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Periodontitis and Cavities

Gum Disease, Inflammation, and Chronic Disease

Gum disease is clearly associated with heart disease and other health-related problems. This is not necessarily due to bacterial spread from the mouth into the bloodstream, as many people think. In fact, “bacteria showers” in the bloodstream are relatively common and occur in response to brushing teeth, bowel movements, and other normal activities. These are rarely dangerous for people with healthy immune systems. Rather, the link between gum disease and other systemic diseases appears to be due to an increased inflammatory response occurring throughout the body and is triggered by inflammation in the gums. The following diseases have been associated with gum disease.

Infective Endocarditis. Infective endocarditis is a serious, potentially fatal bacterial infection of the heart, its valves or inner lining. It occurs when bacteria in the bloodstream are embedded on abnormal heart valves or damaged heart tissue. Dental procedures and diseases are associated with endocarditis in people with underlying congenital heart disease and in those with prosthetic heart valves or who have had other forms of heart surgery (Drangsholt 1998; Lacassin 1995; Van der Meer 1992). About 8% of cases in the United States have been associated with periodontitis or other dental diseases without an associated dental procedure. Chances of infective endocarditis following dental procedures in people with pre-existing heart conditions ranged from 1 per 3000 to 1 per 5000 procedures (Drangsholt 1998). To prevent this condition, some heart patients are advised to take antibiotics during dental procedures.

Cardiovascular Disease. Studies have shown an association between periodontitis and cardiovascular disease (Beck 1999; Loesche 1988; Mattila 1988), and suggest that periodontitis is a risk factor for cardiovascular disease (Loos 2000; Arbes 1999; Beck 1998). Periodontitis is linked to heart disease by inflammation. According to the latest research, large amounts of bacteria in the gums trigger a systemic inflammatory response, with elevated levels of pro-inflammatory chemicals such as COX (cyclooxygenase) products, arachidonic acid, and others. These pro-inflammatory chemicals may contribute to atherosclerosis, which is now understood to be an inflammatory disease that affects the inner linings of arterial walls (the endothelium). Numerous studies have thus linked inflammatory gum disease to cardiovascular events such as stroke, atherosclerosis, and thickening of calcifications in the carotid artery (Dorfer 2004; Grau 2004; Wu 2000; Ravon 2003; Beck 2001).

Obesity. Obesity, a significant risk factor for numerous diseases, has been associated with periodontitis, gingivitis, and dental cavities (Wood 2003). Other conditions associated with obesity such as metabolic syndrome or Syndrome X (a clustering of dyslipidemia, insulin resistance, hypertension, and type 2 diabetes) can worsen periodontitis (Grossi 1998).

Diabetes. Periodontitis is twice as prevalent in diabetics as non-diabetics (Loe 1993). Experimentally produced periodontitis increased blood glucose levels in uncontrolled diabetic animals. Studies have linked glycation and inflammation in diabetics to worsening periodontitis. Alternatively, studies have linked the inflammatory response triggered by worsening periodontitis to amplified glycation, a damaging process that links proteins to glucose molecules and has been implicated in hardening of the arteries and other diseases (Grossi 1998).

Osteoporosis. Significant relationships exist between periodontitis and osteoporosis (Jeffcoat 1996,1998; von Wowern 1994; Streckfus 1997; Ronderos 2000; Tezal 2000; Krook 1972) as well as tooth loss and osteoporosis (Krall 1994, 1996; Tagushi 1999; Grossi 2000).

Pregnancy-Related Issues. Oral infections can increase the risk of low birth weight in newborns (March of Dimes 2000). Pregnant women with periodontitis were found to be 7.5 times more likely to have a pre-term, low-birth-weight infant than pregnant women without periodontitis (Offenbacher 1996). Pregnancy can increase the frequency, severity, and degree of gingivitis (Hugoson 1970; Loe 1965).

Lung Disease. Poor oral hygiene provides an ideal growth environment for anaerobic bacteria, which can cause severe pneumonia, especially in people with impaired swallowing (Shreiner 1979; Komiyama 1985; Costerton 1995; Mergran 1986; Toews 1986; Fiddian-Green 1991; Levison 1994; Moore 2000; Appelbaum 1978; Pratter 1980; Scannapieco 1999).