Laura J. Martin, MD
If your eyes are the window to your soul, then your mouth is a mirror of your health. Although that idea may seem farfetched, health experts believe that good oral health care does more than prevent tooth decay and gum disease.
"Any disease related to the mouth has an impact elsewhere in the body," says Denis F. Kinane, BDS, PhD, at the University of Pennsylvania in Philadelphia.
Researchers are studying the association between oral health, inflammation, and disease. Inflammation, which is the body's response to infection, seems to play a key role in many health conditions, including heart disease, diabetes, and gum disease, also called periodontal disease. Scientists hope to understand how these diseases are interrelated, and whether treating the inflammation caused by gum disease can improve other diseases.
This is important research because about 30% to 50% of American adults have mild to moderate gum disease. Another 5% to 15% have more severe disease, according to the National Health and Nutrition Examination Survey. And although genetics may increase your risk for gum disease, most cases can be controlled by brushing and flossing regularly.
Here's an overview of the latest research on the connection between oral health and overall health.
"In recent years, there's been an interest in the medical community about the chronic diseases of aging and how inflammation in general seems to be the link, whether it's cardiovascular disease, Alzheimer's, or diabetes," says Nadeem Karimbux, DMD, MMSc, assistant dean in the Office of Dental Education at Harvard School of Dental Medicine in Boston. "And periodontal disease fits right into this picture." Because gum disease can be hidden under the gums, it can easily be overlooked. Yet if you calculate the amount of inflammation around the gums in someone with moderate to severe gum disease, it would be equal in size to the palm of your hand, he says.
"If you imagine a person with diabetes walking around with a palm-sized inflammation on their skin, you'd want to jump in and treat it right away," Karimbux says. So why shouldn't you consider that gum inflammation, even though it's in the mouth, adds to the amount of inflammation a person has at any given time and is just another risk factor that connects all these diseases?
The connection between periodontal disease and heart disease is well established in the medical literature, Karimbux says. People with periodontal disease are almost twice as likely to have heart disease according to the American Academy of Periodontology. And a 2008 analysis published in the Journal of General Internal Medicine found that periodontal disease was a risk factor for heart disease separate from other risk factors, such as smoking. Other studies have shown that having gum disease increases the risk for stroke.
How does the inflammation in your mouth affect your heart and blood vessels? Every time you brush or floss, bacteria get released into the blood stream, Karimbux says. According to one theory, bacteria in the blood stream can end up in specific areas, such as where plaque begins to form in the arteries. Once there, bacteria may add to clot formation.
Another theory involves the body's response to inflammation. When gums are inflamed, the body releases certain chemicals into the bloodstream that help fight infection. Scientists think that these chemicals circulate in the blood, and may contribute to plaque buildup in the arteries.
The next question researchers are starting to answer is whether treating periodontal disease will lower the risk for heart disease and other conditions, says Karimbux. He cites a study in the New England Journal of Medicine that looked at 120 patients with severe periodontal disease. Six months after receiving treatment, researchers found lower levels of C-reactive protein in the blood, which is a sign of inflammation. They also found an improvement in blood flow.
Although you have to take into account that it's not a large number of people, Karimbux says, this and other studies are finding that you can lower the amount of inflammation distant from the mouth by treating periodontal disease.
The connection between oral health and diabetes can be described as a two-way street, according to Kinane. "Diabetes has a major impact on all parts of the body, including the oral cavity." Having diabetes increases the risk for infection in the body, which can lead to periodontal disease. "At the same time," Kinane says, "having periodontal disease increases the amount of inflammation your body is coping with." And that actually worsens diabetes, making it harder to keep blood sugar under control.
Studies show that people with diabetes are more likely to develop periodontal disease, especially if their diabetes is not well controlled. So can treating gum disease make it easier to manage diabetes? A 2010 review in Evidence Based Dentistry found that people with diabetes who were treated for periodontal disease could more easily control their diabetes.
"People with diabetes have to brush scrupulously and keep everything totally clean," says Kinane. Anything a person with diabetes can do to reduce inflammation in the body will make it easier to manage the disease, he adds.
Most pregnant women understand that smoking, drinking, and certain health conditions such as high blood pressure increase the risk for preterm labor, or being born early. But keeping your teeth and gums healthy also may help protect the health of your unborn baby. Just being pregnant increases the risk for gum disease because of hormonal changes. And several studies have shown that gum disease increases the risk for low birth weight and preterm labor. A 2011 review in the International Journal of Evidence-Based Healthcare found that treating periodontal disease may lower the risk for low-birth-weight babies and preterm labor. So if you have gum disease and you are pregnant, be sure to see your dentist.
Researchers continue to look for connections between diseases of the body and periodontal disease. Although certain links aren't as well established, there are some interesting developments and areas for further study.
Oral health and lung disease. Studies have found an association between gum disease and certain types of pneumonia, possibly from breathing in bacteria from the mouth. In fact, several studies have found that improving oral health can decrease the risk for pneumonia in nursing home and hospitalized patients. A 2008 study in Respiratory Medicine also found an association between peritonitis and COPD, which also share similar risk factors such as smoking.
Oral health and osteoporosis. Periodontal disease causes bone loss that can lead to tooth loss. So, scientists theorize that having both osteoporosis and periodontal disease may lead to more rapid bone loss than osteoporosis alone would cause. While researchers believe there is a link, studies haven't yet confirmed it.
Gum disease and arthritis. A 2008 study published in the Journal of Periodontology looked at 109 people and found that those with rheumatoid arthritis were eight times more likely to have periodontal disease. There isn't an identified cause and effect relationship between gum disease and arthritis. But researchers believe there is a connection between the two diseases because they are both inflammatory disorders.
"It's all about plaque control -- keep the teeth clean," says Kinane.
If you already have gum disease, talk with your dentist about the best way to keep it under control. "All the literature that we've looked at says that people who are diligent about not only cleaning at home, but who also come in for frequent checkups tend to slow down progression of gum disease the most," says Karimbux.
SOURCES:Denis F. Kinane, BDS, PhD, Morton Amsterdam Dean of Penn Dental Medicine and professor in the department of pathology and of periodontics at the University of Pennsylvania in Philadelphia.Nadeem Karimbux, DMD, MMSc, assistant dean in the Office of Dental Education at Harvard School of Dental Medicine in Boston.American Academy of Periodontology: "Gum Disease Links to Heart Disease and Stroke."American Academy of Periodontology: "Types of Gum Disease."American Academy of Periodontology: "Healthy Gums and a Healthy Heart: The Perio-Cardio Connection."Genco R. "Periodontal Disease and Overall Health: A Clinician's Guide."American Academy of Periodontology: "Fallacies About Gum Disease."Friedewald, V. Journal of Periodontology, July 2009; vol 80, no 7; pp 1021-1032.P. Eke. Journal of Dental Research, November 2010; vol 89, no 11: pp 1208-13.American Academy of Periodontology: "Causes of Gum Disease."Humphrey, L. Journal of General Internal Medicine, December 2008; vol 23, no 12: pp 2079-86.Tonetti, M. New England Journal of Medicine, March 2007; vol 356, no 9: pp 911-920.Vergnes, J. Evidence-Based Dentistry, 2010; vol 11, no 3: pp 73-4.George, A. International Journal of Evidence-Based Healthcare, June, 2011; vol 9, no 2: pp 122-47.Leuckfeld I. Respiratory Medicine, 2008; vol 102: pp 488-494.American Academy of Periodontology: "Researchers Uncover Higher Prevalence of Periodontal Disease in Rheumatoid Arthritis Patients."
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