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Over the past several
months periodontal disease has become front page news as the medical and
dental communities have begun to discuss whether periodontal disease is
related to premature births and heart disease. The purpose of this up-date
letter is to explain periodontal disease itself, and what is known about
periodontal disease and its connection to low-birth weight and heart
attacks.
In excess of
three-quarters of adults 35 and over have some degree of periodontal
disease. Most individuals are familiar with the symptoms of periodontal
disease such as bad breath, frequent gum infections, swollen gums, gums
which bleed or loose teeth. The disease itself is best understood as a
chronic bacterial infection. As bacteria build up under the gum line, a low
grade infection begins to emerge in the gum tissue. The gum tissue itself
reacts to the infection by becoming inflamed and swollen. This is known as
gingivitis. If the level of bacteria is not reduced, the infection spreads
to the bone that supports the tooth and the attachment between the bone,
gum and tooth becomes destroyed. At this point, periodontal disease has
begun. The missing attachment between the bone and gum becomes a
periodontal pocket that contains billions of bacteria. As the bacteria
under the gum line continues to build to a higher and higher level, the
bacteria itself becomes more dangerous as it inflicts greater harm by causing
more extensive bone loss and deeper pockets. In the end, tooth loss will
result.
Now we are learning
that in addition to causing tooth loss, periodontal disease may trigger
premature births and cause heart attacks. In discussing periodontal disease
and its connection to other diseases, the first point to be emphasized is
that there is no concrete proof linking gum disease with heart disease and
low-weight births. However, recent studies on periodontal disease strongly
suggest that individuals with periodontal disease have a higher risk of
heart disease, and that periodontal disease may be responsible for low
weight births.
Looking at heart
disease, periodontal disease is thought to contribute to heart attacks by
releasing bacteria located in infected gum tissue into the bloodstream
which then travels throughout the body. Over time the infectious bacteria
inflicts damage by causing arteries to become obstructed. Periodontal
disease is being looked at as a cause of artery congestion as germs
associated with periodontal disease exhibit clogging properties. For
example, the bacteria Porphyromanas Gingivalis cause blood to clot. In
addition, gum germs have been found in artery-plugging plaque.
Studies examining
periodontal disease and its relationship to heart disease indicate that
individuals with a periodontal condition are at a greater risk of heart
disease. One such study, done in Wisconsin, followed the health of 9,760
Americans from the early 1970s to date. Men who had gum disease when the
study began had a 75% greater risk of heart trouble than those who had no
periodontal problems. Another study followed 1,231 men who were outwardly
healthy when given dental exams in the 1960s. In the years that followed,
men who started out with gum problems had twice the rate of death from
heart disease.
Gum disease may also
be a major contributing factor in low-weight births. The Journal of
Periodontology has reported that periodontal infection may be responsible
for as many as 18% of all births under 5.5 pounds in the United States each
year. Bacteria appear to retard fetal growth by releasing toxins that reach
the placenta and interfere with fetal development. In addition, periodontal
bacteria appear to cause the uterus to contract setting off premature labor.
As I discussed, there
is no definitive proof that periodontal problems cause heart disease and
premature births. However, the evidence suggests that something as simple
as treating gum disease may lower other health risks. Which brings me to
the good news about periodontal disease - in most cases it is entirely
preventable and controllable. Brushing, flossing and manual plaque removal
are effective in preventing and managing gum disease. We know that such
therapy helps keep the bacterial load below the level at which tissue loss
is triggered. Such therapy may also keep bacterial build-up from reaching
the level at which periodontal germs are released into the blood stream.
As many of you are
aware, my philosophy of patient treatment is that of preventive care. I
have previously emphasized preventive treatment in terms of catching tooth
decay. Preventive treatment is also of the utmost importance in catching
periodontal disease. In this respect, I cannot emphasize enough the
importance of regular hygiene exams to detect gum disease as it begins to
develop. In addition, regular cleanings combined with proper home care are
effective in keeping germ levels below the point at which gums become
infected and periodontal disease begins to develop.
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