Periodontitis: the gum problem that can seriously affect your health

martha henriques bbc future

A smile that shows normal teeth.

Author of the photo, fake images

Crowded, misaligned, riddled with cavities and inflamed gums, our teeth are infamous for their flaws.

Modern man is unique in that he must intervene every day to ensure that his teeth and gums do not get diseased.

More than just toothaches and gum pain, our oral health affects everything from our diet to our general well-being to our lifetime risk of death from all causes in any given year.

This is because mouth diseases do not always stay in the mouth.

It is beginning to appear that there is a strong link between oral health and some of the world’s most pressing diseases, including cardiovascular disease, diabetes and Alzheimer’s disease, underscoring the role of the mouth as a mirror of health and disease, and as a sentinel of our general well-being.

Unfortunately, perhaps the most telling feature of oral health is the one that is most often overlooked.

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generalized disease

Periodontitis, or gum disease, is the second most common oral disease after tooth decay. It affects more than 47% of adults over 30 years of age.

After the age of 65, 64% have moderate or severe periodontitis. Globally, it is the eleventh most prevalent disease in the world.

Periodontitis is an infection that is not on the surface of the gums that you can see when you smile, but deep down.

Author of the photo, fake images

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Regular visits to the dentist are essential to maintain good oral health.

After an initial phase of superficial inflammation in the visible part of the gum line (gingivitis), the bacteria travel below the gum line into pockets near the root of the tooth where they erode the structures that hold the tooth in place. its place.

Due to the hidden nature of periodontitis, many people who suffer from it do not know they have it until they have reached a very advanced stage. This disease has a genetic component and is also influenced by oral hygiene.

For most people, the disease isn’t visible until they’re in their 40s or 50s, says Sim K. Singhrao, lead researcher at the University of Central Lancashire School of Dentistry in the UK.

By then, it is possible that serious damage has already reduced the architecture of the tooth, with the risk of losing it. Meanwhile, the infection sent a steady trickle of bacteria, including Treponema denticola and Porphyromonas gingivalis, into the bloodstream for decades.

bacteria in the blood

It is this long-term presence of disease-causing bacteria in the gums and bloodstream that shapes our health far beyond the mouth.

“If you imagine the blood system as a bus, it will carry passengers, things like bacteria in the mouth, and it will spread throughout the body,” says Singhrao.

“Some will fire in the brain, some in the arteries, some still in the pancreas or liver.”

When these organs have vulnerabilities or microbes are not effectively eliminated, they cause inflammation and trigger or exacerbate other inflammatory diseases.

Author of the photo, fake images

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Periodontitis affects 47% of adults over 30 years of age.

In fact, periodontitis is linked to a list of some of the most common non-communicable diseases in the world: cardiovascular disease, diabetes, Alzheimer’s disease, obesity, various types of cancer, rheumatoid arthritis, Parkinson’s disease, pneumonia and complications of the pregnancy. .

bidirectional relationship

For many of these pathologies it is a bidirectional relationship. For example, periodontitis can aggravate conditions such as atherosclerosis, the hardening of the artery walls, and the presence of atherosclerosis also predisposes patients to periodontitis.

There have been no randomized controlled trials (RCTs), considered the gold standard of medical research, to investigate this relationship (it would be difficult to conduct them ethically, refusing a group to treat their periodontitis for a prolonged period to see how it affects their atherosclerosis).

However, the bacteria responsible for periodontitis, normally found only in the mouth, have been discovered in atherosclerotic plaques.

Author of the photo, fake images

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This is partly a genetic problem, but oral hygiene also plays a role.

Of all these chronic conditions, diabetes has the strongest bidirectional link with periodontitis.

People with type 2 diabetes have a three times higher risk of developing periodontitis than people without diabetes.

In people who have type 2 diabetes and periodontitis, the infection worsens the body’s ability to control blood sugar.

But what lies behind this link?

From the gums to the blood system

This is the constant passage of bacteria from the deep pockets of the gums into the bloodstream.

When the immune system detects bacteria or other pathogens, the immune cells release a flood of cellular messenger molecules called inflammatory markers.

These inflammatory markers help the immune system attack and kill invading pathogens.

Occasional swelling and redness around a wound are the result of this efficient inflammatory response.

In the short term, inflammatory markers are excellent guides for the immune system to identify the site of a likely infection.

But when these sentinels remain in the body, they cause a host of problems.

Most conditions related to periodontitis have a well-established inflammatory element.

For example, nearly 30 years ago, an inflammatory marker called tumor necrosis factor alpha was revealed to increase insulin resistance in diabetics.

Author of the photo, fake images

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Not only should the dentist be consulted in case of severe pain, but it is important to carry out regular check-ups.

This discovery was quickly followed by that of a wave of other inflammatory markers that exacerbate both obesity and type 2 diabetes.

This dense network of inflammatory markers has fueled research aimed at treating diabetes by reducing chronic inflammation.

But the constant flow of bacteria from a hidden gum infection does the exact opposite.

“All inflammatory diseases are related, they influence each other,” says Palle Holmstrup, professor emeritus in the department of dentistry at the University of Copenhagen.

“Periodontitis is one of the most common, if not the most common, inflammatory diseases of the human body.”

“These are the same inflammatory mediators that are active in various types of inflammatory diseases: rheumatoid arthritis, heart disease, diabetes, etc. If you have periodontitis, you will have a higher level of low-grade systemic inflammation.”

rat experiments

In humans, it is difficult to directly study how treatment of periodontitis might alleviate conditions such as diabetes, for the same ethical reasons as for atherosclerosis: a patient cannot be denied treatment for their disease, especially if it is suspected that it might aggravate your other conditions. This makes the study of this complex knot of related inflammatory diseases particularly challenging and causal relationships difficult to identify.

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a woman holding her cheek

However, Holmstrup’s group did measure the effect of periodontitis on diabetes in rats.

His group studied the difference in blood sugar response in diabetic rats with a periodontitis-like condition and in diabetic rats without periodontitis.

Periodontitis caused a 30% rise in blood sugar after a meal.

The health effects of tooth loss

The final conclusion of periodontitis, if it is aggressive and left untreated, is tooth loss.

Along with decades of chronic inflammation, tooth loss brings with it a whole new set of health risks, including cognitive decline and dementia.

Bei Wu, senior professor of global health at New York University’s Rory Meyers School of Nursing, found a quantity-dependent relationship: the more teeth are lost, the greater the risk of cognitive decline, and dementia matters.

In the largest study of its kind, Wu studied health data on 34,000 patients in the United States and found that for every missing tooth, the risk of cognitive decline and dementia increased by 1.4% and 1.1%, respectively.

Overall, people who had lost their teeth had a 48% increased risk of cognitive decline and a 28% increased risk of dementia, compared to similar people who had all their teeth.

Tooth loss has been widely overlooked as a risk factor for dementia, and Ms Wu says she is usually looked at with surprise when she points out the link between the two.

“Oral health is a missing piece,” says Wu. “We’re trying to provide the evidence to show that it should be part of the equation.”

While periodontitis is a common cause of tooth loss, there may be other culprits behind its effects besides inflammation.

So far, Wu’s tooth loss studies have only looked at correlations and not causation, but she wants to investigate the role of nutrition in this relationship, among other factors.

“Good dentition could improve nutritional intake and also chewing,” says Wu.

“It could potentially increase blood flow, which could affect cognitive function, but that’s just a hypothesis.”

Oral hygiene

The emerging links between our oral health and this host of other conditions have one very important result: it’s easy to reduce your risk of getting periodontitis and treat it effectively if you already have it.

“If we brush our teeth properly and practice good oral hygiene, we can potentially prevent the onset of periodontitis,” says Wu.

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Tooth loss is linked to many health problems

If the disease occurs, it can be treated early with scaling and root planing, which involves scraping away microbes from the bottom surface of the tooth, above and just below the gum line.

If you have severe periodontitis, the solution may include surgical treatment, “which involves loosening the soft gum tissue, cleaning the root surfaces, and reattaching the tissue,” says Holmstrup.

The problem is detection, due to the often asymptomatic nature of the disease, coupled with the common misconception that unless you have a severe toothache, there is no need to go to the dentist.

Again, the solution is simple: if you have a date, don’t put it off.

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