Periodontal Disease

Description

Alternative Names

Complications

The ultimate outcome of uncontrolled periodontal disease is tooth loss. As the destructive factors cause the breakdown of bone and connective tissue, there remains no anchor for the teeth.

Bad Breath

A much less severe but nevertheless distressing problem caused by periodontal disease is bad breath, although coatings on the tongue may contribute more to bad breath than even periodontal disease.

Heart Disease and Stroke

Some studies have reported a 1.5- to 4-fold increased risk for heart disease in people with periodontal disease. (The highest risk was in men with extensive gum disease, bleeding from every tooth.) In one study, 85% of heart attack patients had periodontal disease compared to 29% of people with no heart problems. In another study of patients with hypertension, severe periodontal disease was associated with damage on the left side of the heart. In addition, high cholesterol blood levels have been associated with chronic periodontal disease. Periodontal disease has also been linked to stroke.

A stroke involves loss of brain functions caused by a loss of blood circulation to areas of the brain. The blockage usually occurs when a clot or piece of atherosclerotic plaque breaks away from another area of the body and lodges within the vasculature of the brain.

Recent evidence is pointing to the inflammatory response as the common element. This is an over-reaction of the immune system that causes injury to tissues in the body. A common link between patients with both heart conditions and periodontal disease may be elevated levels of C-reactive protein (CRP), a marker for the inflammatory response. Some experts believe, then, that immune factors causing this response are released into the blood stream during periodontal disease and cause injury in the arteries supplying blood to the heart. Other evidence suggests that the bacteria itself, particularly P. gingivalis, may play a direct role in arterial injury.

Treating and eliminating periodontitis does not appear to have any effect on preventing heart disease, however. Some experts believe that there is no actual causal relationship, but that common factors induce inflammation and damage resulting in diseases in the blood vessels and in the gums. Studies in 2000 and 2001 suggest that the only significant association between periodontal disease and heart disease is a socioeconomic one. In the 2000 study, for example, patients who had both conditions were more likely to be poor, African American, older, and overweight. They were also more likely to have other risk factors for heart disease, including smoking and diabetes.

Effect on Diabetes

Diabetes is not only a risk factor for periodontal disease, but periodontal disease may exacerbate or even cause diabetes. Some evidence has suggested that the bacteria causing periodontal disease may enter the blood stream and activate cytokines, the damaging factors in the immune system, which then may even destroy cells in the pancreas, where insulin is produced. One study found that treating periodontal disease reduced the need for insulin in some people with diabetes.

Effect on Respiratory Disease

Bacteria that reproduce in the mouth can also be carried into the airways of throat and lungs, increasing the risks for respiratory diseases and worsening chronic lung conditions, such as emphysema.

Click the icon to see an image of emphysema.

Effect on Pregnancy

A number of studies have now strongly indicated that bacterial infections that cause moderate to severe periodontal disease in pregnant women increases the risk of premature delivery and low birth weight infants. The more severe the infection the greater the risk to the baby. Research indicates that the bacteria from periodontal disease may trigger the same factors in the immune system as genital and urinary tract infections do. These biologic substances called prostaglandins and tumor necrosis factor produce inflammation in the cervix and uterus that can cause premature dilation and contractions. Treatments for periodontal disease can reduce the risk for a low-weight birth, and some experts recommend that women have a periodontal examination before becoming pregnant or as soon as possible thereafter. Because women with diabetes are at higher risk for periodontal disease, it is particularly important for diabetics to see a dentist early in pregnancy.