The Link between Oral Gum Disease and My Overall Health

Okay Dr. Koo, what’s the connection between gum disease and my medical health?
The evidence for a connection is strong.
To start, researchers have consistently found significant links between oral gum disease (periodontitis) and coronary heart disease through meta analysis of available data (3) (4). More broadly speaking, periodontal studies find, without challenge, that people with severe periodontal disease are much more likely to have other systemic chronic inflammatory conditions such as diabetes, cardiovascular disease, metabolic syndromes, arthritis, liver disease and adverse pregnancy outcomes. (1) (5)
One 2014 study tracking dental bacteria of baboons suggested a strong causal relationship between chronic periodontitis and adverse pregnancy outcomes. The newborns with periodontitis had increased rates of lower birth weight by 18.1%, decreased gestational age by 9.8% and spontaneous abortion/stillbirth/fetal demise by 8.7%. 1

How do they measure this?
Measuring probability is one way researchers analyze disease behavior. Links can be called prevalence, incidence, risk factors, markers, et al. Following the disease on a microbial level becomes very complex due to the large number of species involved and the difficulty in enumerating a complete set. This can be appreciated when considering the work of the Forsyth Institute in Boston Massachusetts in which most of the researchers are faculty at Harvard School of Dental Medicine. 6 The Forsyth Institute is especially associated with the work of cataloguing a complete list of dental bacteria and following their relationships.
In 2000, the Forsyth Institute counted 347 bacterial species in the mouth with 40% of the species newly identified as oral bacteria. At the time it was estimated that perhaps 500 species actually existed. (7)Well, in 2007, the Forsyth Institute exceeded that number and identified 615 difference species of bacteria in the mouth and are still counting. 6 The process of identifying the bacteria involved cultivating oral bacteria and obtaining full 162 rRNA sequences. 7 This required ribosomal DNA isolation and cloning into E.Coli in order to analyze and obtain bases, especially important for the new species.
A 2007 article of the Forsyth Institute’s work discussed experiments for neutralizing the “bad” dental bacteria that cause destruction in the mouth by swishing with “good” dental bacteria that can neutralize the bad bacteria or their damaging byproducts. This didn’t work. Also discussed were plans to develop a saliva test that can indicate for early cancer as it has been discovered that the balance of bacterial species shifts in a specific manner in people with healthy mouths and those with oral cancer. 6 This valuable screening test is still future to us.


Why is it so complicated?
Because the polymicrobial nature of gum disease and the complexity of the immune response being triggered is complicated.
The study on baboons and pregnancy outcomes illustrates this well. This study was very technical with a strong emphasis on microbiological measurements that seems to better detail out what’s happening. Researchers measured serum inflammatory mediators and IgG antibody levels to twenty “dental” bacteria using quantitative ELISA measurements. They stratified the animal pool on several levels- degree of gum disease, gestational age, specific immune responses. And so they were able to decipher and draw clear links. 1
The results of this study are consistent with various epidemiologic studies that link periodontitis and pregnancy in humans by indicating that women with periodontitis had a higher frequency of stillbirth/abortion/fetal demise compared to periodontally healthy women. Congruently, the baboon study showed an increase in stillbirth/abortion/fetal demise that was 3 times higher in the experimental animal group vs. the control group. 1

Am I affected?
Half of the U.S. population is.
A landmark NHANES (National Health and Nutrition Examination Survey) study from 2009-2010 tracked periodontal disease in the United States and extrapolated that 47.2 % of Americans suffer from gum disease. 2
(The breakdown of the candidate pool with periodontitis breaks down into 30% of Americans with moderate periodontitis, 8.7% with mild periodontitis and 8.5 % with severe periodontitis. The study is notable for its large size, ultimately 3,743 adults, with health not requiring antibiotic prophylaxis, civilian, non-institutionalized and subjects coming from 50 states of the U.S. and D.C. For the first time, NHANES used FMPE or full-mouth periodontal examination protocols. This means probing depth and recession was measured at 6 points on each tooth but not taking into account bleeding points or furcas. The NHANES periodontal surveys of previous years used partial measurements. This FMPE protocol is the strength of the report since it is a comprehensive look at each individual. )
Interestingly the NHANES survey found that periodontitis was highest in age group 50-64YO, men, Mexican-Americans, adults with less than a high school education, adults below the Federal Poverty Level and current smokers.
The study also found that among married persons there was a 44.2% incidence of periodontitis and for widowed persons there was a 62.2% rate of periodontitis. And in between with incidence of periodontitis from 44.2% to 62.2% were never married, divorced and living with partner from lowest to ascending order. 2

What to do?
Consider routine preventive dental care and managing gum disease as one of the pillars of your overall health.


References:

  1. Jeffrey L. Ebersole, PhD. Stanley C. Holt, PhD, and David Cappelli, DMD, PhD.  Periodontitis in Pregnant Baboons: Systemic Inflammation and Adaptive Immune Responses and Pregnancy Outcomes in a Baboon Model. J Periodontal Res. 2014 Apr: 49 (2): 226-236.

  2. P.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.

  3. 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. 

  4. 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.

  5. Lillian Bensley, PhD; Juliet VanEenwyk, PhD; Eric M. Ossiander, PhD Associations of self-reported periodontal disease with metabolic syndrome and number of self reported chronic conditions. Prev Chronic Dis 2011; 8(3):A50.

  6. Cromie, William J. Discovering who lives in your mouth: Bacteria give clues to cancer and gum disease.  Havard University Gazette. August 22.2002

  7. Bruce J. Paster, Susan K. Boches, Jamie L. Galvin, Rebecca E. Ericson, Carol N. Lau, Valerie A. Levanos, Ashish Sahasrabudhe, and Floyd E. Dewhirst. Bacterial Diversity in Human Subgingival Plaque. Department of Molecular Genetics, The Forsyth Institut and Department of Oral Biology, Harvard School of Dental Medicine, Boston, Massachusetts. 11/8/2000.

Author
Catherine Koo, DDS and Victoria Burfield, RDA

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