Concern over the widespread incidence of gum disease in the U.S. has increased as studies show its relationship to major systemic health issues, including heart disease, breast cancer, stroke, diabetes and obesity.
Here is what we know about the relationship of periodontitis and certain serious diseases:
Postmenopausal women with periodontal disease had a 14% higher risk of developing breast cancer, according to a 2015 study led by Prof. Jo Freudenheim of the University of Buffalo and published in the Journal of Cancer Epidemiology, Biomarkers & Prevention. The incidence was even higher for former smokers: 36% more women with periodontitis who had quit smoking within the last 20 years developed breast cancer. Non-smokers had a 6% higher risk.
Freudenheim offered at least two plausible theories for the link: cumulative exposure of breast tissue to periodontal bacteria in the blood stream through brushing, flossing or chewing; or gum inflammation that could exacerbate other conditions in the body. Increasingly, researchers are finding that parts of the body thought to be sterile actually contain bacteria and microbes.
Men are also at advanced risk for various cancers if they have a history of gum disease. According to Perio.org, “men with a history of gum disease are 14% more likely to develop cancer than men with healthy gums.” The American Dental Association (ADA) concurs, explaining that the finding was based on the study of 48,000 men in the U.S. aged 40 to 75. The research also revealed increased risk factors for other types of cancer, including lung cancer (36%), kidney cancer (49%), pancreatic cancer (54%), and blood cancer (30%) over men without gum disease. Needless to say, these numbers aren’t encouraging as it relates to the relationship between the two diseases.
Of course, individual studies cannot establish a causal link and more studies are welcome. Nonetheless, the evidence clearly points to a connection, underscoring why periodontal health should be a priority for all Americans.
Research has shown that people with diabetes are more likely to develop severe gum disease and lose more teeth from it than people who don’t have diabetes. Also, gum disease could have adverse consequences on their ability to regulate glucose levels. It creates a circular relationship because the inability to control glucose levels provides an environment for the bacteria that cause gum disease (which thrive on sugars) to grow. Experts agree that controlling blood sugar levels decreases the risk of gum disease, as well as other complications from diabetes.
Experts see a correlation between oral disease and heart function, although, like all the systemic conditions, it is not a causal relationship. Swelling links the two conditions. Hardened (swollen) arteries are a symptom of heart disease and decrease the flow of blood to your heart, which can lead to a heart attack or a stroke.
Swollen gums are a main symptom of gum disease. However, in the case of periodontitis, the gum infection develops below the gum line, a cause for concern for people with heart disease. Why? Because that bacteria can now travel throughout the body via the many vascular pathways in the mouth, including those that lead back to the heart. In other words, the more bacteria you have in your mouth, the more bacteria you could have in your heart. Experts agree that if you address your oral health, you may decrease the number of bacteria that could be present in your heart.
Researchers in Germany found in a 2004 study that gum disease increased the risk of an ischemic stroke when the patient also had severe periodontitis, particularly for men and for subjects under 60 years of age. An ischemic stroke is a type of stroke caused by a blocked blood vessel the gets blood to the brain. As with the relationship with heart disease, the link between gum disease and stroke is the inflammation present for both and the hardening of the arteries that results from it. Experts agree that by preventing gum disease, you decrease the risk factor for certain types of stroke.
Men in their 30s with severe gum disease are 3x more likely to suffer from erectile dysfunction. Prolonged chronic inflammation associated with gum disease can damage blood vessels leading to impotence.
The Journal of Sexual Medicine published a study a few years back that showed 53% of male patients with Erectile Dysfunction (ED) also suffered severe gum disease. ED affects millions of men in the U.S.; some experts estimate that one in four men seek treatment for the condition. The percentages increase with age. According to WebMD, 5% of men around 40 have ED while 15 to 25% of men aged 65 have it. Like all the other connections, the link between ED and gum disease is tied to the inflammation of the gums that passes to the other systems throughout the body.
While the relationship between gum disease and obesity has been suggested before, recent research has solidified the connection. In June 2016, at the 94th General Session & Exhibition of the International Association for Dental Research, researchers from The University of Adelaide, South Australia presented a study that further linked the two conditions.
The study measured 539 participants, who were tracked from birth for several factors. At age 31, all participants were evaluated for gum disease. The results were clear – obese participants were significantly more likely to have gum disease:
• 11% higher for any periodontitis
• 12% higher for moderate to severe periodontitis
• 22% higher for any periodontitis
• 27% higher for moderate to severe periodontitis
Other diseases that have had a suggested connection to gum disease include osteoperosis, Alzheimer’s and dementia, respiratory disease, liver disease and rheumatoid arthritis.
Of course, you can encourage your patients to increase healthy oral hygiene habits with standard care advice – proper teeth brushing, regular flossing and visiting the dentists – to reduce your risk of gum disease.
If your patient has gum disease, there are several treatment options. Traditional methods include scaling and root planing (aka deep cleaning), antibiotics applied to teeth, and traditional surgery. Other options include minimally invasive laser procedures, such as the LANAP protocol. The LANAP protocol is the only laser gum disease treatment FDA cleared for True Regeneration, re-growing the tissues and bone lost to gum disease. This treatment can aid in reversing gum disease and thus reduce your risk for these other serious diseases.