According to Dr. Mayo of the renowned Mayo Clinic, “If a person can take care of their teeth and gums they can extend their life by at least 10 years”. How could he make such a claim? Recent research acknowledges that gum disease has now been positively linked to a significantly greater likelihood of heart attack, stroke, diabetes, pregnancy complications, and a number of other systemic health issues.
Gum disease is a local inflammatory process in gum tissue caused by the body’s response to a bacterial insult. According to the ADA 70% of people over 35 years of age have oral inflammation (otherwise known as “bleeding gums”.) Bleeding gums are an indicator of chronic inflammation not being controlled. This means that gingivitis is
Just as bad as severe gum disease when it comes to systemic inflammation.
Time Magazine and USA Today recently wrote front page articles on the dangers of chronic inflammation in the body. People often feel that “bleeding gums are normal” and don’t consider it a problem. These people would be highly motivated to take care of their oral health, however, if they fully understood the risk to their health from that “little bit of bleeding.”
The inflammatory process caused by gum disease results in the elevated production of C-reactive protein in the liver (as with any inflammatory process in the body.) Current research now views elevated CRPs (C-reactive protein) as a key culprit that causes damage in the arteries resulting in the formation of clots and plaques which lead to cardiovascular disease.
According to articles in the New England Journal of Medicine and the American Heart Association’s Circulation, C-reactive protein is a more significant indicator for a future heart attack or stroke than is high cholesterol levels. Gum disease is now considered an independent risk factor for heart disease. The average person with gum disease has approximately 2.6 times the risk of a heart attack as compared to the average person.
Half of the people that die of a heart attack have normal cholesterol!
The good news is that CRP levels can be checked with a simple in office blood test. It only requires a finger prick to test. Cancers of inflammatory origin (ex-colon, etc..) are also starting to enter this arena. Some cancers can be discovered early through CRP testing. The other good news is that the inflammation-correlated risk factor for heart disease decreases with successful treatment of gum disease.
It is well known that diabetics, because of their impaired immune systems, are twice as likely to get gum disease. The relationship also goes the other way: the gum bacteria and associated inflammation challenge blood sugar control and increase the rate of diabetes.
Additionally, it has been shown that gum disease greatly increases diabetic complications and hence increases the need for higher levels of medical care. Gum disease also increases diabetic mortality from 3% in non gum-diseased adults to almost 28% when gum inflammation is present.
The Hisayama Study examined the relationship between gum disease and glucose intolerance in non-diabetics. It demonstrated that people with normal sugar tolerance who 10 years later developed impaired sugar tolerance were also much more likely to have gum disease. The study showed how gum disease was related to the possible development of glucose intolerance (diabetes).
The good news is that treating gum disease can significantly lower HbA1c, the definitive measure of blood sugar control. Preventing people from becoming type 2 diabetics can potentially add 8.2 years to their life expectancy.
Gum disease and inflammation have been shown to have an associated increase in risk with pre-term, low-birth weight babies. There is research literature showing reports of 225% and 780% increase in pregnancy complications in pregnant women who have gum problems. The complications include pre-eclampsia and early, pre-term, low-birth weight pregnancies. Presently 1 out of 8 babies are born prematurely. Premature, low-birth weight is the leading cause of death in the first month of life.
In 2006 the OB/GYN journal Obstetrics and Gynecology published the article “Progressive Periodontal Disease and Risk of Very Pre-term Delivery” which concluded that “periodontal disease increases relative risk for spontaneous pre-term births.” Pregnancy-associated gingivitis is usually more of an issue (versus true gum disease) because of most pregnant women’s younger age.
Once again gum treatment has been shown to reduce the incidence of these occurrences. Multiple studies have shown a 68% to 80% reduction in pre-term babies when the mothers received gum therapy. Good oral care is extremely important for the majority of pregnant women.
Your Dentist Could Save Your Life!
Gum disease is undeniably a “silent epidemic.” It is now accepted in the medical community that gum disease and systemic disease are intimately related. Even the medical insurance companies see that treating gum disease is a medical necessity.
Several studies, with insurance companies as the lead or co-investigator, helped in reaching this conclusion. Treating periodontal disease in cardiac patients, diabetics, and pregnant women can be a tremendous cost-saving measure for the insurance companies: it reduces their cost of major heart surgeries, long-term expenses associated with diabetes treatment/dialysis, and post natal intensive hospitalization costs.
Three out of four people die of cardiovascular disease, cancer, and diabetic complications--and chronic oral inflammation affects a full 80% of the population. As it is often said: “Do the math.” The question now isn’t whether treating gum disease will save lives by reducing heart attacks and diabetes as well as other systemic diseases, but rather, how many lives will be saved? Has there ever been stronger evidence to keep your gums healthy in order to live a long and healthy life?
Major Health Risks Linked to Gum Disease
A Periodontal Risk Assesment should now be performed on all adults. This assessment will let you know if your dental (periodontal) condition may be putting you at risk for cardiovascular heart disease (as well as diabetic and pregnancy issues.) The Risk Assessment is designed to provide information for both the dentist and physician regarding the present periodontal status of the patient. It is being done to determine if there is active disease present, which upon examination, produces bleeding when examined with a periodontal probe. The establishment of the Risk Assessment was the joint effort of Neil Gottehrer D.D.S., a nationally and internationally publisher and lecturer, and Marvin Slepian M.D., a renowned cardiologist and developer of many therapeutic solutions and devices including the total artificial heart.
With the introduction of clinical studies that confirm that gum disease is a major potential risk for cardiac disease, the rationale now for examination is to perform a Periodontal Risk Assessment. It’s basically a screening exam for periodontal disease which may place the patient at risk for cardiac disease, thus the designation as a “risk assessment” rather than just a periodontal evaluation for active disease. It’s now about maintaining your health as well as preventing tooth loss.
By performing the Risk Assessment, the dentist will determine if the patient has active gum disease, requiring additional testing and possible treatment. If the assessment results are positive for disease, there is then an indication for referral to the family physician and/or cardiologist for possible systemic blood testing and further evaluation. The Risk Assessment will indicate if there is a need for both the dentist and physician to manage the patient’s health risks.
The new research shows we might be leaving you at cardiac risk (as well as diabetic and pregnancy risks) if we do the same things for you that were once accepted as normal treatment of periodontal disease.
Let’s take a look at the new parameters:
1) Hygiene Management Program — A home hygiene regimen should be done by every patient at least twice a day, if possible twelve hours apart, to remove the offending oral bacteria, above and below the gums. While the use of interproximal cleaning with dental floss is still encouraged, recent evidence shows that use of a powered toothbrush appears to be as effective for most adults as manual tooth brushing combined with interproximal cleaning. Brushing must be immediately followed by oral irrigation (ex-a water pick such as Hydrofloss). The power irrigator reaches the bacteria below the gumline completing the removal of the dental plaque. Anti-microbial rinses and toothpastes are also recommended.
2) Inflammation Modulators — Routine use of inflammatory modulators can successfully address local tissue inflammation via the systemic route. These modulators are used almost without exception to treat inflammation. Two common modulators currently used in periodontal therapy are: a) low-dose doxycycline (Periostat), which does not act as an antibiotic, and b) nutraceuticals, otherwise known as gum vitamins, which are specifically formulated to address gum inflammation. These modulators are used in conjunction with mechanical cleaning.
3) Blood Testing — Two blood screening tests should be done. The first is a High sensitivity C- reactive protein (hsCRP), a blood assay used to estimate an individual’s risk for heart disease and stroke, and measurement of the presence of inflammation or infection. The second is the Hemoglobin A1c test for diabetes. These tests can be done in the dental office with simple finger prick technology or as part of a blood panel as ordered by a physician. It has been documented that both blood levels can be elevated in the patient with active gum disease and that these levels can be decreased with aggressive, but conservative management of the periodontal condition non-surgically.
4) Mechanical Cleaning — The traditional cleaning of calculus(tartar) and plaque using ultrasonics, provided painlessly with today’s new technologies.
5) Laser Assisted Periodontal Therapy — The dental laser is a new technology that has had an incredible impact on the treatment of gum disease. It has allowed us to be much more conservative in restoring healthy gums. It frequently allows us to avoid traditional “gum surgery” and the cutting and sutures that go with it. Laser energy has a tremendous anti-microbial effect and the energy promotes the healing of the gum tissues.
6) Periodontal Crowns — As part of the risk assessment, teeth are evaluated for the need for “periodontal” restorations to retard active disease and reinforce and restore sound tooth structure. These restorations are referred to as periodontal crowns (Captek crown). The Captek crown has been documented to create significant positive response when placed and reduces the inherent risk of additional plaque which may assist in reducing further risk for cardiac disease.
This program of conservative periodontal treatment, supplemented with the inflammatory modulators, has been very successful in helping to reduce periodontal inflammation. Being able to achieve this stable condition has helped to reduce the associated risk for cardiac disease (as well as diabetic and pregnancy complications.) Please consider requesting a Periodontal Risk Assessment for yourself or a loved one.
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Mark J. Fabey D.M.D.
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