Periodontal Disease Kills More than Your Smile

Periodontal disease (PD) is primarily seen in adults. Periodontal disease and tooth decay are the two biggest threats to dental health. However, periodontal disease noticeably increases your risk for other chronic diseases.  Dental hygienist Misty Jones reveals the surprising relationship between periodontal disease and other chronic conditions and natural ways to reduce one’s risk for PD!

Periodontal disease is a chronic inflammatory disease and a global health issue. Bacterial infections and inflammation damage the gums and bones surrounding and supporting the teeth. In its early stage, called gingivitis, the gums can become swollen, red, and may bleed. In its more severe form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out.

Prevalence of Periodontal Disease

A recent CDC report provides the following data related to the prevalence of periodontitis in the U.S.:

47.2% of adults aged 30 years and older have some form of periodontal disease.

Periodontal disease increases with age. 70.1% of adults 65 years and older have periodontal disease.

This condition is more common in men than women (56.4% vs. 38.4%), those living below the federal poverty level (65.4%), those with less than a high school education (66.9%), and current smokers (64.2%).¹

Causes

Bacteria in the mouth infect tissue surrounding the tooth, causing inflammation around the tooth leading to periodontal disease. When bacteria stay on the teeth long enough, they form a film called plaque which eventually hardens to tartar, also called calculus. Tartar build-up can spread below the gum line, which makes the teeth harder to clean. Then, only a dental health professional can remove the tartar and stop the periodontal disease process.

Gingivitis:  Gingivitis is the only stage of periodontal disease that is reversible as it has not yet had time to attack the bones.

Stages of Periodontal Disease:

Bad breath on occasion, swelling and redness of the gums, and bleeding when brushing or flossing are the initial signs to watch for.

Early periodontal disease: The infection and inflammation spread to the bones. Please note PD is chronic and progressive, but in its early stages there are interventions that may slow down its progression.

Moderate periodontal disease: During this stage, the same symptoms as stage two occur but probing depths are greater at six to seven millimeters which allows for even more bacteria to attack not only your bones, the bloodstream, and the immune system as well.

Advanced periodontal disease: The final stage of periodontal disease occurs when the infection deepens even further and the bacteria, once again, evolves into disease-causing bacteria. This stage increases the risk for bone loss by 50-90%. In addition to bone loss, advanced PD causes red, swollen gums that ooze pus, cold sensitivity, further loosening of teeth, painful chewing, and severe halitosis. This stage requires periodontal surgery or periodontal laser therapy to clean the deep bacteria-filled pockets.

Warning Signs of PD:

• Bad breath or bad taste that won’t go away
• Red or swollen gums
• Tender or bleeding gums
• Painful chewing
• Loose teeth
• Sensitive teeth
• Gums that have pulled away from your teeth
• Any change in the way your teeth fit together when you bite
• Any change in the fit of partial dentures

Inadequate Oral Hygiene and Dental Care

Poor oral hygiene, crooked teeth, defective fillings, and bridges that no longer fit properly promote P.D.

Smoking

Smokers are 3 times more likely to have a severe form of periodontal disease than non-smokers.² Smoking cessation not only inhibits further progression of periodontal disease but can also reduce the periodontal tissue destruction.³

Sleep Deprivation

Poor quality of sleep is significantly associated with chronic periodontitis. A study of 10, 291 individuals found sleep deficient persons were 19% more likely to have periodontitis when compared to sleep adequate persons, after adjusting for confounding factors.⁴ Another study of 200 individuals found that the prevalence of poor quality of sleep was 56.75% in cases (periodontitis group) and 43.24% in the control group.⁵ Sleep deprivation and interrupted sleep increase inflammatory compounds. Additionally, sleep deprivation decreases the repair of the cells, hormonal regulation, risk of depression, increased cortisol, impaired glucose metabolism, immune function–all of which can contribute to PD.

Non-Modifiable Risk Factors:

Genetics

Hereditary, lifestyle habits, environmental factors, and chronic diseases interact and contribute to PD. Up to 30% of the population may have some genetic susceptibility to periodontal disease. Genetics may account up to 50% of the causative factors if aggressive PD appears in young individuals.⁶

Immune Problems

Children with primary immunodeficiencies were nearly ten times more likely to be diagnosed with periodontal (gum) disease than systematically healthy age-matched children.⁷

Periodontal disease definitely has an autoimmune aspect. Autoreactive T cells, natural killer cells, proteins, autoantibodies, and genetic factors have an important role in the autoimmune component of periodontal disease. Autoimmune conditions such as type 1 diabetes and rheumatoid arthritis increase the risk for PD.((Autoreactive T cells, natural killer cells, proteins, autoantibodies, and genetic factors have an important role in the autoimmune component of periodontal disease. Autoimmune conditions such as type 1 diabetes and rheumatoid arthritis (RA) increase the risk for PD.⁸ Individuals with RA have high prevalence of alveolar bone destruction and tooth loss which are also sequelae of periodontal disease.

Women’s Hormonal Fluctuations

Hormonal changes in women increase the likelihood of periodontal disease by several different mechanisms. Females may experience gingival inflammation before menstruation and during ovulation due to a high progesterone level. An elevated progesterone level blocks the repair of collagen fibers and causes the dilatation of blood vessels. Similarly, pregnant women most frequently exhibit gingival changes, gingivitis, and sometimes localized growth of gingival tissues. These inflammatory changes disappear within a few months after delivery without causing persistent damage to periodontal tissues. Estrogen deficiency reduces bone density after menopause, culminating in alveolar bone loss and eventually falling teeth.⁹

Dry Mouth

Taking medicine or medical condition that cause dry mouth increases one’s risk for periodontal disease. Snoring and breathing with your mouth open also can contribute to dry mouth. Drugs used to treat depression, high blood pressure, and anxiety, as well as some antihistamines, decongestants, muscle relaxants and pain medications, alcohol and tobacco contribute to dry mouth. Chemotherapy and certain autoimmune diseases may contribute to dry mouth.

Diabetes

While diabetes increases one’s risk for PD, the converse is also true. PD increases one’s risk for diabetes.¹⁰. Diabetes mellitus is associated with periodontal ligament destruction which subsequently can lead to tooth loss. Additionally, diabetes increase inflammation throughout the body.

PD Increases Your Risk for Other Chronic Diseases

Heart & Cardiovascular Diseases

There is strong evidence linking periodontal disease to cardiovascular disease.¹¹ A systematic review identified that periodontitis is a risk factor for coronary heart disease, independent of other risk factors such as diabetes, smoking, and socioeconomic status.¹² A meta-analysis found that periodontal disease is likely to cause a 19% increase in the risk of cardiovascular disease and this increase in relative risk reaches to 44% among individuals aged 65 years and above.¹³

Periodontal disease association with stroke and peripheral artery disease is even stronger than it is for coronary heart disease.¹⁴

Inflammation fuels all stages of atherosclerosis development and links PD to other chronic conditions. If one is prone to clots or has a build-up of cholesterol in the arteries, inflammation aggravates these conditions. Keeping your gums healthy can reduce your risk for a heart disease.

Metabolic Disorders

Several systematic reviews have proposed a link between obesity and periodontal disease and it has been identified as a risk factor for the development of periodontitis.^{15 16} A higher body fat content has been associated with increased gingival bleeding in older patients.

Type 2 diabetic individuals with severe periodontal disease had 3.2 times the risk of mortality due to ischemic heart disease compared to the individuals with no or mild periodontal disease.¹⁷ The presence of any gum inflammation can make it much more difficult for a diabetic to control their blood sugar. Elimination of any gum inflammation can directly improve diabetic control.

Reducing one’s intake of calories (if obese) has been shown to reduce inflammatory changes and diminish the tissue damage in periodontal disease.¹⁸

PD and Cognitive Impairment

Researchers found that severe periodontitis and periodontal inflammation were associated with incident mild cognitive impairment among older community-dwelling men and women after adjusting for age, sex, smoking status, educational level, physical activity level, obesity, depression, and diabetes.¹⁹ 

Premature Births

Periodontitis is related to adverse pregnancy outcomes which include maternal infection, preterm birth, low birth weight, and preeclampsia. Microbiological and immunological factors are implicated in the underlying mechanisms.²⁰

Nutrition and Oral Health

Limit the Sugar

A sugary diet encourages plaque formation and leads to the onset or worsening of dental decay in reaction to poor oral hygiene. It has been observed that sucrose produces more cavities than fructose and glucose.²¹

Indeed, a high frequency of consumption of added sugars is associated with periodontal disease, independent of traditional risk factors, suggesting that this consumption pattern may contribute to the systemic inflammation observed in periodontal disease and associated non-communicable diseases.²²

Adequate Protein

Protein deprivation conducted on rats in the 1950s resulted in the breakdown of periodontal ligaments, degeneration of gingival tissues, and resorption of the alveolar bone. A recent study conducted in Denmark suggested an inverse relationship between high protein intake and periodontitis.

Adequacy in Nutrition

Vegans and vegetarians, take note! Vitamin B-12 is needed for protein synthesis in bone tissue. A prospective cohort study found serum vitamin B12 is inversely linked to periodontal progression and risk of tooth loss.²³

There is significant evidence linking periodontal disease and vitamin C. Eat enough vitamin C-rich foods. A systematic review found that adequate amounts of vitamin C may reduce the risk for PD but not cure it. In the two case-control studies, subjects who suffered from periodontitis presented a lower vitamin C intake and lower blood-vitamin C levels than those without periodontal disease. The patients with a lower dietary intake or lower blood level of vitamin C showed a more significant progression of periodontal disease than the controls.²⁴

Vitamin D deficiency has been linked to the increased prevalence of periodontal disease. Vitamin D stimulates bone-building cells (osteoblasts), optimizes bone remodeling, and increases bone matrix proteins. Additionally, the active form of vitamin D improves calcium absorption and quells inflammation. ²⁵

Protective Minerals

Dietary zinc may also play an important role in maintaining periodontal health and in preventing diabetes-related periodontitis by exerting an anti-oxidant effect. Zinc supplementation may have the potential to augment the therapeutic effects of periodontal therapy.²⁶

Calcium is essential for the maintenance and formation of calcified tissues such as bone and teeth. Magnesium is required for cell metabolism and maintenance and formation of bone. 

Prevention and Treatment

Gingivitis can be controlled and treated with good oral hygiene and regular professional cleaning. More severe forms of periodontal disease can also be treated successfully but may require more extensive treatment. Such treatment might include deep cleaning of the tooth root surfaces below the gums, medications prescribed to take by mouth or placed directly under the gums, and sometimes corrective surgery.

To help prevent or control periodontal diseases, it is important to:

Engage in Good Dental Hygiene

Plaque is a biofilm of glycoproteins, mucin, and bacteria that adheres to surfaces in the oral cavity. If the plaque remains attached to teeth for a couple of days, it mineralizes to form calculus.²⁷The porous calculus provides a potential surface for inhabiting pathogens that cause PD. Brush and floss after each meal to remove the bacteria that cause gum disease. Include your gum line when you brush. See a dentist at least once a year for checkups, or more frequently if you have any of the warning signs or risk factors mentioned above.

Dental procedures for PD may improve chronic diseases associated with periodontal disease. For example, improvement of endothelial function and reduction in systemic inflammation occurred with periodontal treatment.One study reported that these effects significantly lasted for 3–12 months post-treatment.²⁸ Non-surgical periodontal therapy was effective in improving the clinical data and in reducing pro-inflammatory states in hypertensive patients with severe periodontitis.²⁹. 

Watch Your Beverages and When You Eat

Your health is much better if you don’t snack on coffee and soda drinks. Acid from coffee, fruit juices, and sodas help to erode teeth enamel. If you do snack, brush your teeth immediately!

Check Your Blood

As previously mentioned, vitamin D and B-12 deficiencies increase one risk for PD. It is probably wise to get a dietician or nutritionist to review your weekly menu.

Enjoy Whole Plant Foods

Eat colorful fresh or frozen fruits and vegetables. Why? They are loaded with antioxidant vitamins and phytochemicals. A Japanese study showed that a higher intake of dietary antioxidants was inversely associated with the number of teeth in periodontal disease progression, controlling for other variables.³⁰

The blueberry extract, according to studies, hinders bacterial growth and biofilm formation present in PD.³¹ Some studies suggest that lycopene supplementation may enhance the improvement of periodontal health.³²

Improve Your Mental Health

Increased inflammation in the brain is common in major clinical depression, anxiety disorders, and schizophrenia. Depression has been positively linked to PD. Poor oral hygiene often accompanies depression and anxiety. Depressed individuals can have dental caries that could be attributed to dry mouth as a side effect of anti-depressants. The same oral bacteria that cause PD can trigger depression and schizophrenia through a dysregulation of immune system and an elevation of pro-inflammatory compounds.³³

Control Chronic Diseases

Lose weight if you need to because obesity fuels inflammation. Research the best scientifically-validated natural strategies to improve atherosclerosis, hypertension, type 2 diabetes, rheumatoid arthritis, inflammatory bowel disorders, major depression and anxiety, or any other pro-inflammatory medical conditions. Physical therapy, a thorough diagnostic workup, consultation with a plant-based oriented dietician, mental health counseling, and a pharmacist may be needed in addition to your health-care provider. Remember, too, that good dental care may improve your chronic condition!

Swish with Curcumin Tea

Curcumin, an active phytochemical from turmeric, has been shown to possess antioxidant, antimicrobial, anti-inflammatory, and pain-relieving properties. Several studies have assessed the efficacy of curcumin against periodontal diseases. They show that curcumin is equivalent managing periodontitis than the commonly used medications, such as chlorhexidine.³⁴ Turmeric mouthwash prepared by dissolving 10 mg of curcumin extract in 100 ml of distilled water and 0.005% of flavouring agent peppermint oil with pH adjusted to 4 is found to be as effective as most widely used chlorhexidine mouthwash.³⁵ Please note: We are not saying that rinsing with a turmeric mouthwash or brushing with a curcumin paste substitute for other denture procedures needed to slow down PD.

Disclaimer: The information in this article is helpful and is educational. It is not the author’s or authors’ or Wildwood Health Institute’s intent to substitute the blog article for diagnosis, counseling, or treatment by a qualified health professional.

 

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