Gum Disease and Rheumatoid Arthritis

Periodontal disease has also been associated with rheumatoid arthritis an autoimmune disease that inflames joints and causes destruction of cartilage, bone and ligaments.

Diseased gingival tissues and joints affected by rheumatoid arthritis produce similar cytokines and growth factors and these chemicals promote the dissolution of bone, a problem shared by both diseases.

Further, levels of anti-CCP antibodies (anti-cyclic citrullinated peptide antibody) are considerably higher in those patients with periodontal disease who also have rheumatoid arthritis, suggesting that periodontitis may be a contributing factor in the pathogenesis of that condition.

Coincidently, P.gingivalis produces an enzyme that induces citrullination proteins in synovial joints that matches the cell wall of P gingivalis so autoantigens are formed to the bacteria and which attack your joints, causing rheumatoid arthritis. It has also been shown that patients with rheumatoid arthritis are more likely to develop periodontal disease.

Learn more from “Is There a Relationship Between Rheumatoid Arthritis and Periodontal Disease?” Published in the Journal of Clinical Periodontology.

The Mouth-Body Connection

New information about the “oral-systemic link” or “mouth-body” connection is changing the way dentists, physicians and patients view gingivitis and periodontal disease.

Gum disease is now considered to be a medical condition that only dental professionals can treat. That’s because these pathogenic bacteria travel from the oral cavity and throughout the body infect many organs which causes systemic illnesses such as heart attacks, Alzheimer’s Disease, and rheumatoid arthritis. If your gums bleed, you are at risk.

Family history and changes in diet and lifestyle do not fully account for the development of many serious medical conditions. We now know that inflammation caused by oral bacteria is also involved.

That’s because certain oral bacteria generate a destructive immune response or inflammatory response that elevates systemic inflammation. What’s more, it is now believed that gingivitis may be as damaging as full-blown periodontitis. Here’s why:

As bacteria accumulate on the surfaces of the teeth, they form sticky, durable, reef-like colonies. When biofilm is left undisturbed, a group of virulent gram negative anaerobic species emerge that activate the host immunoinflammatory processes. Although these bacteria initiate periodontitis, it appears that host-modifying risk factors also contribute to the severity and extent of the disease.

  • Anti-Inflammatory substances are produced by the immune defense system and these chemicals find their way to other parts of the body.
  • These anti-inflammatory substances are the triggers that increase chronic systemic illnesses such as heart disease, diabetes and cancers.
  • As the stages of periodontal infection continue, gums bleed and open tiny ulcerations that allow bacteria to enter the blood stream and travel throughout our body. This stimulates white blood cells to fight the invasion of microorganisms.
  • Chemicals intended to destroy the invading bacteria are released into the blood stream, but these same chemicals can also damage the healthy tissues as well.

Therefore, it is increasingly apparent that we must adopt new approaches to the treatment and control of gingivitis and periodontal disease. The patent-pending OraVital® System fills this need with the most accurate diagnosis and the most accurate treatment of oral infections such as periodontal disease, halitosis and peri-implantitis with therapies to kill and control the pathogenic biofilms predictably.

For an excellent overview on how to explain the importance of oral health its relationship to overall wellness to your patients, view our free KOL Access Webinar: Teach Your Patients Well,” by John Comisi, DDS, and Karen Comisi CDA, RDA.

This webinar will discuss various ways to help patients manage their oral health, and include the “trials and tribulations” experienced over the years of care for numerous patients.

Gum Disease and Heart Disease

When we have inflammation in the mouth in the form of gingivitis and periodontitis, those inflammatory chemicals in the oral cavity escape into the blood stream and travel to other sites including the large vessels of the heart, for example, the carotid artery.

Live oral microorganisms have been identified in the carotid artery, a major blood vessel. Our immune system produces antibodies to fight these oral bacteria; the antibodies react with bacteria and with specific proteins in heart tissues.

Inflammatory chemicals and other changes activate the production of clots that go on to block vessels to the heart and brain. Every blood clot from a heart attack and stroke contain the DNA or live bacteria from bleeding gums! Just as we have swelling, heat and occasionally pus when we have a skin infection, the same process occurs in the blood vessels – We just can’t see it! Source: Journal of Periodontology (July 2009).

The Invisible, Silent Killer

Cardiovascular disease (CVD) accounts for 53% of death in North America and is the second leading cause of death and disability. 82% of diabetics die from CVD. If you have biofilm left on the gums/tooth junction due to poor self care or bleeding gums you are at risk and need immediate treatment.  Atherosclerosis (hardening and clogging of the arteries) is a major component of cardiovascular disease and affects one in four individuals.

According to the Centers of Disease Control, heart disease (which includes Heart Disease, Stroke and other Cardiovascular Diseases) is the No. 1 cause of death in the United States, killing nearly 787,000 people alone in 2011.

The Perio-Cardio Breakthrough

Long time advocates of the important role that GP dentists, periodontists and dental hygienists can play in the prevention of heart attacks and strokes, authors of the best-selling book “Beat the Heart Attack Gene,” Drs. Bradley Bale and Dr. Amy Doneen recently published an article in the British Medical Journal (BMJ) entitled, “High-Risk Periodontal Pathogens Contribute to the Pathogenesis of Atherosclerosis.” Read it here.

Their BMJ study clearly states, “Periodontal disease due to high-risk pathogens is a contributory cause of arterial disease.” Knowing this, we must do all we can to control these bacteria!

As mentioned previously, atherosclerosis is the largest cause of death and disability in North America. If a patient has a history of CVD and presents with bleeding gums, are you doing all you can to mitigate their risk of heart attack and stroke?

Drs. Bale and Doneen offer a money back guarantee which states that that under their care, you will not have a heart attack or stroke to offer this guarantee, gum disease must be controlled. In fact, they state up to 50% of heart attacks are caused by gum disease and root infection bacteria. That is why they recommend testing for these pathogens – because of the risk they present.

At the same time, they do not recommend oral antibiotics to kill these pathogens because of the systemic effects. Yet they do support the use of an antibiotic rinse and spit method.

Drs. Bale and Doneen recently presented their findings on this new health paradigm and what it means to dental practices and patients in an exclusive, two-part free CE webinar with Dr Hyland for OraVital. They are both available on-demand:

“High-Risk Periodontal Pathogens Contribute to the Pathogenesis of Atherosclerosis.”

According to Dr. Bradley Bale, “Periodontal disease due to high risk pathogens must be considered a contributory cause of arterial disease.” During the webinar, Dr. Bale presents the science which supports this landmark statement.  Dr. Bale also states, “Considering this knowledge, the dental community has a significant opportunity to favorably impact the number one cause of death and disability by effectively managing this type of periodontal disease.” Drs Bale and Doneen’s research is the first to prove a causal relationship between periodontal pathogens and CVD.

“Integrating the Science of Oral/Systemic Health into Clinical Practice.” “It is necessary to respect the clinical context for which the information outlined in the recent BMJ study can be applied to the clinical dental arena,” explains Dr. Amy Doneen.

“What’s more, lines of communication must be created between medicine and dentistry that can clearly articulate the importance of understanding the oral pathogen burden as it relates to the vascular health of the individual patient.”

Gum Disease and Diabetes

There is no doubt that poor control of diabetes predisposes oral tissues to greater periodontal destruction. Poor metabolic control of diabetes makes the individual more susceptible to periodontal disease and can lead to a more aggressive periodontitis once it has developed.

Those adults whose diabetes is controlled do not have any more destructive periodontitis than healthy individuals.

Conversely, untreated oral infections such as periodontitis impede metabolic control and impair the diabetic’s ability to process or utilize insulin. Recent studies have presented evidence of a bidirectional adverse relationship between periodontal disease and diabetes mellitus, both type I and type II. Read an example of one of these studies.

Although diabetes is a metabolic disorder and periodontitis is an infectious disease, both diseases produce pro-inflammatory cytokines such as Interleukin-6. These inflammatory mediators impair the glucose-stimulated release of insulin from the pancreas.

Further, there is indication that a triangular interaction exists among obesity, type 2 diabetes and periodontal disease that is mediated by cytokine produced by fatty tissue and by infected gingival tissue.

Decreasing the oral bacterial load with effective periodontal therapy has been shown to stabilize glycemic control and reduce complications from unstable blood sugar levels. More research is needed to clearly identify the triangular pathway between obesity, periodontal disease and diabetes.

Gum Disease and Alzheimer’s Disease

Bacterial and viral infections commonly found in periodontal disease may impact the brain either directly or through systemic signals to the brain. This may contribute to the development of Alzheimer’s disease. Further evidence is needed to determine whether pathogens contribute uniquely to Alzheimer’s disease.

Periodontal pathogen Treponemas was detected using species specific PCR and antibodies. Importantly, co-infection with several spirochetes occurs in Alzheimer’s Disease (AD). The analysis of reviewed data following Koch’s and Hill’s postulates shows a probable causal relationship between neurospirochetosis and AD. 93.7% of Alzheimer’s patients’ brains contain one of six oral spirochetes. Download the study.

Also, periodontal infection may elevate the systemic inflammatory response and thus contribute to existing brain and vascular pathologies that would impact brain function. Periodontal disease and Alzheimer’s disease may also share genetic traits related to production of inflammatory mediators. Read the supporting research.

Healthy brains did not contain these spirochetes. Syphilis and Lyme disease are caused by spirochetes. Their brains are similar to those of Alzheimer’s patients upon death. If you have bleeding gums you have spirochetes causing an infection.

Spirochetal infection occurs years or decades before the manifestation of dementia. As adequate antibiotic and anti-inflammatory therapies are available, as in syphilis, one might prevent and eradicate dementia. The OraVital System can control these spirochetes.

Gum Disease and Respiratory Conditions

Periodontal diseases can also lead to respiratory disease including pneumonia and acute bronchitis as well as chronic obstructive pulmonary diseases. This link between microbial infection and pneumonia results from aspiration of oral microorganisms into the respiratory tract.

Pathogens are shed into the saliva and aspirated into the lung where they cause infection. Host defense mechanisms are unable to eliminate the microorganisms resulting in aspiration pneumonia. Cytokines originating from periodontal tissues may contribute to respiratory inflammation by making changes in the respiratory epithelium.

The swallowing difficulty that often accompanies elderly individuals also increases the amounts of bacteria in the mouth as many suffer from oral dryness. Insufficient saliva does not effectively wash the oral debris, increasing the likelihood that oral debris will inadvertently be inhaled into the lungs.

Mechanical ventilators magnify the risk for those patients who cannot breathe on their own and these patients are 20 times more likely to develop pneumonia. Oral bacteria form biofilms and they can also grow on the inside of the ventilator tube (as it does in dental waterlines) and increase the risk of aspiration.

Health care associated (hospital acquired) pneumonia is a common cause of death in elderly patients and is caused by species that do not often colonize the oropharynx.

The oral cavity has been suggested as an important reservoir for these pathogens and there is conclusive data that preventive oral care such as helping the patient cleanse the mouth reduces mortality from this type of pneumonia.

If patients in nursing homes had their teeth/gums brushed only twice a week, death from pneumonia can be reduced by 10%. Read the study, “A Systemic Review of the Preventive Effect of Oral Hygiene on Pneumonia and Respiratory Tract Infections in Elderly People in Hospitals and Nursing Homes”.

For additional information on this subject, watch our free CE Webinar from KOL Angie Stone, RDH,BSc entitled “Dying From Dirty Teeth: The Need for Geriatric Oral Care”

As our population continues to age and more and more people become dependent on nursing home care, the problem of poor oral health is growing quickly. And it turns out that teaching care providers to brush and floss their clients’ teeth is not really the best answer.

This course will get attendees energized about caring for the elder population. Especially appropriate for dentists, hygienists and dental assistants.

Gum Disease and Pregnancy Risks

In February 2010, the National Institute of Health published an announcement stating that premature birth affects 13 million infants world-wide each year and that 1 out of 3 preterm infants is born to a mother who has a silent infection of the amniotic fluid.

Growing evidence supports the concept that gingival infection plays a role in pregnancy complications, inducing premature birth as well as inhibiting the growth and development of the unborn child.

The increase in hormonal activity during pregnancy can cause gingival tissues to bleed more easily and may promote bacterial overgrowth. Increased numbers of Prevotella intermedia and F nucleatum have been found in the biofilm in pregnancy gingivitis.

Studies at Case Western Reserve University (Y.W. Han, 2006) demonstrated that maternal oral bacteria have been found in human amniotic fluid showing that there is direct movement of oral periodontal pathogens through the blood to the fetus.

Two separate studies, one in Chile and the other in the United States have similar results. In the Chilean study (Lopez N. 2002) 400 pregnant women with periodontal disease were in the study.

Of the half of these women that had scaling and root planing during pregnancy, 1.8 percent gave birth early. The other half of the study did not have any scaling or root planing until after delivery. In this group, 10.1 percent gave birth early.

In the U.S study, a study of 123 mothers who received periodontal treatment prior to delivery (Jeffcoat M. University of Alabama), 4.1 percent gave birth early whereas another group of 733 mothers with untreated periodontal disease had an early delivery rate of 13.7 percent. If your gums bleed and you want to conceive or are pregnant you are at risk and need care.

Gum Disease and Osteoporosis

Bone loss is a condition shared between periodontal disease and osteoporosis.

Osteoporosis occurs as bone resorption becomes more prevalent and there is considerable demineralization. Osteoporosis and periodontal disease both have excessive osteoclastic activity and bone loss initiated through chronic inflammatory conditions.

This shared chronic inflammatory response may predispose individuals with periodontitis to osteoporosis. In addition, risk factors such as age, smoking and estrogen deficiency are the same for both periodontal disease and osteoporosis.

The link between periodontal disease, osteoporosis and other media conditions is further explained in “Periodontal Disease and Systemic Conditions: A Bidirectional Relationship.”

Gum Disease and Life Expectancy

A study based in Sweden addressed the issue of periodontal disease as a risk marker for mortality. This study evaluated the relationship between periodontitis and premature death 16 years after the diagnosis of periodontitis.

The individuals in this study had a long history of chronic inflammation and a heavy microbial burden. The host defense system may have been weak.

Results confirmed that periodontitis in young adults with missing molars due to gum disease before the age of 40 is a risk marker for premature death. The prematurely deceased women in the study died 36.1 years sooner than life expectancy and the deceased men 31.6 years sooner.

Young individuals with periodontitis and missing molars seem to be at increased risk for premature death by life-threatening diseases, such as neoplasms, and diseases of the circulatory and digestive systems. Therefore, reducing the bacterial burden of affected individuals and identifying the bacteria responsible for the diseases causing death in these subjects are critical.

“Our findings have public health consequences and may create a basis for prophylactic measures that, in view of the prevalence and outcome of periodontal diseases and the costs it incurs to society are well warranted”.

For more information on the oral-systemic link and dental-medical collaboration, we suggest you watch “Inspiring Community Dental-Medical Collaboration” a free KOL Access Webinar presented by Charles Whitney, MD.

This webinar will provide members of the entire dental team with a practicing physician’s insight into the medical mind set and share valuable tips on how to successfully break down the walls between medicine and dentistry.

The result: The co-management of patients to prevent disease, improve existing medical conditions achieve a higher level of overall health and enjoy longer “health spans”.