The Power of Periodontal Disease

When it comes to dental visits, most patients come in for their routine exam and cleaning.  More often than not, patients who are recommended scaling and root planing, which are also termed "deep cleaning", are intimated by the idea of having extensive treatment or the cost.  According to CDC, 47.2% of adults over the age of 30 have some form of periodontal disease.  This number increases to 70.1% for adults that are 65 years or older¹.

It is important to know that periodontitis is not only restricted to our mouth.  Rather, it has profound correlations and effects on our systemic health.  Here is a run down how periodontal disease and our health are interconnected:

• Diabetes Mellitus
  • Uncontrolled blood glucose is associated with increased chance of infections including periodontitis^2,3.
  • Studies suggest that periodontal treatment and improved oral hygiene may help control HbA1c^4,5.
  • Some studies also suggest that the interrelationship between periodontal disease and diabetes are bidirectional, where controlled blood glucose may decrease the chance of periodontal disease, and vice versa⁶.

• Female Sex Hormones
  • ​Puberty - gum responds more sensitively to plaque but can be prevented with good oral hygiene.
  • Menstrual Cycle - causes increased change of gingivitis; gingivitis xmay feel worse during menstruation.
  • Pregnancy - pregnancy does not cause gingivitis, but is rather caused by plaque; during pregnancy gum is more sensitive to plaque.
    • Severity increased in 2^nd or 3^rd month of pregnancy
    • Gingivitis is more severe by the 8th month and improves during the 9th month.

• Heart and Arteries
  • ​Periodontal disease increases chance of future heart disease by 19%, of which the risk is greater by 44% for those who are 65 years of age or younger⁷.
  • Bacteria from periodontal disease may get introduced to our bloodstream and cause bacteremia and likelihood of heart infection.  About 8% of all infective endocarditis cases are associated with periodontal disease without treatment⁸.
  • Periodontitis causes thickening of carotid artery wall when compared to patients with no periodontitis⁹.

• Stroke
  • ​Evidence suggests that patients with periodontitis are approximately 3 times more likely to have stroke than those without periodontitis^7,10.

• Pregnancy and Child Birth
  • ​Women with periodontitis that has 3mm attachment loss over 60% of sites in the mouth has a 7.5 times increased risk for having low-birth-weight infant¹¹.
  • Studies indicate statistically significant outcome in reducing risk of preterm birth when pregnant women with periodontitis is treated¹².

While current studies are not suggesting direct causal relationship with the listed complications, they do support the evidence of periodontal disease being a risk factor and playing an important role in our overall health.  It is only wise to invest our time and effort in maintaining proper oral health care.  With these evidences available to us, it enables us to build a more promising and healthy future.  Neglect is only at the expense of one's health.

References

1. CDC: Periodontal Disease. March 10, 2015. [accessed 2016 Sept 15]. http://www.cdc.gov/oralhealth/periodontal_disease/

2. Bartolucci EG, Parkes RB: Accelerated periodontal breakdown in uncontrolled diabetes: pathogenesis and treatment, Oral Surg Oral Med Oral Pathol 52:387, 1981.

3. Safkan-Seppala B, Ainamo J: Periodontal conditions in insulin-dependent diabetes mellitus. J Clin Periodontol, 1992; 19:24,.

4. Su L, Liu W, Xie B, Dou L, Sun J, Wan W, Fu X, et al. Toothbrushing, Blood Glucose and HbA1c: Findings from a Random Survey in Chinese Population. Sci Rep, 2016 July 7; 6:28824.

5. Costa KL, Taboza ZA, Angelino GB, Silveira VR, Montenegro R Jr, Haas AN, et al. The Influence of Periodontal Disease on Changes of Glycated Hemoglobin Levels in Type 2 Diabetics: a Retrospective Cohort Study. J Periodontol. 2016 Aug 26:1-13.

6. Taylor GW. Bidirectional interrelationships between diabetes and periodontal diseases: an epidemiologic perspective. Ann Periodontol. 2001 Dec;6(1):99-112.

7. Janket SJ, Baird AE, Chuang SK, Jones JA. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 May;95(5):559-69.

8. Drangsholt MT. A new causal model of dental diseases associated with endocarditis. Ann Periodontol. 1998 Jul;3(1):184-96.

9. Beck JD, Elter JR, Heiss G, Couper D, Mauriello SM, Offenbacher S. Relationship of periodontal disease to carotid artery intima-media wall thickness: the atherosclerosis risk in communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2001 Nov;21(11):1816-22.

10. Wu T, Trevisan M, Genco RJ, et al: Periodontal disease and risk of cerebrovascular disease: the first National Health and Nutrition Examination Survey and its follow-up study, Arch Intern Med. 2000 160:2749.

11. Offenbacher S, Katz V, Fertik G, Collins J, Boyd D, Maynor G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol. 1996 Oct;67(10 Suppl):1103-13.

12. Kim AJ, Lo AJ, Pullin DA, Thornton-Johnson DS, Karimbux NY. Scaling and root planing treatment for periodontitis to reduce preterm birth and low birth weight: a systematic review and meta-analysis of randomized controlled trials. J Periodontol. 2012 Dec;83(12):1508-19. doi: 10.1902/jop.2012.110636. Epub 2012 Mar 1.