The Mouth-Body Connection
Gum Disease is an infection of the gums and bone that support teeth. Anytime your body is infected by bacteria or virus, your body will trigger the immune system into action. The immune system is your body’s defence against intruders (bacteria/viruses) or injury. Inflammation is the process of self-defence mounted by the immune system. It is a complex system that involves both immune cells and many kinds of chemical messengers.
Acute inflammation helps to beat the invader (e.g. infecting bacteria) and sets the stage for the body to repair itself.
Chronic, or long-term inflammation, wears out the body. The immune system gets fatigued. It is like a country that has spent many years in war, things don’t work as they should. This makes the body susceptible to many other illnesses.
Periodontal disease is a preventable and treatable disease.
Managing it at an early stage might reduce the risks of a multitude of ills.
As a source of chronic inflammation and bacterial infection, advanced gum disease (known as periodontal disease) may affect other organ systems causing conditions like cardiovascular disease, rheumatoid arthritis, lung infections, cancer, and even dementia
Gum disease is an inflammation of the mouth. It releases inflammatory components, such as bacteria, into the circulation. The bacteria can enter the bloodstream and travel to other organs in the body, causing complications.”
People with advanced gum disease have two to three times the risk of having a heart attack, stroke, or other serious cardiovascular event.
People with advanced gum disease (also known as periodontal disease) have two to three times the risk of having a heart attack, stroke, or other serious cardiovascular event.
There is debate about the relationship between gum disease and heart disease. Many people with heart disease have healthy gums, and not everyone with gum disease develops heart problems. It is argued that both conditions share risk factors like smoking, poor diet and generally unhealthy habits.
Still there’s a growing suspicion that gum disease may be an independent risk factor for heart disease. It could be that periodontal disease increases the body’s burden of inflammation and makes some tissues in the body more vulnerable to damage.
What is encouraging is a recent study by University of South Carolina School of Medicine which showed that periodontal treatment could help to reduce the rate of recurrent stroke, myocardial infarction (MI) or death in the 1-year follow-up.
In other words, get rid of the oral disease to improve your chances of a healthier heart.
There is emerging evidence to suggest that gum disease can increase the susceptibility of a person to develop diabetes and, that effective gum treatment can improve diabetic control
Studies have also established that people with diabetes are two to three times more likely to develop irreversible gum disease than people without.
Scientific literature consistently supports a relationship between periodontitis and insulin resistance. It has been argued that periodontal disease exacerbates insulin resistance, a chronic condition implicated in the development of type 2 diabetes mellitus.
There could be vicious cycle or two-way susceptibility. The consequences of diabetes include poorer immune response, poorer wound healing, and increased inflammatory response all of which increase the susceptibility of a person with diabetes to develop severe gum disease.
Diabetes that is not controlled well leads to higher blood sugar (glucose) levels in the mouth fluids. This promotes the growth of bacteria that can cause gum disease. On the other hand, infections from untreated periodontal disease can cause the blood sugar to rise and make it harder to control diabetes.
The good news is that there is research showing that treating periodontal disease makes it easier to control the diabetes. The removal of bacteria by dental treatment leads to a decrease of inflammation, which in turn reduces insulin resistance; this in turn reduces the sugar level. The absence of inflammation causes a decrease in adrenaline level, which in turn regulates anti-insulin action, leading to decrease in sugar level. These facts together lead to an overall reduction in the dosage of insulin or oral anti-diabetic drugs.
There’s a direct connection between pregnancy and bleeding gums. During pregnancy, increased levels of the hormone, progesterone, cause an increased response to plaque bacteria which can lead to gingivitis (inflammation of the gums).
Nearly 60 to 75% of pregnant women have gingivitis, the early stage of periodontal disease that occurs when the gums become red and swollen from inflammation. If gingivitis is not treated, the bone that supports the teeth can be lost, and the gums can become infected. Teeth with little bone support can become loose and may eventually have to be extracted. Periodontitis has also been associated with poor pregnancy outcomes, including preterm birth (infants are born prior to
completion of 37 weeks) and low birth weight.
Statistics do show that the more severe the gum disease, the increased risk of pre-term births. The risk of pre-term births is particularly higher in women who have periodontal disease (more severe gum disease) and also have complications like pre-eclampsia, obesity or high blood pressure.
How periodontitis causes adverse pregnancy outcomes is not yet fully understood.
A couple of theories have been presented
- Bacteria from infected tissues in the mouth enter the blood stream and infect the placenta — the organ that nourishes the fetus throughout pregnancy. Chemicals released from this infection may cause rupture that leads to pre-term delivery.
- The inflammation of periodontal disease produces chemical messengers (cytokines, prostaglandins) which induce contractions of the uterus i.e. early labour.
Research has also shown that treatment of the periodontal disease reduces the bacteria and inflammatory agents, thereby reducing the rate of the pre-terms births.
Treatment of periodontal disease during pregnancy has been shown to be safe and effective.
It is an essential part of preventive care or health maintenance.
Lung Infections & Covid-19
How does periodontal disease affect the lungs?
Bacteria that grow in the oral cavity that travels into the lungs can cause respiratory problems such as pneumonia. This occurs mostly in patients with periodontal disease
Gum disease can also worsen the chronic inflammation in lung diseases such as asthma and Chronic Obstructive Pulmonary Disease (COPD). Inflammation in the airways is one factor that leads to more frequent symptoms and lung damage. Infected and inflamed gums send out a “distress signal” that
places the rest of the body on alert. This can lead to more inflammation in the lungs.
This is particularly true for the elderly and nursing home patients. This shows the necessity for practicing good oral hygiene even for the chronic sick and bed-bound.
Periodontal Disease risk factors include tobacco smoking, diabetes, medication, and obesity Similarly, other studies suggest the association between Periodontal Disease and other diseases such as diabetes, hypertension, asthma, liver diseases. These are also the risk factors that contribute to complications with Covid-19.
In one research, 568 patients were studied Those with periodontitis, the most severe form of gum disease, were at least three times more likely to experience COVID‐19 complications including death, ICU (Intensive Care Unit) admission, and the need for assisted ventilation.
One study from China has put forward the theory that the damaged gum tissues of periodontal disease present more receptors or points of entry for the corona virus.
Hence the practice of good oral hygiene is even more important during the pandemic.
Gum disease, especially Periodontal Disease – the kind that is irreversible and causes tooth loss- may be associated with mild cognitive impairment and dementia 20 years later, according to a New York School of Public Health study published in the journal Neurology.
A study from Taiwan’s Chung San Medical University that followed more than 27,900 people over 10 years found that people with periodontal disease faced up to 70 percent greater risk for developing
Alzheimer’s, compared to those with healthy gums. Another 2016 study found that among people who already have the disorder, cognitive decline progressed six times faster in those with oral
Oral bacteria, including the leading culprit in the disease, Porphyromonasgingivalis, can enter the bloodstream through tiny tears in bleeding or inflamed gums. That makes it easier for periodontal bacteria to travel from the mouth to the brain
Once inside the brain, P. gingivalis can kill brain neurons and boost production of beta-amyloid plaques, clumps of tangled proteins that are a hallmark of Alzheimer’s, an international team reported in 2019 in Science Advances. The researchers also found that gingipains—toxic enzymes released by P. gingivalis—were present in 96 percent of the brain samples from deceased Alzheimer’s patients and in the spinal fluid of living patients. Chemicals that blocked gingipains beat back P. gingivalis brain infections and restored neurons in the hippocampus, a brain area essential for forming memories.
It is possible that pro-inflammatory molecules travel from the gums to the brain either via the blood or nerve cells, where they cause more inflammation. Over time, this inflammation can damage neurons and potentially cause the brain changes we see in Alzheimer’s disease.
To put it simply: gum disease may cause inflammation in the brain, which brings about changes like the production of beta-amyloid plaque that are associated with Alzheimer’s.
Gum and periodontal disease are one of the major preventable causes of inflammation in the body. Controlling inflammation in the mouth and gums can help prevent many diseases, including cardiovascular disease and potentially even Alzheimer’s.
People with cognitive decline, Alzheimer’s patients, older adults, and anyone at higher risk of developing Alzheimer’s or dementia should take their dental health very seriously. Flossing and toothbrushing could be two of the most powerful tools for your overall health.
People who have rheumatoid arthritis are 20 times more likely to have infected gums than those who don’t. In addition, the more advanced the periodontal disease, the more severe the rheumatoid arthritis. This suggests that oral infections may drive or worsen rheumatoid arthritis.
It is thought that chronic inflammation i.e. a prolonged immune response to periodontal bacteria in the mouth and bloodstream leads to systemic (generalized in the body) inflammation. This, in co-incidence with trauma to the joints, trigger auto-immune antibodies that attack the body’s joints and tissues leading to painful swelling and joint deformity.
In a vicious cycle, with painful joints, it would be more difficult to care for oneself e.g. the dexterity required to brush the teeth well.
The bacteria, Fusobacterium nucleatum, has long been suspected of in the development of colon cancer. It is a bacteria found in dental plaque and is known for its “stickiness” or adhesive properties.
This oral microbe has been found in the cancer tissues of the colon and even in metastatic tissues i.e. when the cancer spread to other organs in the advanced stages.
A study conducted by Columbia University’s College of Dental Medicine in New Yorkfound that the periodontal bacteria F. nucleatum produced a protein that causes inflammation and speeds up the growth of cancerous cells “like throwing gasoline onto a fire”