Gum disease and systemic diseases

In the last few years, researchers have found possible links between periodontal disease and systemic diseases and the public at large seem quite aware of the same and are concerned about the effects on themselves. One study in the US states that nearly half of all adults suffer from some form of periodontal disease and visit the dental clinic every day. With the growing number of patients suffering from periodontal disease, not only in the US, but in India and other countries too, dental teams have to be well aware of the periodontitis-systemic disease link, and provide clear evidence-based advice and information to their patients.  

How are gum disease and other systemic diseases linked?

There are 3 mechanisms that are highlighted:

1. As a result of transient bacteremia, metastatic spread of infection from the oral cavity,
2. From the effects of circulating oral microbial toxins, there can be a metastatic injury
3. Immunological injury induced by oral microorganism could cause metastatic inflammation

Once you have succumbed to periodontitis it can create an impact on systemic diseases in three ways:

1. by shared risk factors
2. subgingival biofilms – as reservoirs of gram-negative bacteria
3. The periodontium – as a reservoir of inflammatory mediators.

Below described are two pathogenic mechanisms that explain how periodontal disease can contribute to systemic disease.

1. Direct mechanism: As periodontitis progresses and worsens, there is a direct entry point created for periodontal bacteria to be passed into the systemic circulation through the epithelium lining the periodontal pockets – This is because the epithelium lining periodontal pockets is ulcerated and creates the entry spot. These bacteria could then have direct effects on the organs.
2. Indirect mechanism: Periodontal bacteria's inflammatory response or its by-products can have indirect systemic effects. Inflammation itself is involved in the pathogenesis of many chronic illnesses – illnesses such as type 2 diabetes, cardiovascular disease, and rheumatoid arthritis. Chronic periodontitis, therefore, represents a source of chronic inflammation that may be a significant contributing factor in the pathogenesis of other inflammatory based diseases and is hence an indirect mechanism.

Here is a list of systemic diseases; periodontitis or gum disease has been associated with –

• Respiratory disease: Bacteria that grow in the oral cavity can be drawn out into the lungs and cause respiratory diseases such as pneumonia. Pneumonia, involving infection within the airways, may be associated with periodontitis as many potential opportunistic pathogenic bacteria are found within the oral cavity. Periodontitis has also been linked with Chronic Obstructive Pulmonary Disease (COPD). However, there are few studies investigating the effects of established chronic periodontitis in relation to acquired lung infections.
• Chronic Kidney Disease: There is certainly no direct link yet established between CKD and periodontitis, but the chronic infection and CKD's close linkage with diabetes could be a possibility, the research is still on.
• Rheumatoid arthritis and Osteoporosis: There is a link between osteoporosis and bone loss in the jaw. Due to the density of the bone in osteoporosis patients, there could be tooth loss, which means the teeth no longer have a solid foundation. Rheumatoid arthritis and osteoporosis are also due to persistent synovial inflammation and associated damage to articular cartilage and underlying bone.
• Cancer: Researchers show that men with gum disease are 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers. Although the research is in progress to make more findings, periodontitis has been identified as a possible risk factor for pancreatic and oro-digestive.

  The topic still remains under intense research and debate within dentistry fraternity, but it is a clear indication for us to give attention to our gum and oral health. always get a dentist to examine your dental health if in doubt. Ask your question in the comments below