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The Link Between Gum Disease and Overall Health

NEW YORK (Apr 3, 2012)

Early twentieth-century physicians had a few tools in their diagnostic kit that differ from those used today. One was the idea that the mouth was the mirror to the body. "They would look in the mouth, and would be able to tell if a patient was anemic or not, and if patients had a range of other problems," according to John T. Grbic, D.M.D., M.M.Sc., Professor and Director of the Division of Oral Biology at the Columbia University College of Dental Medicine as well as a periodontist at NewYork-Presbyterian/Columbia University Medical Center. Physicians now rely on a variety of blood tests to diagnose diseases such as anemia, and have not focused on examining the mouth as carefully for signs of systemic diseases.

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But according to Dr. Grbic and Philip D. Pack, D.M.D., a periodontist at NewYork-Presbyterian/Weill Cornell Medical Center, the mouth, and particularly the state of the gums, can tell doctors and dentists a lot about a patient's overall health. Over the last 10 or more years, periodontists – specialists trained to treat inflammation of the oral cavity – have developed the concept of a "perio-systemic connection," said Dr. Pack, because of observations and studies showing a link between periodontal disease and heart disease, stroke, diabetes, respiratory disease, kidney, pancreatic, and blood cancers, rheumatoid arthritis, and the likelihood of delivering preterm, low-birthweight babies. Some of these associations may be just that: associations, he added. "People who have poor oral health may just have poor general health. They neglect their oral health and they also neglect their general health." But research is underscoring the link between several systemic disorders and the gums, and the common thread is inflammation, said Dr. Pack.

John T. Grbic, D.M.D., M.Med.Sc
John T. Grbic, D.M.D.,
M.Med.Sc

One of the clearest relationships is between diabetes and periodontal disease, which probably has to do with vascular and immunological changes in people with diabetes, Dr. Grbic said. "In periodontal disease there's an inflammatory reaction to plaque bacteria. In diabetics the ability to fight off the infection and to heal is decreased, so they have increased inflammation in the gums," he said. Diabetics have about a three-fold higher incidence of periodontal disease, and having periodontal disease may actually make their diabetes worse, he said. "Infections like periodontal disease can impair the body's ability to process or use insulin, and blood sugar levels rise. So treating periodontal disease may actually improve diabetics' "glycemic control." The results of a large NIH-funded study looking at that relationship will be available in a year or two, and will shed more light on this link, he added. In the meantime, if you're at risk for diabetes, be sure to have your gums checked regularly by a periodontist.

Philip D. Pack, D.M.D.
Philip D. Pack, D.M.D.

Coronary artery disease may be fueled when bacteria from the mouth enter the bloodstream and attach to plaques in the coronary arteries, eventually contributing to clot formation, Dr. Pack explained. Inflammation caused by periodontal disease may also increase plaque buildup, which may contribute to narrowing of the arteries. Periodontists and cardiologists should educate their patients who have cardiovascular disease about the importance of regular periodontal checkups, he added.

People with rheumatoid arthritis (RA) are eight times more likely to have periodontal disease than those without this chronic inflammatory disease. But research has shown that by improving the care of their gums and teeth, patients with RA can lessen the severity of their symptoms and cause a decrease in levels of an inflammatory marker in their blood.

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"When you treat patients you see how destructive bacteria can be in the mouth, and there's no barrier between the mouth and the rest of the body," Dr. Pack said. "People assume a barrier exists because dentists are dentists and physicians are physicians, but the body doesn't know that."

While the underlying mechanism is not clear, what is clear is that people with rheumatoid arthritis, heart disease, diabetes, or pregnant women with a history of dental problems should see a general dentist for a comprehensive evaluation and should most importantly be evaluated by a periodontist for inflammation, infection, and bone loss, Dr. Pack said.

But the key is to go back even farther and determine how to prevent periodontal disease from developing in the first place, Dr. Grbic added. "The answer to that is, don't smoke, see a dentist regularly, and perform good home care – in other words, brush and floss."

Contributing to this article:

John T. Grbic, D.M.D., M.M.Sc., is a Periodontist at NewYork-Presbyterian/Columbia University Medical Center and a Professor and Director of the Division of Oral Biology at the Columbia University College of Dental Medicine.

Philip D. Pack, D.M.D., is a Periodontist at NewYork-Presbyterian/Weill Cornell Medical Center.

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