation to Periodontal Health.
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PERIODONTAL DISEASE AND HEART DISEASE
Infective endocarditis is a condition characterized by inflammation of the interior lining of the heart and the heart valves, generally cased by bacterial infection. Heart valves that have been damaged or are abnormal are at highest risk for infective endocarditis, but infection can also occur in normal valves when large number of bacteria is present. Researchers believe that when an individual is diagnosed with periodontal disease, a normal task such as chewing or brushing can injure gum tissue, allowing bacteria to enter the bloodstream. The accumulation of these bacteria on heart valves often leads to a fatal infection unless treated.
Coronary artery disease is another type of cardiovascular disease in which the walls of the coronary arteries (heart blood vessels) gradually thicken due to the build-up of fatty proteins. Often blood clots form in these narrowed coronary arteries and normal blood flow activity is obstructed, depleting the heart of the nutrients and oxygen needed to function properly. Scientists now believe that bacteria found in the oral cavity enter the bloodstream, attach to fatty plaques and may contribute to clot formation. Researchers have found that people suffering from periodontal disease are twice as likely to suffer from coronary artery disease than those without periodontal disease. Current data leads scientists to believe that periodontal disease is an important risk factor for heart disease, working in concert with other risk factors such as age, smoking, diabetes, hypertension and elevated blood cholesterol.
Additionally, in a recent 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 a control group. The American Heart Association estimates approximately 58 million Americans, 1 in 5, suffer from cardiovascular disease, making it the number one cause of death in the U.S.
PERIODONTAL DISEASE AND RESPIRATORY DISEASES
Bacterial respiratory infections are thought to be acquired through aspiration (or 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 causing infections or worsening 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 can 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 frequent bouts of respiratory disease in COPD patients, likely because of the high levels of oral bacteria and inflammation present in their gums as the result of poor oral hygiene and periodontal disease.
According to the National Center for Health Statistics, millions of Americans suffer from respiratory diseases: 4.2 million cases of pneumonia are reported each year, and (COPD) including chronic bronchitis and emphysema, are responsible for over 160,000 deaths, 10 million office visits and 2 million hospitalizations annually.
PERIODONTAL DISEASE AND DIABETES MELLITUS
Diabetes mellitus, or diabetes as it is commonly called, is a disease in which unusually high levels of sugar are found in the blood due to the body's inadequate utilization of insulin--a hormone manufactured in the pancreas to produce energy. There are two forms of diabetes: Type 1 and Type 2. People with Type 1 diabetes produce little or no insulin, and those with Type 2 diabetes produce normal or slightly above average amounts of insulin, but the body has grown resistant to its effects, resulting in an insulin shortage.
The link between periodontal disease and diabetes has been well documented. Studies have found periodontal disease to be more prevalent in diabetics versus non-diabetics. This is probably due to the fact that diabetics are more susceptible to contracting infections. In fact, diabetics lose more teeth than non-diabetics.
Now however, researchers are also finding that periodontal disease may predispose or exacerbate the diabetic condition. In a randomized, controlled trial, periodontal treatment in diabetics showed a reduction in the need for insulin following periodontal treatment of two separate groups of diabetic patients. A longitudinal study of diabetes and periodontal disease found that severe periodontitis might be an important risk factor for the progression of diabetes and physicians should consider the periodontal status of diabetes patients having difficulty with glycemic control.
The prevalence of diabetes has increased by 75 percent over the past 35 years. According to the Centers of Disease Control, nearly 16 million American, 5.9 percent of the population, live with the disease, and 5.4 million are unaware they have the illness. As with the many infection-related complications of diabetes, gum disease is intrinsically linked to poor metabolic control.
PERIODONTAL DISEASE AND PRE-TERM, LOW BIRTH WEIGHT BIRTHS
Pregnant women are particularly prone to periodontal (gum) disease as they go through the hormonal changes associated with pregnancy, and research has found that women with periodontal disease may be at higher risk of delivering pre-term low birth weight (PLBW) infants.
Researchers have studied the relationship between infection and PLBW, particularly genitourinary tract infection (GUI), for several years. It appears GUI infection causes the levels of PGE (prostaglandin), and TNF (tumor necrosis factor), biological fluids that normally induce labor, to increase rapidly, leading to premature deliver. Scientists suspect periodontal disease; also a bacterial infection could trigger a similar increase in PGE and TNF molecule levels, thus inducing premature labor.
The relationship between infection, especially GUI, and adverse pregnancy outcomes has been well documented in animals and human studies. In a recent study of periodontal infection in pregnant or postpartum women, those with periodontal disease were more likely to deliver a PLBW infant than women without periodontal disease. Medical professionals have been intrigued by these results and have urged additional research in this area.
PLBW babies, infants born before the 37th week of pregnancy, account for 5 million neonatal intensive care unit days a year, at an annual cost of more than $5 billion. Additionally, 25 percent of PLBW births occur without a known risk factor such as tobacco use, genetics, drug and alcohol use, level of prenatal care, nutrition and urinary tract infection. The extent to which periodontal disease contributes to the unexplained risk of PLBW births is important to know, and several studies are ongoing to assess this association.
Unlocking The Secrets Of Saliva
Although many people assume saliva merely aids in food digestion, its main role is protedtion against disease and decay of the mouth's tissue. Chih-Ko Yeh, Ph.D., BDS, Associate Professor of Dental Diagnostic Science at the University of Texas Health Science Center in San Antonio, is one of the experts unlocking the secrets of saliva to find relief for patienst with salivary dysfunction.
According to an article in The Mission, May 2003, Yeh and other researchers hope to treat salivary dysfunction by regenerating the salivary gland.
"Gene therapy would be an ideal way to treat this disorder," Yeh said. "We could inject te gene therapy directly into the glands themeselves. That;s our dream. We're working on it."
The average person produces just over two cups of saliva every day. People with a low saliva rate and those with salivary dysfucntion face serious health risks, according to the article.
Besides discomfort in talking, chewing and swallowing, a low saliva flow rate compromises a person's overall health. Saliva has a high concentration of calcium so that the teeth don't disolve. Saliva coats the mouth to maintain hydration, and salivas antimicrobial proteins protect against infections. Those proteins, according to the article, prevent tooth decay and protect the body against bacteria and viruses trying to invade through the mouth.
The major interests of the Texas researchers are to understand how salivary glands and saliva are compromised with Sjogren's syndrome, HIV infection and age. Although the belief is that aging does not affect saliva, the researchers say their work shows that it does.
"We're finding a link between salivary dysfunction and major diseases like diabetes, hypertension and HIV," Yeh said. "And we also see a correlation between salivary dysfunction and certain drugs." |
Cigarette Smoking and the Periodontal Patient
Forty years have passed since the landmark U.S. Surgeon General's report in 1964 warned that smoking played a causative role in lung cancer and was associated with cardiovascular disease.1 Since then, the list of smoking-related health effects has grown and includes lung cancer, as well as other cancers, chronic obstructive lung disease, cardiovascular disease, pregnancy complications,2 osteoporosis,3 and several other adverse health consequences. For dental health professionals, the knowledge that oral cancer4 and periodontal disease5,6 are adverse health effects of smoking is particularly significant.
This review will focus on the following questions: 1) What is the evidence for smoking as a risk factor for periodontitis? 2) How does smoking impact the response to periodontal therapy? 3) What are potential etiologic mechanisms for the effect of smoking on periodontal status and treatment response? 4) What is the role of dental health professionals in tobacco cessation? 5) What are suggested cessation methodologies that are recommended by dental professionals? 6) How are behavioral and chemotherapeutic cessation techniques best used in the dental setting?
For more detailed information on this subject click on the hyperlink below.
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