Lifetime Family Dentistry, Oral Systemic Link

Heart Disease and Stroke: The Oral Systemic Link

A number of studies now support the fact that there is a very strong link between poor oral health, particularly periodontal disease, and heart disease and stroke. This link is important to know about, because approximately 36% of all deaths in America are caused by cardiovascular disease.

Some research indicates that controlling periodontal disease can lower the risk of stroke by half, and heart disease by two-thirds. If this research is confirmed by further studies, it will represent the greatest breakthrough yet in the prevention of cardiovascular disease.

No one is sure exactly why cardiovascular disease is so strongly linked to periodontal disease. There are several theories, though. One of the leading theories is that periodontal disease, which is America's most common inflammatory disease, increases the level of inflammation throughout the body, including inflammation in blood vessels. Inflammation is now known to be a primary cause of heart disease and stroke.

Many researchers and clinicians think that inflammation is even more harmful to the cardiovascular system than the most established, classic risk factors, such as high LDL cholesterol. The link between inflammation and heart disease helps explain why almost half of all people who develop heart disease do not have any of the well-known risk factors for the disease, other than high levels of inflammation.

Besides inflammation, other theories say that small blood clots that form in the oral cavity as a result of periodontal disease sometimes enter the bloodstream, and can contribute to heart attacks and stroke. Another theory is that periodontal disease reduces the blood supply to the brain, by thickening the primary artery that brings blood to the brain, the carotid artery. Also, the bacteria from periodontal disease has been shown to contribute to hardening of the arteries, or atherosclerosis.

It has not yet been proven to a degree of absolute certainty that periodontal disease is a primary causative factor, instead of just a coincidence. However, one of the most persuasive indicators is a studying showing that 25% of people who had heart attacks had periodontal disease, but did not have any other of the common problems associated with heart disease, including high blood pressure, high cholesterol, or obesity.

Studies show that the degree of severity of periodontal disease is directly related to the severity of coronary artery disease. In one study of people with coronary atherolsclerotic heart disease, known as CAD, almost 85% had periodontal disease, compared to only about 22% of people who did not have CAD.

There is also evidence that cumulative tooth loss, which is a good indicator of severe periodontal disease, is closely related to peripheral artery disease, or PAD, particularly in men.

Other research shows that periodontal disease is closely associated with high blood pressure, which is often regarded as the main cause of heart attack or myocardial infarction. Therefore, it's possible that periodontal disease may be an indirect cause of heart disease, as well as, in some cases, a direct cause.

Therefore, it makes abundant sense for people who are worried about cardiovascular disease to control their periodontal disease. This may be just one way to prevent cardiovascular disease, but it appears to be a very important way. Besides, it is not as demanding as other preventive measures, such as losing weight or exercising, and can therefore be a good way to kick-start a comprehensive program for heart-health.

The Oral Systemic Link to Certain Cancers

Periodontal disease has been closely linked to the fourth-leading cause of cancer death (pancreatic cancer), as well as the sixth-leading cause of cancer death (oral cancers). The high death rate for both of these types of cancer stems largely from the fact that both very resistant to treatment. Also, pancreatic cancer presents a special challenge, because it does not usually present many signs or symptoms, until it is too late to be treated effectively.

An article published in the Journal of the National Cancer Institute, based on a study by the Harvard School of Public Health, showed an alarming incidence between periodontal disease and pancreatic cancer. In this study of 51,000 people, it was shown that people with periodontal disease had a 64% higher risk of pancreatic cancer than people with no periodontal disease. The people with the worst cases of periodontal disease, including those that had suffered excessive tooth loss, had the greatest risk.

As with many serious diseases that are associated with periodontal disease, a leading theory of causation is that gum disease significantly increases inflammation in the body, including organs such as the pancreas, and that this inflammation is a direct trigger of cancer cell formation. Another presumed reason for the link between periodontal disease and pancreatic cancer is that periodontal disease creates carcinogenic compounds know as nitrosamines that enter the pancreas, and damage its cells.

As with most cancers, there may well be multiple risk factors associated with the development of pancreatic cancer. Therefore, despite the studies that have been done, it is difficult to say exactly how much periodontal disease contributes to pancreatic cancer. However,

It is undeniable, though, that the link between pancreatic cancer and periodontal disease does have one beneficial aspect. It makes it easier to spot the cancer early. The presence of periodontal disease can be one of the initial indicators of pancreatic cancer, appearing before other indicators, and can therefore lead to earlier treatment.

There is also a strong link between periodontal disease and oral cancers. This may be due to the fact that the site of these cancers is in very close proximity to periodontal disease. Sometimes, chronic infectious disorders can compromise the long-term health of organs and glands. For example, it is known that recurrent, chronic infections of the prostate gland can predispose men to prostate cancer later in their lives.

The Oral Systemic Link to Diabetes, Obesity, and Metabolic Syndrome

Diabetes, obesity, and metabolic syndrome are inextricably linked. They are all conditions of impaired glucose metabolism, or poor ability to control blood sugar levels. Periodontal disease is one of the factors that can lead to impaired glucose metabolism. One indication of this is that people with diabetes are twice as likely as people without it to have periodontal disease.

In general, type 2 diabetes, the type of the disease that is related to lifestyle factors, is relatively rare among people who are not obese, or do not have metabolic syndrome. Metabolic syndrome is, in effect, a very mild form of diabetes, and commonly occurs before the onset of diabetes. It can become increasingly severe as time passes, unless people intervene with factors such as dietary change, increased exercise, and weight loss. Metabolic syndrome is sometimes first noticed as the condition of hypoglycemia, or low blood sugar, which causes minor degrees of the same symptoms of metabolic syndrome and diabetes: weakness, hunger, irritability, and mildly impaired cognitive function.

Periodontal disease triggers blood sugar instability by impairing the ability of insulin to maintain normal levels of blood sugar. This impaired ability, known as insulin resistance, is present among the majority of people with diabetes, metabolic syndrome, or obesity.
A complication of helping to control diabetes by clearing up periodontal disease is that diabetes itself is a major cause of periodontal disease. Sometimes periodontal disease is referred to as the "sixth symptom of diabetes." Therefore, periodontal disease and diabetes reinforce each other, and can contribute to a cycle of illness. Because of this, it's important to treat the diabetes at the same time that periodontal disease is treated.
It has been shown in studies that treating periodontal disease alone can reduce the need for insulin. However, it is far more prudent to treat both diseases simultaneously, to intervene in the spiral of dysfunction and disease.

The Oral Systemic Link to Alzheimer's, and Other Diseases Associated With Inflammation

Over the past several years, more and more evidence has mounted that inflammation is one of the most common contributors to a wide range of diseases, including cardiovascular disease, diabetes, cancer, and Alzheimer's. These are the diseases that kill most Americans, and cause the greatest degree of suffering and medical expense.
Therefore, anything that can reduce the level of inflammation within the body can be of a great value for resistance to disease, and overall health. Because controlling inflammation is so important, it is now common for doctors to recommend that people in midlife and beyond take small doses of nonprescription anti-inflammatories every day, such as aspirin.

Many other doctors also recommend that people try to reduce inflammation by avoiding excessive intake of certain foods, such as red meat, and by taking anti-inflammatory supplements, such as fish oil.

Periodontal disease is a terribly harmful source of inflammation. When the oral cavity is full of infection and inflammation, as a result of periodontal disease, it spreads this inflammation throughout the body. Inflammatory carriers enter the bloodstream, lungs, and saliva, and travel throughout the system, increasing existing inflammation, and creating inflammation in previously healthy tissues.

The contributory link between periodontal disease and Alzheimer's is well supported by studies, including a New York University study, presented at the Alzheimer's Association 2008 International Conference. This study showed that twice as many people who had Alzheimer's tested positive for antibodies in their blood that result from a type of bacteria most commonly found in the mouth. For people who are willing to fight their own periodontal disease, this finding is encouraging. It means that they can help delay or prevent the onset of Alzheimer's. When good oral health is combined with other factors that help prevent Alzheimer's, such as a healthy diet and exercise, the risk of this dreaded disease can be significantly reduced.

The Link Between Periodontal Disease and Pre-term Birth

Periodontal disease is very closely linked with pre-term birth. The risk of pre-term birth can be greatly reduced by proper treatment of periodontal disease. This is good news for prospective parents, because pre-term birth is the single most common cause of major birth defects, including loss of vision and hearing, developmental delay, and cerebral palsy.

One study, published in the Journal of Microbiology, indicated that infection with periodontal disease may be the primary trigger for as many as 80% of all pre-term births. The director of the study stated, "The earlier the woman goes into pre-term labor, the higher the chance that she will be infected."

Most pregnancies last about 40 weeks. To be considered pre-term, a birth must take place during week 37, or before. About 12% of all births in America are pre-term. The incidence of pre-term birth has increased by 30% since 1981, for reasons that are considered unknown.

It's believed that periodontal disease causes pre-term birth when bacteria from the mouth enter the bloodstream and travel to the uterus, where they colonize, and cause inflammation.

In another study of pregnant women, doctors removed amniotic fluid from women who were known to have high-risk pregnancies. Of the women, 85% had bacteria in their amniotic fluid that had not been previously detected.

As with diabetes, the cause/effect phenomenon that links pre-term birth with periodontitis appears to be cyclical, with pregnancy promoting gum disease, and gum disease promoting pre-term birth. It has long been known that it's common for pregnancy to cause at least minor problems with the gums, but it is now known these problems then heighten the risk of pre-term birth.

Therefore, it is wise for pregnant women to be especially diligent in maintaining optimal oral health throughout their pregnancies.

Help for People With Fully Developed Disease

The hallmark of integrative medicine and integrative dentistry is to treat the person who has the disease, and not the disease that has the person. This means treating people not only in regard to their minds, bodies, and spirits, but also treating them for the wide variety of risk factors and contributory illnesses that may have contributed to their most significant illness.

Sometimes lesser problems are created by the primary problem, but sometimes the smaller problems occur before the primary problem, and contribute to its onset. In either situation, it's important to treat all of the problems that exist. They may be intricately interwoven, and may be perpetuating one another.

This approach is rapidly gaining favor over the older approach of isolating diseases and conditions, one by one, and focusing on single treatments. Sometimes this results in just suppressing the symptoms of the primary problem, without ever getting to its root causes. It is better to try to achieve a robust recovery of the entire system.
Therefore, if a patient has periodontal disease, as well as a more life-threatening problem that is associated with it, such as heart disease or diabetes, it's wise to treat the periodontal disease as part of a comprehensive program of recovery.

Sometimes the treatment of periodontal disease can significantly improve the response to treatment of the more threatening disorder. Research indicates that this can occur in diabetes, heart disease, and in the risk of pre-term birth. Treating periodontal disease may also be a significant factor in helping people recover from other diseases, particularly if they are not well-entrenched, or severe. For example, treating periodontal disease often helps people with premature wrinkling, and sexual dysfunction, and it obviously can help with bad breath, which can be bothersome. Without doubt, it is of tremendous help in preventing tooth loss, which is often very distressing for older people.

When a comprehensive recovery program is applied to a complex disease, though, it is often difficult to assign an exact ratio of benefit for each of the elements of that program. For example, if a diabetic begins exercising more and eating less, it's hard to tell what has the most benefit. Similarly, when diabetics also resolve their periodontal disease, it can be impossible to know exactly how much that contributed to recovery.
Also, many of the factors that help control periodontal disease, such as a good diet, or supplementation with nutrients, can also be directly beneficial to serious diseases.
Therefore, the wise course of action is to clear up any possible condition that might be contributing to a serious disease. This often aids in not only recovery from the primary problem, but can also have many other benefits that are not even related to the primary problem.