The medical and dental community would never have imagined thirty years ago that we would be discussing gum disease and cardiovascular disease in the same sentence.  The belief at that time was that tooth and gum problems were exclusively dental issues, and this led to many people not realizing the importance of oral health.  The past decade has produced an impressive array of research that has changed the way we view the relationship between gum disease and overall health.  It is clear that daily brushing and flossing must be a part of a program to maintain favorable overall health.

Research has shown a strong association between periodontal disease (gum disease) and major medical conditions such as heart disease, stroke, diabetes, respiratory disease and pregnancy complications (pre-term low birth weight).  Let us start by reviewing the definition of periodontal (gum) disease.

What Is Gum Disease?

Gum disease (periodontal disease) is caused by plaque deposits on the teeth that harbor bacteria which infect the gums.  The gums may become swollen and bleed while brushing.  As the disease progresses, the infection becomes more serious causing a separation of the teeth and gums which is termed a “pocket”.  The infection can become severe causing dramatic bone loss and ultimately, loss of the teeth.  Individuals with the highest risk for gum disease are smokers, diabetics, or those with a family history of gum disease.

Gum Disease In Women

Hormonal fluctuations have also been linked to the inflammatory findings in gum disease.  This is of particular relevance to women since hormonal impact can be seen during puberty, menstruation, pregnancy and menopause.  These all represent higher risk times for women, and can promote pronounced gum inflammation.  It has been estimated that approximately 25 percent of women between 30 and 54 have active bone loss associated with gum disease.  This figure increases to almost 50 percent for women who are over 55.

For many years, dental professionals believed that periodontal disease was solely the result of a bacterial infection caused by a buildup of plaque between the teeth and under the gums.  However, this could not explain the varying levels of bone loss reaction to the plaque accumulation.  This led to research that identified the body’s response, or what we term “the host response” as a critical key to the cause of gum disease.  Shortly thereafter, new research began to link gum disease to a variety of health conditions.

Heart Disease And  Stroke

Researchers have found that people with gum disease are almost twice as likely to suffer coronary artery disease than those without gum disease.  This in turn, may increase the chance of a heart attack.  Other studies have demonstrated a relationship between periodontal disease and stroke.  One study showed that individuals diagnosed with acute cerebrovascular ischemia (stroke) are more likely to have an underlying oral infection than those without stroke.

One theory that explains these findings is that oral bacteria may enter the bloodstream and attach to the fatty plaques within the walls of heart vessels.  The bacteria could then cause injury to the vessels which results in clot formation.  These clots can obstruct normal blood flow to vital organs, thus causing heart attack or stroke.  Another theory points to the inflammatory process resulting from gum disease, which may contribute to swelling of the arteries.  Regardless of the theories, it appears clear from the studies that the long term effects of gum disease, such as extended bacterial exposure and the resulting inflammatory response may be a critical risk factor for cardiovascular disease.

Diabetes

It has long been known that diabetes is a major risk factor for gum disease.  Diabetics are at significantly higher risk for experiencing bone loss related to gum disease, when compared to non-diabetics.  Diabetics with poor control are at the highest risk.  However, recent research suggests that the relationship may go both ways.  Gum disease can increase blood sugar levels, making it difficult to achieve diabetic control and increasing the risks of diabetic complications.  Studies have shown that when diabetics treat their gum disease, their blood sugar levels will improve.  One study suggests that gum disease may induce diabetes in borderline patients.

Pregnancy Complications

Studies have shown a relationship between periodontal disease and preterm, low birth weight babies. Pregnant women with periodontal disease may be seven times more likely to have a baby that’s born too early and too small. A cellular chemical called prostaglandin, is produced in the inflammatory cycle of periodontal disease.  Prostoglandin is also known as a potent inducer of labor.  Pregnant women should be screened for active gum disease and treated appropriately to improve oral health during pregnancy and reduce the risks of early labor.

Conclusions

It should not surprise us that a long-standing, chronic oral infection, such as gum disease, should have such a widespread impact on the overall health of the human body.  The research is now defining these relationships, and new associations are being identified each year.  Proper screening and diagnosis of gum disease is the first step to health, and your family dentist is an appropriate starting point.  If you are found to have gum problems, you may be referred to a periodontal specialist.  If you suspect that you have gum disease, or you are in a high-risk category (smokers, diabetes, family history), you may wish to seek a gum disease screening by a periodontal specialist.

This article first appeared in the 2009 May / June edition of the The New London Women’s Journal