Berks County Medical Society Medical Record Fall 2017 - 26

M e d i c a l R e c o R d F e at u R e

HOW ORAL HEALTH
AFFECTS THE
ENTIRE BODY
by Tammy Balatgek, DDS, MS

F

or many years, physicians and dentists have specialized
in their respective fields with the body and oral cavity. However, recent findings have strongly suggested
that oral health may be an indicator of systemic health. The
purpose of this article is to outline the significant findings
supporting the association between periodontal disease and
systemic conditions such as cardiovascular disease, type 2
diabetes, pregnancy complications,1 and Alzheimer's disease.
There have also been studies showing relationships between
gum disease and osteoporosis, rheumatoid arthritis, and
stroke.2
Periodontal disease is one of the most common chronic
infections in adults and refers to the inflammatory processes
that occur in the gingival tissue and bone surrounding the
teeth when bacteria (dental plaque) accumulate. The chronic
and progressive bacterial infection of the gingiva leads to bone
destruction and loss of attachment to the teeth, resulting in
loose teeth. Periodontal disease has stages ranging from mild,
called gingivitis, which affects 75% of the adults in the United
States, to moderate, affecting approximately 30% of the adult
population, to advanced disease, affecting 10% of the adult
population.3
Heart or cardiovascular disease is the number one cause of
death in the United States, claiming more lives than all types
of cancer combined. Risk factors for heart disease include:
high blood pressure, high cholesterol, diabetes, gum disease,
physical inactivity, poor diet, smoking, and alcohol. Several
studies have been analyzed and report that periodontal disease
is a risk factor or marker for coronary heart disease (CHD)
that is independent of traditional CHD risk factors.4 When a
person has gum disease, the periodontal bacteria travel from
the mouth into the blood stream and cause body-wide inflammation which damages the blood vessel linings, the first step
toward heart attack and stroke. Periodontal disease showed significant associations with biomarkers of endothelial dysfunction, including higher levels of C-reactive protein and LDL
Cholesterol.5 Between 80-90% of heart disease can be prevented with lifestyle changes, including periodontal treatment.

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There are approximately 29.1 million persons in the US
with type 2 diabetes mellitus, and 95% of people with diabetes
also have periodontal disease. There is evidence to support
the existence of a two-way relationship between diabetes and
periodontitis, with diabetes increasing the risk for periodontitis, and periodontal inflammation negatively affecting glycemic control. The presence of dangerous oral bacteria triggers
inflammatory mediators activating the inflammatory response
which results in increased blood glucose levels. Then a bigger rise in glucose levels impairs the body's ability to use the
glucose for energy as it stays in the blood and doesn't reach the
cells. Periodontal disease decreases glycemic control. The good
news is that good oral hygiene and treatment of periodontal
disease and reducing oral inflammation may have a positive
effect on the diabetic condition.6
Pregnancy complications including preterm birth have also
been linked to periodontal disease. There have been several
published studies on this association and Offenbacher et al
reported the incidence of preterm birth in women without
periodontal disease was 11.2% compared to 28.6% preterm
births in women with moderate to severe periodontal disease.7
Although the exact mechanism is not fully understood, one
suggestion is that the effect of periodontal disease on preterm
and low birth weight babies results from the stimulation of
fetal membranes on prostaglandin synthesis by cytokines
from the inflamed gingival tissues, or through the effect of
endotoxin derived from periodontal disease. Endotoxin from
periodontal pathogens might signal preterm labor through
primed monocyte-macrophage activation in peripheral blood
and endometrium.8
Alzheimer's Disease (AD) is a neurogenerative disease
which increases with age and is characterized by inflammatory
features to the central nervous system. Periodontal disease can
be thought of as a low-grade systemic disease that releases proinflammatory cytokines into systemic circulation and causes
elevation of C-reactive protein. Two proposed mechanisms
have been presented to explain the association of AD and
periodontitis:


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Berks County Medical Society Medical Record Fall 2017

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