Earlier this month, a team of researchers from the
University of Connecticut and London announced that
aggressive treatment of gum disease can improve the
function of blood vessel walls in the body,
potentially reducing the risk of heart attacks.
A few weeks before that, researchers from the
Harvard School of Public Health reported a study of
more than 51,000 male health professionals, which
showed that men who had gum disease, or
periodontitis, were far more likely than those
without it to get pancreatic cancer.
Other studies have shown links between gum disease
and diabetes, heart disease, stroke and even --
though this is more controversial -- pregnancy
problems such as low-birth-weight infants. The
evidence is accumulating faster than you can say
"don't forget to floss" that taking good care of
your teeth -- and treating gum disease aggressively
-- may be one of the best things you can do not just
for your mouth, but for your overall health. With
pancreatic cancer, for instance, previous studies
had suggested such a link, but those studies were
muddied because many participants smoked, and
smoking is a risk factor for both diseases. This
time, even among never-smokers, gum disease was
linked to a doubling of the cancer risk, said
epidemiologist Dominique Michaud, the first author,
of the Harvard School of Public Health. It’s still
not clear, cautioned Michaud, whether that means the
gum disease led to the cancer.
Chronic inflammation anywhere, including swollen
gums, makes the body release nasty chemicals called
cytokines that have been linked to many problems,
including diabetes and heart disease. The crucial
point, in other words, is that “oral infections have
systemic effects,” said Dr. Thomas Van Dyke , a
professor of periodontology and oral biology at the
Boston University School of Dental Medicine.
In some cases, these systemic effects are probably
linked to the direct spread of oral bacteria through
the bloodstream to other parts of the body, but most
In other cases, oral bacteria have been found in
plaques in artery walls, though it is not clear
whether these bacteria are a cause of heart disease
or merely incidental, said Dr. Bruce Pihlstrom ,
acting director of the center for clinical research
at the National Institute of Dental and Craniofacial
Research, part of the National Institutes of Health.
But most of the systemic problems linked to
periodontitis, which affects millions Americans to
varying degrees, are believed to be problems of
chronic inflammation.
The clearest example of that is the association
between periodontitis and diabetes, said Dr. Robert
J. Genco , a periodontologist at the University of
Buffalo. He and others have shown that people with
diabetes have more severe periodontal disease and
have it at an earlier age than non-diabetics. And
it’s a two-way street: People with diabetes who also
have periodontitis have more trouble controlling
blood sugar than diabetics without periodontitis.
It makes sense. Cytokines, such as those generated
in chronic gum inflammation, can disrupt the system
by which insulin, the hormone that escorts sugar
into cells, sends chemical signals inside cells.
This can trigger insulin resistance, which often
leads to diabetes.
And obesity -- long known as a major cause of
diabetes, in part because fat cells in the abdomen
pump out so many cytokines -- is also now seen as a
direct risk factor for periodontitis, said Genco.
(Like Van Dyke, Genco is a co-author of a special
Scientific American publication on oral health paid
for by Proctor & Gamble, makers of Crest toothpaste
and Oral-B electric toothbrushes. It is available
online at
www.dentalcare.com/soap/products/index_promotion_sa.htm.)
Cytokines can also trigger inflammation in artery
walls, raise blood pressure, worsen cholesterol
profiles and increase the tendency for blood to
clot, which can lead to potentially fatal heart
attacks.
Animal studies have also shown that deliberately
inducing periodontitis triggers plaque buildup in
the coronary arteries, said epidemiologist Kaumudi
J. Joshipura , director of the division of dental
public health at the University of Puerto Rico in
San Juan.
A large study published in 2003 in the on-line
journal Stroke showed that people who had lost a lot
of teeth were more likely to have both severe
periodontal disease and clogged coronary arteries.
Another study that year showed a direct link between
periodontal disease and stroke in people who had
never smoked. And a study published in 2005 in the
journal Circulation showed that older adults with
higher levels of periodontitis-causing bacteria in
their mouths also had thicker arteries in the neck
that supply the brain, a predictor of heart attack
and stroke.
Pregnancy complications, too, have been linked to
gum disease, perhaps because chronic inflammation
leads to high levels of a hormone-like substance,
called prostaglandin E-2, which can induce labor.
But last year, a study in the New England Journal of
Medicine of 823 women with periodontal disease
showed that treatment did not lower the risk of
premature or low birth-weight babies. A second
government study of 1,800 more women is now
underway.
Bottom line? "The associations between periodontitis
and systemic disease are provocative and important,"
said Pihlstrom of the national dental institute.
But even if there were no links to systemic health,
“taking care of your mouth is important for its own
sake,” Pihlstrom said. Regular brushing, flossing
and visits to a dentist can help reduce the risk of
periodontitis -– and can help you keep your teeth as
you get older.
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