September 29, 2011

Periodontal Disease: Dangerous to Your Health

The World Health Organization reports that 85% of the USA population has some kind of periodontal disease.  A small portion is due to genetics, but most is contributed to ineffective oral hygiene and a high sugar diet.

Periodontal Disease: A group of diseases that affect the bone and tissues that support the teeth. What this really means is gum disease that causes pockets and bone loss around the teeth.  You need four things to have gum disease: tooth, bacteria, sugar, time. These are the same factors that cause cavities.

Everyone has bacteria in their mouths that can cause gum disease.  When we eat sugar and don’t remove it in a timely manner the calcium rich saliva can harden the resulting plaque into tartar (calculus). In the below picture you see an example of both tooth decay and calcified plaque called calculus.  This periodontal disease is so severe it is causing a periodontal abscess. The bone loss is deep down along the side of this tooth and has made it get loose enough to need extraction.  This patient has not had their teeth examined or cleaned for several years. Remember, once bone loss has happened, it is very difficult if not impossible to regenerate.

Treatment for Gum Disease:

  • Gingivitis– This can be found around the teeth before periodontal disease forms pockets.  It is when the gums first start to get red and bleed.  It is cause by plaque staying too long around the necks of your teeth. The treatment for this is a good cleaning every 6 months and home oral hygiene instructions. The prognosis is good with treatment.
  • Mild Periodontal Disease– This is when gingivitis has been around your teeth too long.  Pockets (>4mm) are beginning to form around the necks of the teeth.  It maybe hard to distinguish from gingivitis on x-rays and any aggressive treatment is usually refused by dental “allowance” companies so they will not have to pay for your treatment.  Scaling and root planing is usually prescribed for this condition and is very effective in treating it.  Following the scaling and root planing is a maintenance appointment every 3-4 months with a good cleaning and home oral hygiene instructions.  This removes not only the calcified plaque above the gum line, but also the tartar below.  Removing the calcified plaque below the gum line is key to arresting this stage of periodontal disease. This tartar cannot be removed with a toothbrush and floss alone.  Only a professional cleaning can help. Perio Protect can be used with good success, but you have to use it all the time for it to work. Laser debridement is very effective as well.  The prognosis for this phase of the disease is fair with treatment.
  • Moderate Periodontal Disease– Bone loose can be clearly seen on the radiographs and pocket depths of 5-6mm are found around the necks of the teeth.  Scaling and root planing is a common treatment plan.  However, new treatments such as laser therapy is growing in popularity.  Some patients are referred to the periodontist for treatment which can include scaling and root planing in conjunction with some form of surgery. The prognosis is guarded with treatment.
  • Severe Periodontal Disease– Bad news! Bone loss and pockets >6mm deep.  There is no way a patient can clean their teeth properly without professional assistance.  If you are referred to a periodontist at this point they may want to consider extractions and implants.  Patient who do not want to be referred to the specialist can go into compromised maintenance therapy.  This is where the hygienist cleans out you pockets as well as she can with scaling and root planing.  This will not ever cure your disease, but it may slow it down greatly.  Eventually, the bone loss will become so severe that the tooth gets loose and may fall out. The prognosis is poor.
  • End Stage Periodontal Disease– This is not an actual category of this disease, it is simply the stage I call it when periodontal disease is so bad, teeth are falling out by themselves. The only treatment is extraction.  There are a variety of ways to restore lost teeth. Those ways are explored in more depth in other blogs on this website.  The prognosis for end stage periodontal disease is hopeless.

Why is Periodontal Disease dangerous to Your Health?

When bacteria lives deep under your gum line bleeding is common. Every time you stimulate bleeding with your toothbrush or floss or eating you have the chance to cause bacteria to enter your bloodstream.  This near constant flow of bacteria into your bloodstream is not good.
  • Cardiovascular Disease– Periodontal disease is considered an independent risk factor for atherosclerosis which can contribute to cardiovascular diseases.  A few years ago there was a well know syndicated humorist called Louis Grizzard who famously died at the young age of 47 from cardiovascular disease and possibly dental neglect.
  • Diabetes– is a very complicated metabolic disease causing high blood sugar.  Not enough insulin is produced or cells cannot use the insulin anymore.  In a nut shell, diabetes makes it harder to fight infection.  This can lead to rapidly advancing gum diseases.
  • Cerebrovascular Disease– is a condition that results from problems with the bloodstream inside the brain. It is very similar to the complications due to cardiovascular disease.  Bacteria from periodontal disease can accumulate inside the blood vessels and contribute to the formation of atherosclerotic plaques which can either block oxygen to certain parts of the brain (stroke) or cause them to weaken enough to pop (cerebrovascular hemorrhage).
  • Osteoporosis– Clearly this condition of the bone is linked to periodontal disease.  It is just unclear which is influencing which.
  • Liver and Lung abscesses– Periodontal disease sheds bacteria throughout the body through the bloodstream and where the blood is filtered or narrowed into a capillary bed (liver/lung) it can get lodged and in certain instances grow into a local nidus of infection called an abscess.
  • Pancreatic Cancer– Although it has not been proven, nitrosamines produced by periodontal disease bacteria may be responsible for causing cancer in the body, including the pancreas.
  • Alzheimer’s– The link between periodontal disease is not well understood.  It may be similar to how other bacteria such as syphilis makes to to the brain.
  • Pregnancy Complications– Although the data is inconclusive, low birth weight and periodontal disease is continuing to be studied.
The Perio Protect Method of treatment is catching on as a hopeful overall painless treatment for periodontal disease and ramped caries.

References:

1. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2011 Sep;54(9):1089-96. [Relationship between periodontitis and systemic diseases]. [Article in German] Jepsen SKebschull MDeschner J. Poliklinik für Parodontologie, Zahnerhaltung und Präventive Zahnheilkunde, Rheinische Friedrich-Wilhelms-Universität Bonn, Welschnonnenstr. 17, 53111, Bonn, Deutschland, jepsen@uni-bonn.de.
2. J Microbiol Immunol Infect. 2010 Dec;43(6):491-7. Invasive infections of Aggregatibacter (Actinobacillus) actinomycetemcomitans. Wang CYWang HCLi JMWang JYYang KCHo YKLin PYLee LNYu CJYang PCHsueh PR. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
3. Przegl Lek. 2009;66(7):373-9. [Bacteriological spectrum of periodontal pocket in patients with coronary heart disease and myocardial infarction]. [Article in Polish] Bochniak MSadlak-Nowicka JKedzia ASobiczewski W. Katedra i Zakład Periodontologii i Chorób Błony Sluzowej Jamy Ustnej, Gdańskiego Uniwersytetu Medycznego.
4. Indian J Med Res. 2007 Feb;125(2):129-36. Association of common chronic infections with coronary artery disease in patients without any conventional risk factors. Goyal PKalek SCChaudhry RChauhan SShah N. Departments of Cardiac Anesthesiology, All India Institute of Medical Sciences, New Delhi, India. princeofcoma@yahoo.co.uk
5. Thromb Res. 2009 Mar;123(5):780-4. Epub 2008 Sep 11. Porphyromonas gingivalis infection and prothrombotic effects in human aortic smooth muscle cells. Roth GAAumayr KGiacona MBPapapanou PNSchmidt AMLalla E. Division of Surgical Science, Department of Surgery, College of Physicians & Surgeons, Columbia University, New York, NY, USA.
6. J Periodontal Res. 2006 Aug;41(4):350-3. Periodontal pathogens in atheromatous plaques isolated from patients with chronic periodontitis. Padilla CLobos OHubert EGonzález CMatus SPereira MHasbun SDescouvieres C. Laboratorio de Investigación Microbiológica, Universidad de Talca, Talca, Chile. cpadilla@utalca.cl
7. J Clin Periodontol. 2005 Jul;32(7):708-13. Bacteraemia following periodontal procedures. Kinane DFRiggio MPWalker KFMacKenzie DShearer B. University of Louisville School of Dentistry, Louisville, KY 40292, USA. dfkina01@louisville.edu
8. West Indian Med J. 2011 Jan;60(1):86-90. A preliminary investigation of periodontal disease and diabetes in Trinidad. Balkaran RNaidu RTeelucksingh SSeemungal TPereira LPPrayman EBissoon A. School of Dentistry, Faculty of Medical Sciences, The University of the West Indies, Trinidad and Tobago, West Indies. ramaa.balkaran@gmail.com
9. Eur Rev Med Pharmacol Sci. 2011 Jul;15(7):751-8. Diabetes mellitus: biochemical, histological and microbiological aspects in periodontal disease. Marigo LCerreto RGiuliani MSomma FLajolo CCordaro M. School of Dentistry, Catholic University of the Sacred Heart Rome, Italy. luca.marigo@rm.unicatt.it
10. J Indian Soc Periodontol. 2010 Jul;14(3):148-54. The link between periodontal disease and cardiovascular disease: How far we have come in last two decades ? Dhadse PGattani DMishra R. Department of Periodontics, Hitkarini Dental College and Hospital, Dumna Road, Jabalpur – 482002, India.
11. Obesity (Silver Spring). 2011 Jul 14. doi: 10.1038/oby.2011.218. [Epub ahead of print] Total Tooth Loss and Systemic Correlates of Inflammation: Role of Obesity. Meisel PWilke PBiffar RHoltfreter BWallaschofski HKocher T. Dental Clinics, Department of Periodontology, Ernst Moritz Arndt University Greifswald, Greifswald, Germany.
12. Bratisl Lek Listy. 2011;112(7):416-20. Oral manifestations of diabetes mellitus and influences of periodontological treatment on diabetes mellitus. Straka M. Department of Stomatology, Slovak Medical University, Bratislava, Slovakia. mudrstraka@r3.roburnet.sk
13. J Indian Soc Periodontol. 2010 Oct;14(4):207-12. Diabetes and periodontitis. Deshpande KJain ASharma RPrashar SJain R. Department of Biochemistry, Dr. HS Judge Institute of Dental Sciences & Hospital, Panjab University, Sector 25, Chandigarh, India.
14. J Periodontal Res. 2011 Jun 17. doi: 10.1111/j.1600-0765.2011.01388.x. [Epub ahead of print] Do patients with aggressive periodontitis have evidence of diabetes? A pilot study. Davies RCJaedicke KMBarksby HEJitprasertwong PAl-Shahwani RMTaylor JJPreshaw PM. School of Dental Sciences and Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
15. Semin Thromb Hemost. 2011 Apr;37(3):181-92. Epub 2011 Mar 31. Dental infection and vascular disease. Zoellner H. The Cellular and Molecular Pathology Research Unit, Department of Oral Pathology and Oral Medicine, The University of Sydney, Westmead Centre for Oral Health, Westmead Hospital, Westmead, Australia. hans.zoellner@sydney.edu.au
16. Indian J Dent Res. 2011 Mar-Apr;22(2):270-6. Correlation of periodontal status and bone mineral density in postmenopausal women: A digital radiographic and quantitative ultrasound study. Vishwanath SBKumar VKumar SShashikumar PShashikumar YPatel PV. Department of Periodontology, JSS Dental College and Hospital, Mysore, India.
17. Int J Evid Based Healthc. 2010 Sep;8(3):129-39. doi: 10.1111/j.1744-1609.2010.00171.x. Relationship between periodontal disease and osteoporosis. Megson EKapellas KBartold PM. Colgate Australian Clinical Dental Research Centre, Dental School, University of Adelaide, Adelaide, South Australia, Australia.
18. Bone. 2011 Mar 1;48(3):552-6. Epub 2010 Oct 14. Prediction of hip and hand fractures in older persons with or without a diagnosis of periodontitis. Persson GRBerglund JPersson RERenvert S. Department of Periodontology, University of Bern, Bern, Switzerland.
19. Climacteric. 2010 Dec;13(6):523-9. Epub 2010 Aug 7. Periodontitis and osteoporosis: a systematic review. Martínez-Maestre MÁGonzález-Cejudo CMachuca GTorrejón RCastelo-Branco C. Hospitales Universitarios Virgen del Rocío, Seville, Spain.
20. J Indian Soc Periodontol. 2009 May;13(2):90-6. Osteoporosis: “A risk factor for periodontitis”. Koduganti RRGorthi CReddy PVSandeep N. Professor and H.O.D, Department of Periodontics, Panineeya Mahavidhyalaya Institute of Dental Sciences and Research, Kamala Nagar, Dilsukhnagar, Hyderabad – 500 060, India.
21. Hepatol Res. 2011 Feb;41(2):194-6. doi: 10.1111/j.1872-034X.2010.00748.x. Liver abscess caused by periodontal bacterial infection with Fusobacterium necrophorum. Yoneda MKato SMawatari HKirikoshi HImajo KFujita KEndo HTakahashi HInamori MKobayashi NKubota KSaito STohnai IWatanuki KWada KMaeda S,Nakajima A. Division of Gastroenterology Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, Yokohama Department of Pharmacology, Osaka University, Graduate School of Dentistry, Suita, Osaka, Japan.
22. Intern Med. 2003 Aug;42(8):723-5. Lung abscess caused by Actinomyces odontolyticus. Takiguchi YTerano THirai A. Department of Internal Medicine, Chiba Municipal Hospital, Chiba.
23. Am J Clin Nutr. 2003 Jul;78(1):176-81. Tooth loss, pancreatic cancer, and Helicobacter pylori. Stolzenberg-Solomon RZDodd KWBlaser MJVirtamo JTaylor PRAlbanes D. Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA. rs221z@nih.gov
24. J Natl Cancer Inst. 2007 Jan 17;99(2):171-5. A prospective study of periodontal disease and pancreatic cancer in US male health professionals. Michaud DSJoshipura KGiovannucci EFuchs CS. Department of Epidemiology, Harvard School of Public Health, Kresge 920, 677 Huntington Ave., Boston, MA 02115, USA. dmichaud@hsph.harvard.edu
25. J Dent. 2010 Feb;38(2):83-95. Epub 2009 Nov 4. The association between periodontal disease and cancer: a review of the literature. Fitzpatrick SGKatz J. Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL 32610-0416, USA. sfitzpatrick@dental.ufl.edu
26. Alzheimers Dement. 2008 Jul;4(4):242-50. Epub 2007 Dec 21. Inflammation and Alzheimer’s disease: possible role of periodontal diseases. Kamer ARCraig RGDasanayake APBrys MGlodzik-Sobanska Lde Leon MJ. Department of Periodontology and Implant Dentistry, College of Dentistry, New York University, New York, NY, USA. ark5@nyu.edu
27. Clin Obstet Gynecol. 2007 Jun;50(2):454-67. Should we treat periodontal disease during gestation to improve pregnancy outcomes? Ferguson JE 2ndHansen WFNovak KFNovak MJ. Department of Obstetrics and Gynecology, College of Medicine, University of Kentucky, Lexington, Kentucky, USA. James.Ferguson@uky.edu
28. J Neuroinflammation. 2011 Aug 4;8(1):90. [Epub ahead of print] Alzheimer’s disease – a neurospirochetosis. Analysis of the evidence following Koch’s and Hill’s criteria. Miklossy J.
29. Alzheimer Dis Assoc Disord. 2005 Jul-Sep;19(3):156-8. The cure of one of the most frequent types of dementia: a historical parallel. Nitrini R. Neurology, University of São Paulo School of Medicine, Brazil. rnitrini@uol.com.br
30. J Periodontol. 2011 Aug 5. [Epub ahead of print] Birth Weights of Children of Aggressive Periodontitis Patients. Schenkein HAKoertge TESabatini RBrooks CNGunsolley JC. Virginia Commonwealth University, School of Dentistry, Department of Periodontics
31. Odontology. 2011 Jul 8. [Epub ahead of print] Periodontal disease as a risk factor for adverse pregnancy outcomes: a systematic review and meta-analysis of case-control studies. Corbella STaschieri SFrancetti LDe Siena FDel Fabbro M. Department of Health Technologies, IRCCS Istituto Ortopedico Galeazzi, Dental clinic, University of Milan, Via Riccardo Galeazzi, 4, 20161, Milan, Italy.