• Periodontitis Impacts your risk of Diabetes and the Health of your Blood Vessels

    by Catherine Koo, DDS and Victoria Burfield, RDA
    on Aug 8th, 2017

 

Gum disease or periodontitis has a negative effect on your health extending beyond the oral cavity.  In fact, the tissue damage that comes from periodontal inflammation is connected to damage throughout one’s body.  Studies find that periodontitis is an independent predictor of diabetes and that treating periodontitis reverses damage to your blood vessels. This blog should convince you of the gravity in treating any gum disease you may have.  And what is the likelihood one has gum disease?  A  U.S. government study ascertained that almost half of us have gum disease.

In fact, an estimated 47.2% of adult Americans suffer from gum disease or periodontitis.  This is taken from the U. S. government’s 2009-2010 National Health and Nutrition Survey which is notable for its large size, 3,743 participants.(6)  From this study, the the link between periodontitis and type 2 diabetes was tracked over 2 decades of follow-up. The results found that periodontitis was, in fact, a novel predictor of diabetes for the nationally representative sample from the NHANES study. This study adjusted out the impact of known diabetes risk factors such as diet and tobacco usage.  In fact, it was seen that those participants with intermediate periodontitis had a twofold increased odds of incident diabetes compared to the risk for those with milder periodontitis. (3)

 

 

click Table to enlarge

 

Regarding coronary heart disease, research has consistently found periodontitis to be significantly linked (4) (5) Even more ominous, studies have found that periodontitis has a  causal relationship with endothelial dysfunction. So, now, we’re switching gears and looking at how periodontitis affects one’s blood vessels. (1) Endothelial dysfunction is a problem with the inner lining of blood vessels and is the first step towards atheroscelorosis or thickening of the arteries.  When arteries become blocked, what follows is blocked oxygen delivery to the surrounding tissues or organs, stroke and possibly death. Clinical studies show that in the presence of periodontal bacteria, there is an increased thickness of the carotid intima media or inner lining of the blood vessel.   In other words, the condition of atherosclerosis increases in an individual with periodontitis and therefore, the incidence of cardiovascular events like stroke would increase for that individual (2).

The mechanism connecting gum disease to atherosclerosis is thought to be due to periodontal bacteria damaging tissues by triggering inflammation (1)  Both diabetes and cardiovascular disease have systemic inflammation as a precursor. (3)  Studies show that therapy treating periodontitis resulted in an improvement in endothelial function. And, the most pronounced reversals in endothelial damage were observed following intensive periodontal treatment of the severest periodontitis cases. (1)(2)  This improvement was measured in significantly improved flow-mediated dilatation of the brachial artery and a significant decrease in C-reactive protein concentrations which is a blood test marker for inflammation in the body. (1 )Tonetti’s study found that 60 days after intensive periodontal treatment, flow-mediated dilatation improved and plasma levels of soluble E-selectin (an inflammatory marker specific for endothelial cells) were lower. (2)

It should be noted that it is difficult for researchers to trace connections due to the polymicrobial nature of gum disease and the complexity of the immune response being triggered.  But, to be sure, these studies do show that if one is interested in decreasing one’s risk for diabetes, not having periodontal disease would decrease that risk. Also, treating one’s gum disease, especially if it is an advanced case, would reverse damage to blood vessels. Although further studies are recommended to strengthen findings, treating and managing gum disease are prudent first steps to decreasing the incidence of atherosclerosis, cardiovascular events and diabetes in an individual.


     

 References:

  1. Gerald Seinost, MD, Gernot Wimmer, MD, Martina Skerget, MD, Erik Thaller, DDS, Marianna Brodmann, MD, Robert Grasser, MD, Rudolf O. Bratschko, MD, and Ernst Pilger, MD. (2005). Periodontal treatment improves Endothelial Dysfunction in patients with severe Periodontitis. American Heart Journal , 950. DOI: 1016/j.ahj.2004.09.059 

  2. Maurizio S. Tonetti, D.M.D., Ph.D., Francesco D'Aiuto, D.M.D., Ph.D., Luigi Nibali, D.M.D., Ph.D., Ann Donal, Clare Storry, B.Sc., Mohamed Parkar, M. Phil., Jean Suvan, M. SC., Aroon Hingorani, Ph.D., Patrick Vallance, M.D., and John Deanfield, M.B., Chir. (2007). Treatment of Periodontitis and Endothelial Function. The New England journal of Medicine , 911-920. DOI: 10.1056/NEJMoa063186

  3. Ryan T. Demmer, PHD, MPH, David R. Jacobs, Jr., PHD, and Moise Desvarieux, MD, PHD. (2008). Periodontal Disease and Incident Type 2 Diabetes. Results from the First National Health and Nutrition Examination Survey and its Epidemiologic Follow- Up Study. National Center for Health Statistics at Centers for Disease Control Prevention, (7) 1373-1379. DOI: 10.2337/dc08-0026

  4. Bahekar AA, Singh S, Saha S, Molnar J, Arora R. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis. Am Heart J. 2007 Nov;154(5):830-7. 

  5. Linda L. Humphrey, MD, MPH, Rongwei Fu, PhD, David I. Buckley, MD, MPH, Michele Freeman, MPH, and Mark Helfand, MD, MPH. Periodontal Disease and Coronary Heart Disease Incidence: A Systematic Review and Meta-analysis. Published online September 20, 2008.

  6. I. Eke, B.A. Dye, L.Wei, G.O. Thornton-Evans, and R.J. Genco. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. National Health and Nutrition Examination Survey.

Author Catherine Koo, DDS and Victoria Burfield, RDA

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