Learn About - California Periodontitis Disease

Periodontal Disease is a Risk Factor for Systemic Disease

It is well known that periodontal (gum) diseases are a series of bacterial infections that destroy the gum tissue and bone that support the teeth. Left untreated, periodontal disease can lead to tooth loss. What is commonly not thought of is how this oral infection can also affect the rest of the body.

An infection in the mouth can affect the overall health and have serious systemic (general body) manifestations. Like other infections, the bacterial cells that cause periodontal disease, or their toxic products, can enter the blood system and affect other organs.

Research studies indicate that periodontal infections can affect the overall health and that periodontal disease is a risk factor for many health problems.

Bacteremia: Bacteremia is an infection caused by infectious organisms in the blood system. The bacteria that cause periodontal disease can enter the blood system through cuts in the gum provoked by normal chewing or brushing habits.

The bacteria can also enter the blood system directly through the infected gum tissue in a periodontal pocket. The more infected the gums are, the more likely bacteria are to enter the blood system. These bacteria can travel and infect other organs. The best way to prevent bacteremia caused by oral bacteria is by maintaining oral health.

Infective endocarditis: People that have damaged heart valves, a history of rheumatic fever with subsequent heart valve damage, aortic stenosis, certain heart murmurs, and mitral valve prolapse with regurgitation are at greater risk of developing infective endocarditis -- an infection of the lining and valves of the heart.

If not treated immediately with antibiotics, this infection can be fatal. The best way to prevent infective endocarditis is by minimizing the amount of bacteria in the mouth. Several periodontal treatments, like meticulous home care with brushing and flossing, combined with professional cleanings and modification of risk factors related to periodontal disease, are essential in controlling the bacterial infection.

In addition, the American Heart Association has recommended antibiotic treatment prior to certain dental procedures for people that are at high risk of infective endocarditis. These dental procedures include tooth extraction, surgical treatment, scaling and root planing, and implant treatment. Your dental care provider needs to be aware of your medical history in order to better treat you and prevent systemic complications.

Cardiovascular disease: Evidence suggests that having periodontal disease puts you at greater risk for cardiovascular disease. The bacteria that are normally found in the mouth have been found in the artery walls of people with cardiovascular disease. These bacteria can irritate the arteries, leading to fatty deposits and eventual blockage of the arteries resulting in heart attacks or strokes.

Heart attacks: The bacterial infection that causes periodontal disease may also affect the heart. In fact, all other conditions being equal, people with periodontal disease may have twice the risk of having a fatal heart attack as people that don't have periodontal disease.

Strokes: Strokes occur when a blood vessel in the brain becomes blocked and there is reduction in the oxygen delivery to the brain cells. This can lead to paralysis, speech problems, and even death. A research study of 10,000 people found that periodontal disease can increase your risk of having a stroke by two-fold.

Artificial joints: Artificial joints or prosthetic devices may be vulnerable to infection by the bacteria that cause periodontal disease. These bacteria can enter the blood stream through small ulcerations in the gums or as a result of dental treatment. To prevent infection of artificial joints maintain meticulous oral hygiene and consult your dentist and physician about the possibility of antibiotic treatment before dental procedures.

Diabetes: Periodontal disease can increase insulin requirements and diabetic complications. Treating periodontal disease can actually reduce the need for insulin.

Respiratory disease: People with advanced periodontal disease are four and a half times more likely to have chronic respiratory disease. The bacteria that cause periodontal disease can be aspirated into the lungs increasing the risk for pneumonia and other respiratory diseases.

Once again, to prevent the serious systemic complications related to periodontal disease infection, see your dentist or periodontist for a periodontal screening and treatment as indicated. Treatment of periodontal disease may save your life!

Premature, low-birth weight babies: If you do have periodontal disease and are pregnant, you may have a higher risk of having a premature, low-birth weight baby. Pregnant women who have periodontal disease are seven and a half times more likely to have a baby that is born too early or too small. This time, treating periodontal disease can help improve your health and that of your baby.

So, because periodontal infections can affect the overall health and periodontal disease is a risk factor for many health problems, seeking periodontal treatment can help improve your oral and overall health.

By Laura Minsk, DMD

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Periodontal Disease: Preventing Tooth And Bone Loss

The best way to control periodontal disease and to help prevent tooth loss is with early detection and treatment. Three out of four people are afflicted by periodontal disease at some point in their lives, so everyone should be tested. After reviewing a patient's dental and medical history, the dental care provider or periodontist will conduct a thorough clinical intraoral exam called a periodontal charting.

This consists of taking a series of measurements around each tooth. Unless the gums are very inflamed and sensitive, the periodontal charting causes minimal discomfort.

The space between the gum and the tooth is measured using a periodontal probe. This space is called the probing or pocket depth. In a healthy mouth, this space should be between 0 and 3 millimeters.

The amount of recession or loss of gum around each tooth is measured. In healthy mouths, the gum tissue should be at the junction of where the crown of the tooth meets the root. The two measurements (pocket depth and recession) are then added to calculate the amount of attachment loss around each tooth. The greater the amount of attachment loss, the more advanced the periodontal disease.

While completing the periodontal charting, a dentist will evaluate the conditions of an individual's gums. Healthy gums are pale pink, firm, and immobile. The gums should not bleed during the probing exam. Bleeding gums during this exam are a sign of gum inflammation, gingivitis or periodontitis.

The dentist will also measure tooth mobility. Under normal functional conditions, teeth should not move. Tooth mobility is a sign that there has been bone loss around the teeth or that the biting forces are too strong. If so, the dentist may also assess a patient's occlusion, or bite. If the bite has changed or if the forces on the teeth are too strong, there may be an acceleration of bone loss around the teeth.

A full mouth series of X-rays (approximately 20 films) are also indispensable in a periodontal examination.

In addition to identifying areas with cavities, bone infection, tumors, or developmental abnormalities, X-rays help reveal if bone loss has resulted from periodontal disease. The crest of the teeth's supporting bone is normally 2 mm below where the crown of the tooth meets the root. A greater distance indicates a history of bone loss.

Although bacterial samples are not usually taken for diagnosis of periodontal disease , under certain circumstances, it may be necessary to take a bacterial culture from a plaque sample. This is especially valuable to help detect sites at high risk for disease progression or if conventional treatment is not working.

The culture is analyzed in a laboratory for the presence of certain bacteria that are known to contribute to gum disease. Actually, of the more than 300 different types of bacteria normally found in the mouth, there are only about 13 that are known to be associated with causing periodontal disease. After identifying the specific disease-causing bacteria, the laboratory can test to determine what antibiotics they are susceptible to.

Depending on the risk factors (see article " Risk Factors for Periodontal Disease") involved and a person's specific situation, other tests may also be required. Under certain circumstances, a dentist may require diagnostic casts (molds of one's teeth), medical laboratory tests, medical consultation, or genetic testing.

After completing the periodontal examination, the dentist will be able to discuss with the patient the diagnosis, treatment alternatives, potential complications, and expected results. The key to long-term periodontal health is early diagnosis and treatment. Because everyone is at risk of developing periodontitis, everyone should be routinely tested.

By Laura Minsk, DMD