RISK FACTORS THAT INFLUENCE EXPRESSION
OF PERIODONTAL DISEASE

       Renal Disease

Obesity                Alzheimer               Pancreatic Cancer

Click on any of these topics to learn more about 
how these factors affect periodontal disease and your overall health.

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Systemic Risk Factors

Healthy Mouth = Healthy Body

Untreated periodontal disease in effect "seeds" the bloodstream with disease-causing bacteria.

1. A weakened immune system that can slow wound healing and diminish a person's response to hepatitis B and flu vaccines.

2. Tooth Loss

3. Weight and Teeth-Being overweight may also contribute to bacterial infection of the gums that can lead to tooth loss.  In a study at Case Western Reserve University , obese adults between he ages of 18-34 were 76% more likely to have periodontal disease than similar aged people at a healthy weight.  And adults under 35 with large waistlines, at least 34 inches for women and 40 inches from men, were about twice as likely to have gum disease as their slimmer counterparts.  While the study does not prove that obesity causes gum disease, it points out that excess fat secretes substances called cytokines that can damage tissues around the teeth.  Also heavy consumption of sugary foods may allow bacteria to thrive in the mouth, while fiber rich fruits and vegetable may inhibit plaque.

4. Smoking-Smoking increases the risk of getting gum disease by 4x more than nonsmokers. It is responsible for more than half of the adult gum diseases.  Smokers have:

          Severity of the disease increases with extent and duration of smoking exposure.

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    5.  Diabetes Mellitus-Diabetes is the sixth leading cause of death in U.S.  Almost one-third of individuals with diabetes have severe periodontal disease.

Periodontal disease in diabetics results in:

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   6.  Osteoporosis -Periodontal disease caused a 4x higher frequency of height loss in the jaw.

   7.  Spontaneous Preterm Birth- Preterm, low birth weight babies refers to infants who are born prior to 37 week s of pregnancy and weigh less than 5.5 pounds at birth. These births account for 60% of babies who die in infancy.

   Gums infected with periodontal disease are toxic reservoirs of disease causing bacteria.  The toxins produced by the bacteria  attack the gums, ligaments, and bone surrounding the teeth to produce infected pockets that are similar to large infected wounds in your mouth.  The infected pockets provide access the your bloodstream allowing bacteria to travel throughout your body.

Your body reacts to the infections in your gums by producing prostaglandins, a natural fatty acid that's involved with inflammation control an smooth muscle (uterine) contraction.  During your pregnancy the level of prostaglandins gradually increases, peaking when you go into labor.  One theory is that, if extra prostaglandins are produced as a reaction to the bacterial infection in your gums, your body may interpret it as a signal to go into labor and your baby can be born to early or too small.  Also fusobacterium nucleatum, bacteria that originate in the gum tissue around teeth, has been found in the placenta.

 Thus, gum disease can increase your risk for preterm birth and low birth rate babies by as much as 18%. Women with periodontal disease are 3-5 times greater risk of a preterm birth than those who have no gum disease. Also the hormone surges in pregnancy can cause pregnancy tumors (inflamed benign growths in the gum tissue). 

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     8.Heart Disease-Heart disease is the leading cause of death in both men and women.  Coronary artery disease occurs when the arteries of the heart become narrowed or blocked by plaque-a deposit of fatty material in the lining of blood vessels. 

One potential  risk factor for heart disease is advanced gum disease. 

Thus periodontal disease increases severity and risk of heart disease and stroke.  Periodontal bacteria (C-reactive protein CPR) gains entry into the systemic circulation with bactermia causing changes in blood vessel walls and exacerbated atherosclerotic plaque. Flossing matters!:  People who have both gum disease and a high body mass index, were more likely to have increased C-reactive protein-a serum in blood that is a marker for heart disease.  The CRP has been shown to be a more predictive marker for heart attack than low density lipoprotein (LDL) levels.  Also P gingivalis produces proteases and other pathogens enter the bloodstream thru the disease gum tissue pockets.  National Health & Nutrition Examination   Archives of Internal Medicine 12/03

Infective Endocarditis, a potentially fatal disease in which the inner lining of the heart becomes inflamed.

Did you know that the connection between gum disease and heart attacks is higher than the connection between high cholesterol and heart attacks?

There is LOTS of research being done on CV and PD .  Both from the bacterial state AND the immunological state that underlies both diseases. So far PD and CV are not causal but are related by cytokine and
interleukin reactions both forming collagenase. Altering those reactions (lessening the immune response) has led to less of both diseases.  It appears that the simple elimination of oral bacteria is not enough since it cant' be done effectively enough BUT altering the immune reactions in conjunction with chronic debridement and bacterial lessening and oxidizing of the antigenic chemistry that causes it to begin with DOES help
Dr Dave IDF 1/06
 

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    9.  Stroke-A stroke or "brain attack" is a serious condition caused by a sudden loss of oxygenated blood to an area of the brain, due to a clot or rupture in a blood vessel. Fatty deposits lodged in carotid arteries of stroke sufferers shows that 70% contain bacteria - and 40% of that bacteria comes from the mouth.

Oral signs of a stroke include slurred speech  difficulty swallowing, weak palate, and a reduced gag reflex.

Risk for stroke is 2.8 times greater for individual with gum disease than those without periodontal disease.

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   10. Pulmonary Infection and Oral Diseases

If you have gum disease you may be inhaling harmful bacteria from the infection in your gums into your lungs which can cause pneumonia, bronchitis, emphysema, chronic obstructive pulmonary disease. Individuals with COPD have shown that gum disease particularly bone loss, is a risk factor for COPD.    An increase in dental plaque may place these individuals a greater risk for respiratory infections. 12 studies provide direct evidence of the association between pulmonary infection and oral diseases.  This association occurs in people with severe compromised health, in frail elderly people and in patients with chronic pulmonary disease.  Improving oral hygiene might reduce the risk of pneumonia among people at risk.  Thus, it is important for people at risk to have necessary regular recall appointment and the introduction of specific oral hygiene courses for caregiver in long term care institutions.**

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    11.  Cancer

For a detailed report on Periodontal Risk Factors look here: Periodontal Risk Factors 

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    12. Renal Disease

Periodontitis and Renal Disease

Periodontitis, a chronic bacterial infection of the oral cavity, is a novel risk factor for atherosclerotic cardiovascular disease (CVD). Given the numerous shared risk factors for CVD and chronic kidney disease (CKD), we hypothesized that periodontitis also is associated with renal insufficiency in the Dental Atherosclerosis Risk in Communities study.
Methods: We conducted a cross-sectional study of 5,537 middle-aged black and white men and women. Periodontitis was determined by using an independent clinically derived definition and categorized as healthy/gingivitis,
initial, and severe. Renal insufficiency is defined as glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2.  Results: A total of 2,276 individuals had initial periodontitis, and 947 individuals had severe periodontal disease. One hundred ten individuals (2%) had a GFR less than 60 mL/min/1.73 m2. Compared with healthy/gingivitis, initial and severe periodontal disease were associated with a GFR less than 60 mL/min/1.73 m2 (odds ratio, 2.00; 95% confidence interval, 1.23 to 3.24) forinitial periodontal disease and an odds ratio of 2.14 for severe disease
(95% confidence interval, 1.19 to 3.85) after adjustment for important risk factors for CVD and CKD. S
Conclusion: This is the first study to show an association of periodontal disease with prevalent renal insufficiency. A prospective study is necessary to determine the exact nature of the observed relationship.

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    13. Possible Alzheimer's signpost Gum inflammation may be linked to increased risk of the brain
disorder. By Kevin W. McCullough, Times Staff Writer 6/05.Missing teeth and gum disease at an early age may be linked to an increased risk of Alzheimer's disease, researchers have found, bolstering the increasingly strong connection between early exposure to chronic inflammation and the degenerative brain disorder.

The study, among the findings presented last week at the first Alzheimer's Assn. International Conference on Prevention of Dementia, examined lifestyle factors of more than 100 pairs of identical twins. All of the pairs included one twin who had developed dementia and one who hadn't. Because identical twins are genetically indistinguishable, the study involved only risk factors that could be modified to help protect against dementia.

Twins who had severe periodontal disease before they were 35 years old had a fivefold increase in risk of developing Alzheimer's disease, the researchers found. Periodontal disease may be a marker for chronic exposure todisease that provokes an inflammatory response. Chronic inflammation can damage tissue, including the brain, which may contribute to the development of the disease.

I would think of the periodontal disease as a signpost, not a cause. Periodontal disease is also linked to general health, and even the inflammatory link to Alzheimer's may involve several factors. This finding reinforces a long-standing appreciation . that indicated inflammation in the brain was an essential part of the disease process,.

April 2005 • Volume 45 • Number 4 Pathogenesis and Treatment of Kidney Disease and Hypertension Periodontal disease is associated with renal insufficiency in the Atherosclerosis Risk In Communities (ARIC) study Abhijit V. Kshirsagar, MD, MPH Kevin L. Moss John R. Elter, DMD, PhD James D. Beck, PhD Steve Offenbacher, DDS, PhD Ronald J. Falk, MD

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  14. Obesity Periodontal Disease Linked to Obesity. A recent study published as a supplement to the Journal of Periodontology found that obesity, independent of any factors such as age, race, gender, or ethnicity, is a significant predictor of periodontal disease. Researchers at the University at Buffalo analyzed the national sample and determined that insulin resistance mediates the relationship between the two conditions.

The data showed that the severity of periodontal attachment loss increased proportionally as insulin resistance increased. Also, the number of teeth lost increased with greater insulin resistance. Compared to the lowest insulin resistance group, people with the highest insulin resistance lost an average of 1.1 more teeth.

People who have higher body mass index produce cytokines (hormone-like proteins), that lead to systemic
inflammation and insulin resistance. We propose that chronic stimulation and secretion of proinflammatory cytokines associated with periodontal infection also occurs, contributing to insulin resistance, which may further predispose to diabetes mellitus.

The team of researchers showed that people with diabetes who suffer from periodontal disease may be prone to greater mortality from diabetic complications, which include kidney complications and cardiovascular disease, than diabetics who do not.(1) cited News adha.org www.perio.org.

  15. Periodontal Disease Linked with Pancreatic Cancer

* Division of Nephrology and Hypertension, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC* Division of Dental Ecology, School of Dentistry, University of North
Carolina at Chapel Hill, Chapel Hill, NC, USA * The Atherosclerosis Risk in Communities study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute
contracts no. N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022. In addition, this study is supported by National Institute for Dental and Craniofacial Research grant no. DE13019 and by the General Clinical Research Center grant no. RR00046. Dr. Kshirsagar’s efforts were supported by a grant from Renal Research Institute. * ⁎Address reprint requests to Abhijit V. Kshirsagar, MD, MPH, Division of Nephrology and Hypertension, CB 7155 348 MacNider Hall, Chapel
Hill, NC 27599-7155. * Email address: sagar@med.unc.edu (Abhijit V. Kshirsagar)

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Updates

Radiographic Measures of Chronic Periodontitis and Carotid Artery Plaque

 Chronic periodontitis (CP) is associated with stroke and subclinical atherosclerosis, but clinical measurement of CP can be time consuming and invasive. The purpose of this study was to determine whether radiographically assessed CP is associated with nonstenotic carotid artery plaque as an ultrasound measure of subclinical atherosclerosis. Panoramic oral radiographs were obtained from 203 stroke-
free subjects ages 54 to 94 during the baseline examination

Severe periodontal bone loss is associated independently with carotid atherosclerosis. Panoramic oral radiographs may thus provide an efficient means to assess CP in studies of atherosclerosis risk.

Steven P. Engebretson, et al.,Radiographic Measures of ChronicPeriodontitis and Carotid Artery Plaque Stroke. 2005;36:561

ADHA, 7/04.

Managing Risk Factors in Successful Nonsurgical Treatment of Periodontal Disease, Dr. Gottehrerr, Dentistry Today, January 2003 pg 64-69.

** Link Between Pulmonary Infection and Oral Diseases, NDA pg 10, February 2003.