The long-suspected link between oral and general health is becoming more high profile in the UK media as well as within dental and medical circles as increasing evidence is produced to support its validity.
The British Society of Periodontology (BSP) errs on the side of caution when it comes to reporting and promoting the connections between healthy gums and conditions such as cardio issues or diabetes. There has been some research linking gum diseases (periodontitis) with adverse pregnancy outcomes, however, the research is not yet convincing. Alzheimers Disease is another area where there is still further research required to establish firm connections. However as a general
rule of thumb, good oral health is considered a vital part of overall wellbeing and therefore it is likely, longterm, to have a much more far-reaching impact than is currently evidenced. Periodontitis, although not a cause of mortality, is a major public health concern because of its high prevalence in the population and its negative impact on oral health, ability to chew, appearance, quality of life, dental care costs and tooth loss. In addition, as a progressive, chronic inflammatory disease, untreated periodontitis has the potential to undermine overall health and exacerbate other inflammatory conditions.
Although diabetes and periodontitis may seem like very different diseases, dentists have known for a long time that people with diabetes are more likely to suffer from periodontitis, which may be worse and harder to treat, compared with people who do not have diabetes. If a person’s blood sugar levels are under good control, however, gum treatment is more likely to be successful. But that’s not the end of the story; scientists are now finding that gum disease may also have an effect on diabetes, making blood sugar control more difficult.
It is not yet completely understood why gum disease should have an effect on diabetes, but scientists think that some of the germs that infect the gums when we get gum disease can escape into the bloodstream. This triggers a reaction from our immune system, which can lead to the release of powerful molecules that have harmful effects on other parts of the body, resulting in worsened blood sugar control.
Professor Mariano Sanz, chairman of periodontology at the University Complutense in Madrid, explains: “There are millions of bacteria in the mouth and there is a clear possibility of inflammatory reactions deriving from this bacteria… and there is
evidence that there are people who are susceptible to systemic inflammation which can affect many different parts of the body.”
Recently, an international panel of leading clinicians and research scientists convened at a landmark meeting in Spain, organised jointly by the European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP), to review the latest scientific research into periodontitis and cardio (ACVD) conditions.
The EFP is one of the foremost dental organisations in Europe, with a membership comprising of 28 national periodontal societies with over 13,000 members, and works to promote awareness and understanding of, and best practice within, periodontology. The AAP is the leading professional organisation for periodontists in the United States, with a membership of more than 8,000 specialists.
After a detailed review of the evidence, the experts produced a consensus report outlining current understanding of the relationship between periodontitis and cardiovascular disease. They also formulated new evidencebased guidelines for general dental practice.
The most likely explanation for how periodontitis affects ACVD is that periodontal bacteria and their products (such as endotoxin) from periodontal pockets enter the circulation and provoke an acutephase and subsequent inflammatory
response. Mediators produced as part of this host response then promote the development, of fatty lesions (atheroma) in the arteries, increasing the risk of an ACVD adverse event.
Research shows that the likelihood of periodontal bacteria entering the bloodstream (bacteraemia) after chewing, brushing, flossing or scaling depends upon the patient’s periodontal health. Bacteraemia is more common and involves a wider range of bacteria (including periodontal pathogens) in patients with periodontitis, compared with patients who have gingivitis or
healthy mouths.
The first person to identify potential issues may be the dentist who should screen any patient presenting with signs of periodontitis for symptoms of systemic illness. This is something that the BSP and EFP would like to encourage – dentists who see early signs of periodontitis to act on it immediately – either through direct treatment or referral to a perio specialist.
There is a lot more to do in terms of research but it seems certain that oral health is indisputably linked to general health and if strong evidence has been found for diabetes and cardio problems, it is highly likely that more areas of health are directly affected by the bacteria found in the mouth. We will continue to discover more as new research findings are presented.