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Oral Bacteria Create Risks: Heart Diseases, Diabetes, Dementia

How do oral bacteria cause problems? Heart disease is not periodontal disease located in your chest. Patients are often surprised to learn that high-risk oral germs, such as the ones that cause gum disease, enter the blood stream. Identified as bacterial “attackers,” they create a serious threat to arterial health that can lead to heart attacks and strokes, as well as diabetes and birth complications. So, how do they hurt us?

Heart Disease

Bacteria that cause gum disease travel through the bloodstream, causing damage and inciting inflammation in arteries. A heart attack is triggered by the blockage of one of the arteries that supply the heart muscle with oxygen rich blood. Occlusion of the coronary arteries is now known to be caused not only by deposits of bad cholesterol, but by the movement and of heart

Pregnancy

Fusobacterium nucleatum, or Fn, is associated with risk to infect the mother's blood and the placenta. Presence of Fn can cause premature delivery of the baby, lower birth weight and at the same time problems for the mother such as high blood pressure and kidney failure.

Han YK. Fusobacterium: A commensal turned pathogen. Curr Opinion Microbiol 2015, 23: 141-147.

Arthritis

Rheumatoid arthritis is a chronic condition of the immune system. The inflammation which spurs this form of joint disease is caused by autoimmunity, or the body reacting against itself. Heightened levels of total body inflammation worsen rheumatoid arthritis, and the cause of that inflammation is in part due to oral bacteria. In a recent study, persons with mouth infections involving Porphyromonas gingivalis, Pg, and Fusobacterium nucleatum, Fn, have a significantly increased risk of developing rheumatoid disease.

Johansson L, Sherina N, Kharlamova N, et al. Concentration of antibodies against Porphyromonas gingivalis is increased before the onset of symptoms of rheumatoid arthritis. Arthritis Res Ther 2016;18:201

Diabetes

If you have diabetes, or have metabolic syndrome and are insulin resistant/pre-diabetes, gum disease and the bacteria that cause it can make diabetes worse. In fact, diabetes makes gum disease worse as well. Diabetes results when the body cannot produce insulin (type 1) or the body's tissues become resistant to insulin (type 2). The inflammation of the beta cells within the pancreas, which produce insulin, are the basis for both types of diabetes. Recent studies have proven that elevated amounts of oral bacteria, usually also causing gum disease, can raise blood sugar and cause inflammation of beta cells.

Kumar M, Mishra L, Mohanty R, Nayak R. "Diabetes and gum disease: the diabolic duo". Diabetes Metab Syndr 2014;8:255-8

Dementia and Brain Health—Alzheimer’s Disease

Recent medical studies point to poor oral health, and high levels of certain oral bacteria in our gums with the increased risk to develop Alzheimer’s and other types of dementia. In addition, the direct effects of those oral bacteria to cause atherosclerosis in vessels within the brain create significant risk for stroke and vascular types of dementia.

Cancer

Chronic gum disease involving oral bacteria is a risk factor for the development of certain cancers, including those involving the pancreas, esophagus, colon, lungs and the head and neck. Advanced periodontal disease is associated with 2.5 fold increase in smoking related cancers. Elevated levels of bacteria Aa and Pg have a greater chance of recurrence or failed response to treatment of breast cancer. In addition, untreated gum disease is a cause of ongoing inflammation, which may promote advancing growth of tumors.

Missing Teeth

Tooth loss is a consequence of advanced gum disease. The problem begins with infection that resides in the space between the teeth and gums (periodontium). As the infection worsens, the body responds with needed but sometimes destructive inflammation due to selected type of bacteria. Over time, the ligament that attaches a tooth to the underlying jaw bones, is loosened and may even dissolve, which results in the loosening of that tooth. Managing the gum infection, first by testing for the specific bacteria involved, and then tailoring the specific treatment, will prevent tooth loss.

Baumer, A, Pretzl, B, Cosgarea, R, Kim, TS, Reitmeir, P, Eickholz, P, Dannewitz, B. Tooth loss in aggressive periodontitis after active periodontal therapy: patient-related and tooth-related prognostic factors J Clin Periodontol. 2011 Jul;38(7):644-51.

Bad Breath

One cause of bad breath or halitosis are bacteria that produce Sulphur containing chemicals, a by-product of the chemicals metabolism process. Many of the bacteria causing gum disease have this capability. Lowering the levels of bacteria such as Treponema denticola, Td, and Porphyromonas gingivalis, Pg and Prevotella intermedia, Pi will lessen the causes of bad breath.

Kapoor, U; Sharma, G; Juneja, M; Nagpal, A (2016). "Halitosis: Current concepts on etiology, diagnosis and management.". European journal of dentistry. 10 (2): 292-300

Oral Inflammation and the Heart

Infections of the gums are caused by a variety of bacteria. The inflammation that results from gum infection can also lead to the spread of those bacteria elsewhere in the body. A cause of atherosclerosis, involving large blood vessels in the heart and in the neck, are one of the places these oral bacteria can land. These bacteria cause local inflammation and the risk of forming unwanted blood clots. A stroke is caused when blood clots, arising from these areas of diseased blood vessels, break loose and migrate to the brain, where they cut of the blood supply to that area of the brain. In this way, oral bacteria are involved in strokes.

Dorfer, CE, Becher, H, Ziegler, CM, Kaiser, C, Lutz, R, Jorss, D, Lichy, C, Buggle, F, Bultmann, S, Preusch, M, Grau, AJ. The association of gingivitis and periodontitis with ischemic stroke J Clin Periodontol. 2004 May;31(5):396-401.

Gum Disease

Gum disease is a condition where the tissues that surround the teeth become inflamed due to infection by certain types of bacteria in the mouth. Dentists call gum disease periodontitis, and is measured by the depth to which they can advance a probe into the space between the gums and the tooth. This technique is called the pocket depth. The deeper the pocket, the worse the gum disease. Testing for the specific types of bacteria that cause gum infections and the resulting inflammation helps dentists better know how to precisely treat gum disease.

Periodontal (gum) disease: causes, symptoms and treatments. NIH publication 13-1142, 2013.

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