Gum disease could lead to other problems

If you're one of those people who lives by the philosophy, "Caveman didn't brush his teeth, so why should I?" you might just want to rethink your approach to oral hygiene in light of some recent research.

A study supported by the National Institutes of Health in the journal "Circulation" reported that, "Older adults who have higher proportions of four periodontal-disease-causing bacteria inhabiting their mouths also tend to have thicker carotid arteries, a strong predictor of stroke and heart attack."

But wait, there's more.

A recent study published in the "Journal of Alzheimer's Disease" has linked gum disease with Alzheimer's through the presence of certain periodontal bacteria in the brains of deceased Alzheimer's patients.

Or try this one: A 2011 Yale University report suggested that "changes in oral bacteria play a role in the risk for developing pneumonia."

Can any of these studies absolutely and positively say that gum disease causes heart, lung or brain diseases? The answer, so far, has mostly been no.

According to Dr. Shaun Whitney, a Coeur d'Alene board certified periodontist, periodontal disease is a "chronic inflammation in the oral cavity." Much of the uncertainty in declaring direct cause-and-effect here comes from the fact that there have been many studies on this, but most of them have been retrospective studies - they look backward to see what happened. It's pretty hard to do a prospective study under these circumstances.

Because of this problem, he said, it's impossible at this time to predict the future from current studies because they show associations and not definitive causes.

"People seem to be at higher risk for heart problems the greater their periodontal disease," said Dr. Ronald Fritz, a board certified cardiologist at Heart Clinics Northwest.

"I tend to look at my patients' teeth whenever they come into my office because if, say, the patient has an artificial heart valve, periodontal disease will put them at very high risk of infection. The artificial valve itself is not normal tissue and bacteria are more likely to settle on that and cause infection.

"The valve infection occurs because the periodontal disease allows access of the bacteria surrounding our teeth into the bloodstream. If a person has even a mildly abnormal heart valve, bacteria can settle on the heart valve and destroy it."

There are nearly a thousand varieties of mouth bacteria. In periodontal disease, the gum pocket is an ulcerated lesion resulting from the breakdown of normal tissue defenses. This process, in turn, allows bacteria and its products to exit directly into the bloodstream.

According to Dr. Anthony Giardino, a Post Falls board certified periodontist, "It's analogous to having an open wound that's infected. What you're looking at is the incidence of bacteremia, which refers to the presence of bacteria in the bloodstream. This can be caused by day to day activities like flossing, brushing and even just chewing food.

"That's why it's important to treat the gum disease to heal the gum pocket lesion and remove the harmful bacteria. We can't yet say gum disease causes diseases such as Alzheimer's, but it seems the research done so far indicates that periodontal disease may well be a contributing factor to the onset or worsening of those diseases."

Fritz said that periodontal disease can make existing systemic inflammatory processes worse.

"If you've got a pocket around your tooth, those substances get into the bloodstream," he said. "That stimulates a systemic inflammatory process and can trigger a heart attack.

"The white cells fighting the infection cause the release of other substances that make the plaque in the arteries more vulnerable to rupturing. When rupture causes thrombosis, that's what precipitates the heart attack."

It should be clear by now that it's in everyone's best interests to take care of their gums before things get to the high-risk stage. Yes, handsome teeth and gums are definite social assets, but they are also important to our general body health. Giardini said that most people are unaware they have gum disease in its early stages.

Some might ask if the fix is worth the pain.

The good news here is that the field of periodontics has made major advances in recent years and with the use of special lasers such as the LANAP, much of the traditional - traumatic - digging and gouging has gone the way of the horse and buggy. Many periodontists now offer IV sedation in addition to local analgesia.

"We all know that gum disease infection contributes to a lot of our chronic illnesses and that there is also evidence it may be associated with preterm low-birth weight deliveries and pneumonia in the elderly," Giardino said. "We know it's definitely a contributing factor, but we can't yet say that it caused the disease."

There are, however, ongoing primate studies in the area of gum disease, he said, that are not necessarily limited to conducting retrospective investigations. So, perhaps in the future, a better defined causal link will come out of these studies.