The Mouth-Body Connection

Research has recently proven what dentists have long suspected: that there is a strong connection between periodontal disease and other chronic conditions such as diabetes, heart disease, stroke, infections and osteoporosis.

Periodontal disease is characterized by inflammation of the gum tissue, presence of disease-causing bacteria, and infection below the gum line. Infections and bacteria in the mouth can spread and lead to other medical health issues. Therefore, maintaining excellent oral hygiene and reducing the progression of periodontal disease through treatment will have benefits beyond preventing gum disease and bone loss. It can also reduce your risk of developing another serious condition.

Diabetes and Gum Disease

Diabetes is a serious, incurable disease that is characterized by too much glucose, or sugar, in the blood. Type II diabetes occurs when the body is unable to regulate insulin levels, meaning too much glucose stays in the blood. Type I diabetics cannot produce any insulin at all. Diabetes affects between 12 and 14 million Americans, and can lead to a variety of health issues, such as heart disease and stroke.

Research has shown people with diabetes are more likely to develop periodontal disease than non-diabetics. Diabetics with insufficient blood sugar control also develop periodontal disease more frequently and severely than those who have good management over their diabetes.

The connection between diabetes and periodontal disease results from a variety of factors. Diabetes sufferers are more susceptible to all types of infections including periodontal infections due to the fact diabetes slows circulation which allows bacteria to colonize. Diabetes also reduces the body’s overall resistance to infection, which increases the probability of the gums becoming infected.

Moderate to severe cases of periodontal disease elevate sugar levels in the body, increasing the amount of time the body has to function with high blood sugar. Diabetics with periodontitis are most likely to suffer from increased levels, making it difficult to keep control of their blood sugar. Further, high glucose levels in saliva promote growth of gum disease-causing bacteria.

Blood vessel thickening is another concern for diabetics. Blood vessels function by providing nutrients and removing waste products from the body. When they become thickened by diabetes, these exchanges are unable to occur. As a result, harmful waste is left in the mouth and can weaken the resistance of gum tissue, leading to infection and disease.

Smoking and tobacco use is detrimental to anyone’s oral and overall health, but it is particularly harmful to diabetics. Diabetic smokers 45 and older are in fact 20 times more likely to develop periodontal disease than those who do no smoke.

It is therefore crucial for people diagnosed with diabetes to maintain healthy teeth and gums. This includes diligent home care, including brushing at least twice a day and flossing at least once a day, as well as receiving a comprehensive periodontal exam from a dental professional once a year. Studies now show that treatment of periodontal disease in Diabetics can improve control of their diabetes.

Heart Disease, Stroke and Gum Disease

Coronary artery disease occurs when fatty proteins and a substance called plaque build up inside the walls of your arteries. This causes the arteries to narrow, constricting blood flow. Oxygen is then restricted from traveling to the heart which results in heart disease and can manifest as shortness of breath, chest pain, and even heart attack.

The link between periodontal disease and heart disease is so apparent that patients with oral conditions are nearly twice as likely to suffer from coronary artery disease as those with healthy mouths. Periodontal disease has also been proven to exacerbate existing heart conditions. Additionally, patients with periodontal disease have been known to be more susceptible to strokes. A stroke occurs when the blood flow to the brain is suddenly stopped. This may occur, for example, when a blood clot prevents blood from reaching the brain.

One cause for the connection between periodontal disease and heart disease is oral bacteria entering the bloodstream. There are many strains of periodontal bacteria. Some strains enter the bloodstream and attach to the fatty plaques in the coronary arteries. This attachment leads to clot formation and increased risk to a variety of health problems including heart attacks.

Inflammation caused by periodontal disease creates an increase in white blood cells and C-reactive proteins (CRP). CRP is a protein that has long-been associated with heart disease. When levels are increased in the body, it amplifies the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, causing the liver to produce extra CRP, which then leads to inflamed arteries and possibly blood clots. Inflamed arteries can lead to blockage, which can also increase the risk for heart attacks and strokes.

Heart disease is the leading cause of death in the United States for both men and women. Practicing good oral hygiene including twice daily brushing and daily flossing, and obtaining treatment for periodontal problems may help reduce the risk of heart disease.

Osteoporosis and Gum Disease

Osteoporosis is a condition common in older patients and particularly in women, that is characterized by the thinning of bone tissue and loss of bone density over time. Osteoporosis occurs when the body fails to form enough new bone, or when the body absorbs too much old bone. The leading cause of osteoporosis is a drop in estrogen in menopausal women, or a drop in testosterone among men. Sufferers of osteoporosis must take extra care in daily activities, as they are at increased risk for bone fractures.

Because periodontal disease can also lead to bone loss, the two diseases have been studied for possible connections. Research found that women with periodontal bacteria in their mouths were more likely to have bone loss in the oral cavity and jaw, which can lead to tooth loss. Studies conducted over a period of 10 years also discovered that osteoporosis patients could significantly reduce tooth loss by controlling periodontal disease. Further, it was found that post-menopausal women who suffer from osteoporosis are 86% more likely to also develop periodontal disease.

One of the reasons for the connection between osteoporosis and periodontal disease is an estrogen deficiency. Estrogen deficiency speeds up the progression of both oral bone loss and other bone loss. It also accelerates the rate of loss of fibers and tissues which keep the teeth stable. Tooth loss occurs when these fibers are destroyed.

Low mineral bone density is one of the several causes of osteoporosis. The inflammation from periodontal disease weakens bones more prone to break down. This is why periodontitis can be particularly detrimental and progressive to patients with osteoporosis.

If you are diagnosed with osteoporosis, it is extremely important to take preventative measures against periodontal disease to protect your teeth and oral bones.

Women and Gum Disease

Women have unique health care needs. These needs change with a woman’s body during puberty, pregnancy and menopause. As specialists in periodontal disease, periodontist have a unique understanding of a woman’s unique periodontal needs during their lifetime.

Hormones and Gum Disease

Hormonal fluctuations throughout a woman’s life can affect many tissues, including the gums. These changes may increase a woman’s susceptibility to periodontal disease or bleeding gums associated with gingivitis, and may make it necessary for a woman to seek out specialty care with a periodontist.

Menstruation and Gum Disease

The production levels of progesterone and estrogen in women increase with maturity. With these elevated hormone levels, there is an increased risk of developing gingivitis and periodontitis. The gums may become swollen, turn red, and may even feel tender to touch. Gingivitis associated with menstruation can occur right before a woman’s period but usually clears up once the period has started. During this time, it is very important to maintain good oral hygiene at home and keep regular visits with a dentist or periodontist.

Pregnancy and Gum Disease

Pregnant women with periodontal disease expose their unborn children to a variety of risks and possible complications. Pregnancy causes many hormonal changes in women, which increase the likelihood of developing periodontal disease such as gingivitis. These oral problems have been linked to preeclampsia, low birth weight of the baby, as well as premature birth. Fortunately, halting the progression of periodontal disease by practicing high standards of oral hygiene and treating existing problems can help reduce the risk of periodontal disease-related complications by up to 50%.

There are several factors that contribute to why periodontal disease may affect the mother and her unborn child. One is an increase in prostaglandin in mothers with advanced stages of gum disease, particularly periodontitis. Prostaglandin is a labor-inducing compound found in the oral bacteria associated with periodontitis. Because periodontitis increases the levels of prostaglandin, the mother may go into labor prematurely and deliver a baby with a low birth weight.

Another compound that has recently been linked to premature birth and low birth weights is C-reactive protein (CRP). CRP is a protein that has long-been associated with heart disease. Periodontal disease increases CRP levels in the body, which then amplify the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, causing the liver to produce extra CRP, which then leads to inflamed arteries and possibly blood clots. Inflamed arteries can lead to blockage, which can cause heart attacks or strokes. Although it is not completely understood why elevated CRP also causes preeclampsia, studies have overwhelmingly proven that an extremely high rates of CRP in early pregnancy definitely increases the risk.

Finally, the bacteria that invade and colonize the gum pockets in a diseased mouth can travel through the bloodstream and affect other parts of the body. For pregnant women, research has shown that these bacteria may colonize in the internal mammary glands and coronary arteries.

If you are pregnant, it is important to practice effective home care for preventing gum disease. Periodontists can help assess your level of oral health and develop preventative measures and treatment plans to best protect you and your baby. Tenderness, redness, or swollen gums are a few indications of periodontal disease. Other symptoms include gums that bleed with tooth-brushing or eating, gums that are pulling away from the teeth, bad breath, and loose teeth. These signs especially during pregnancy should not be ignored and may require treatment from a periodontist.

Oral Contraceptives and Gum Disease

Synthetic hormones in oral contraceptives are designed to mimic pregnancy and therefore can predispose a woman to periodontal disease and gingivitis. (See the Pregnancy and Periodontal Disease section above).

Menopause and Gum Disease

Women who are menopausal or post-menopausal may notice a change in the way their mouths look and feel. During menopause as well as the post-menopausal years there is a decline in estrogen, which is associated with an increased risk of periodontal disease, gingivitis as well as dry mouth, burning sensations in the gums and altered taste sensation. Regular and frequent periodontal cleanings are beneficial for the long term health of a woman’s gums and longevity of her teeth.

Feel free to contact a member of the California Society of Periodontists if you are a woman and concerned about your dental health.