The Mouth-Body Connection

Research proves that there is a strong connection between periodontal disease and other chronic conditions such as diabetes, heart disease, and osteoporosis.

Characteristics of periodontal disease is  inflammation of the gum tissue, presence of disease-causing bacteria, and infection below the gum line. A host of problematic health issues may occur when infection and bacteria from the mouth spread throughout the body. By maintaining excellent oral hygiene and treating periodontal disease to reduce its progression, there are health benefits beyond preventing gum disease and bone loss.  Proper oral hygience may help you prevent developing serious medical conditions.

Diabetes and Periodontal Disease

Diabetes is a serious, incurable disease characterized by too much glucose, or sugar, in the blood, thickening of blood vessel walls, and the reduced ability to fight infections. Patients may experience diabetes in either one of two ways, Type I Diabetes, known as Insulin Dependent Diabetes Mellitus. or Type II Diabetes, knows as Non-Insulin Dependent Diabetes Mellitus. Type II diabetes presents when the body is unable to regulate insulin levels, meaning too much glucose remains in the blood. Type I diabetes occurs when the pancreas cannot produce any insulin at all. Diabetes affects between 12 and 14 million Americans, and can lead to a variety of health issues, such as heart disease and stroke. Oftentimes, diabetes treatment focuses on controling blood sugar levels, blood cholesterol levels, and blood pressure known as the diabetic triad.

Medical and dental research has shown that people with diabetes are more likely to develop periodontal disease than people without diabetes. Patients with diabetes who experience insufficient blood sugar control also develop periodontal disease more frequently and more severely than those who manage their diabetes well. One of the best tests for blood sugar control is the Hemoglobin A-1-C blood test and some new guidelines have been established for this important test.

The correlation between diabetes and periodontal disease is multifactorial.  Patients with diabetes are more prone to experience all types of infections, including periodontal infections, as the diabetes slows circulation reducing the natural cleansing of the blood vessels and allowing bacteria to colonize. Also, by reducing the body’s resistance to infection, diabetes increases the probability of gum infections.

With increasing levels of periodontal disease, patients with diabetes may experience elevated blood sugar levels thus increasing the amount of time their body functions with high blood sugars, rendering their ability to control their blood sugars more difficult. Dr. Noraian has had patients who claim their blood sugars control has improved once their periodontal disease has been treated. Furthermore, the bacteria responsible for periodontal disease thrive in the presence of high blood sugars which in turn leads to high glucose levels in saliva and the periodontal pockets which promote growth of the bacteria responsible for gum disease.

Earlier, we mentioned that there is a tendency for blood vessels to thicken with diabetes. Think of blood vessels as the plumbing the body needs to bring nutrition and repair to the body’s tissues as well as to remove waste products from the body. As the vessels thicken, the efficiency to provide nutrients and then remove waste become less effective. As a result, harmful waste products left in the mouth weaken the resistance of gum tissue, leading to infection and disease.

For years, we have known that anyone who smokes or uses tobacco damages their oral and overall health, and it is particularly harmful to patients with diabetes. For example, patients with diabetes who smoke age 45 and older are 20 times more likely to develop periodontal disease than those who do not smoke.

As part of the protocol at our office, we ask all of our patients to brush their teeth well for two minutes at a time with a soft or extra soft toothbrush, to floss their teeth every day, and to visit their dentist regularly; and it is especially important for patients with diabetes to practice these measures. If people don’t brush their teeth, harmful bacteria consumes the excess sugar and colonizes beneath the gum line.

Heart Disease, Stroke and Periodontal Disease

When fatty proteins and plaque buildup on the walls of a person’s arteries, coronary heart disease sets in and causes the arteries to narrow, constricting blood flow which reduces the flow of oxygen that your body’s tissues require to stay healthy. When oxygen is restricted to the heart, patients may experience shortness of breath, chest pain, and even heart attack.

Patients with periodontal disease are two times more likely to suffer coronary heart disease. Furthermore, periodontal disease may aggravate existing heart conditions and patients with periodontal disease have a higher chance of stroke. A stroke happens when the blood flow to the brain stops most commonly when a blood clot prevents blood from reaching the brain.

As periodontal disease is caused by bacteria, these oral bacteria may enter the bloodstream and may attach to the fatty plaques in the coronary arteries. This attachment forms a blood clot and increases the risk of a variety of health issues including heart attack.

We also mentioned that periodontal disease is caused by inflammation, which stimulates an increase in white blood cells and C-reactive proteins (CRP). CRP is a protein commonly associated with heart disease. When CRP increases in the body, it increases the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, causing the liver to produce extra CRP, which then leads to inflamed arteries and possibly blood clots. Inflamed arteries can lead to blockage, which give rise to heart attacks or strokes.

Coronary heart disease is the leading cause of death in the United States for both men and women. Good oral hygiene practice and receiving treatment for periodontal problems can help prevent the risk of developing coronary heart disease.

Pregnancy, Women’s Health Issues and Periodontal Disease

Pregnant women are known to take better care of themselves once they find out they are pregnant. It has been well documented that when a pregnant woman has periodontal disease their unborn child may be exposed to a variety of risks and possible complications. As pregnancy causes many hormonal changes in women, the likelihood of developing periodontal disease such as gingivitis, or gum inflammation, increases. Most importantly, these oral problems have been linked to preeclampsia, or low birth weight of the baby, as well as premature birth.  A person can stop the progression of periodontal disease through proper oral hygiene and appropriate treatment. Simply by treating existing problems can help reduce the risk of periodontal disease-related complications by up to 50 percent.

There are several factors affecting how periodontal disease impacts the mother and her unborn child. Pregnant women with advanced stages of periodontal disease, particularly periodontitis have an increase in prostaglandin. Prostaglandin is a labor-inducing compound found in the oral bacteria associated with periodontitis. Hence, for mothers with periodontitis their levels of prostaglandin increase, and they may go into labor prematurely and deliver a baby with a low birth weight.

The presence of C-reactive protein (CRP) is another compound linked to premature births and low birth weight babies, and it has also been associated with heart disease. Periodontal disease increases CRP levels in the body, which amplifies the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, causing the liver to produce extra CRP, which then leads to inflamed arteries and possibly blood clots. Inflamed arteries can lead to blockage, which can cause heart attacks or strokes. Although health professionals don’t understand why elevated CRP also causes preeclampsia, studies prove that extremely high rates of CRP in early pregnancy increase the risk.

Finally, the bacteria responsible for periodontal disease that invade and live in the gum pockets of a diseased mouth may travel through the bloodstream and affect other parts of the body. For pregnant women, research shows that these bacteria may colonize in the internal mammary glands and coronary arteries.

If you are pregnant, it is important to practice good oral hygiene to prevent gum disease. Dr. Noraian can help assess your level of oral health and develop preventative measures and treatment plans to help protect you and your baby.

Just as in pregnancy, women may experience hormone level changes during puberty, while taking birth control or during hormone replacement therapy for the treatment of menopause. These increased hormone levels make the body more sensitive to the presence of bacteria without the patient even knowing about it. Increasing routine home care (brushing and flossing) and making sure to follow up with a dentist or periodontist regularly during these times are particularly important to help control periodontal disease. During these times of increased circulating hormones, women may discover that their regular routine for personal oral hygiene is not sufficient to control their periodontal health.

Respiratory Disease and Periodontal Disease

When a person inhales fine droplets of liquid into their mouth, throat, or lungs it may cause respiratory disease particularly when these droplets contain germs that can spread and multiply within the lungs and impairs breathing. Recent research also proves that bacteria found in the mouth and throat can settle into the lower respiratory tract and cause infection or worsen existing lung conditions.

For example, pneumonia may occur when bacteria that grow in the oral cavity travel into the lungs causing respiratory problems. This type of pneumonia occurs mostly in patients with periodontal disease. Also, patients with periodontal disease are more susceptible to bronchitis and emphysema. Chronic obstructive pulmonary disease (COPD), a respiratory condition characterized by blockage of the airways, and caused mostly by smoking, is worse if the patient also has periodontal disease.

Lowered resistance, or lowered immunity, is one of the reasons for the connection between respiratory problems and periodontal disease. Patients experiencing respiratory problems generally have low immunity which allows periodontal bacteria to grow easily above and below the gum lines without protection from the body’s immune system. When a person contracts periodontal disease, it will only progress and worsen respiratory issues.

There is also a link to inflammation of the oral tissue and respiratory problems. Oral bacteria causing the irritation can travel to the lungs, and contribute to the inflammation of the lung lining. This creates respiratory problems because it limits the amount of air that can pass freely through the lungs.

If you are diagnosed with respiratory disease or periodontal disease, it is possible Dr. Noraian will work with your physician to plan how to best treat both conditions and eliminate further complications.

Osteoporosis, Aging and Periodontal Disease

For a long time, osteoporosis was a condition affecting mostly women.   Today, more and more men have symptoms of this potentially debilitating affliction, characterized by the thinning of bone tissue and loss of bone density. Think of your body as a series of chemical reactions, some that build up your body and some that break down your body. Osteoporosis occurs when the body fails to form enough new bone, or when the body absorbs too much old bone. The leading cause of osteoporosis is a drop in estrogen in menopausal women, or a drop in testosterone among men.  People who suffer from osteoporosis must take extra care in daily activities, as they are at increased risk for bone fractures. Elderly patients have challenges surviving bone fractures late in life due to poor healing from osteoporosis.

Health professionals have studied the two diseases for possible connections because periodontal disease contributes to bone loss. Research found that women with periodontal bacteria in their mouths were more likely to have bone loss in the oral cavity and jaw, which can lead to tooth loss. Studies conducted over a period of 10 years also discovered that osteoporosis patients could significantly reduce tooth loss by controlling periodontal disease. Furthermore, this research showed that post-menopausal women who suffer from osteoporosis are 86 percent more likely to develop periodontal disease.

One of the reasons for the connection between osteoporosis and periodontal disease is an estrogen deficiency. Low estrogen levels speed up the progression of both oral bone loss and other bone loss. It also accelerates the rate of loss of fibers and tissues, which keep the teeth stable. Tooth loss occurs when these fibers are destroyed.

Low mineral bone density is one of the several causes of osteoporosis. The inflammation from periodontal disease weakens bones. This is why periodontitis progresses faster in patients with osteoporosis.

If you are diagnosed with osteoporosis, it is important to take preventative measures against periodontal disease to protect your teeth and oral bones and it is a good idea to see Dr. Noraian to have a baseline assessment of your periodontal status so that he may compare your future examinations for changes.