Periodontal  Updates

The following articles are some that caught my eye and were important enough I thought to pass on. There is a quick summary on each one then the full article is included below. Periodontal disease is becoming more and more recognized as a major health risk beyond the thought of loosing ones teeth...

Floss or Die ! You should read this entire article. The evidence is mounting quickly that heart disease and periodontal disease go hand-in-hand. The studies are impressive and some span 30+ years.
Are spouses at risk of being infected with perio disease? It seems obvious after reading this that periodontal disease is contagious.
Gum Disease-Heart Disease Link Link to article written by the American Academy of Periodontology

Floss or Die !!

Sounds like something from a standup comic routine doesn't it ?

This article comes as no surprise to me or to most others within the dental profession. For many years, it has been recommended by the American Heart Association to administer to someone with a heart condition (especially heart murmurs) antibiotics before having their teeth cleaned.

It is a known that the bacteria in and around the gums will invade the bloodstream during a cleaning appointment and there is a chance that a rapid bacterial infection will occur within a damaged heart from these same bacteria. The more irritation from gum disease, the more bacteria in the bloodstream. In a healthy mouth, the gums will not bleed during home care nor at the hygiene appointment.

It is in this light that the following article is VERY interesting in regards to everyone's general health.

From the Associated Press

Anybody who has been to a dentist has heard it: Flossing and brushing keep the gums healthy so your teeth don't fall out. But the hygienist probably didn't mention your heart. Scientists are investigating the idea that bad gums create mischief in places far from the mouth. They say the bacteria that live around the teeth, or perhaps the body's reaction to them, may even contribute to disease that eventually could do you in. At a recent conference on the subject at the University of North Carolina, Dr. Raul Garcia playfully flashed a slide that warned: "Floss or die."

Garcia a dentist at the Department of Veterans Affairs Outpatient Clinic in Boston, admits there is no proof that bad gums do anything worse than ruin your teeth. But a strong circumstantial case is emerging. "It's not an unreasonable hypothesis, although on the surface it appears to be a leap of faith," said Dr. Steven Offenbacher, a dental researcher at the University of North Carolina.

Offenbacher is studying the possibility that gum disease is a major trigger of premature births. Others are examining theories that it helps clog the arteries and cause heart attacks or that it contributes to diabetes.

About three-quarters of adults older the 35 have some degree of periodontal disease, a condition that often gives off few warnings except, perhaps, red gums and bleeding when brushing. Under the gum surface, however, are billions of bacteria. In theory, they create a smoldering, low-grade infection that inflicts its damage slowly over time.

The main evidence so far comes from studies that follow large numbers of people to see if those who have bad gums fare differently from those who don't . The studies strongly hint that people with periodontal disease have a higher than usual risk of heart attacks.

Among the most impressive is the VA's Informative Aging Study in Boston, which has followed 1,231 men who were outwardly healthy when they were given thorough dental exams in the 1960s. The men who started out with bad gums have had about twice the death rate as others, especially from heart disease.

Another study, conducted over six years on 44,119 male health professionals at the Harvard School of Public Health, found that those with 10 or fewer teeth had about a two-thirds higher risk of heart disease than men with nearly all their teeth.

Yet another study from the Marshfield Medical Research Foundation in Wisconsin checked on the health of 9,760 Americans surveyed in the early 1970s. By 1987, heart disease was 25 percent more common in those who had gum disease at the outset. Men younger than 50 at the start of the study had about a 75 percent greater risk of heart trouble.

These studies suggest bad gums could be as strong a risk factor for heart attacks as smoking

The statistical link with premature births is less convincing.

Doctors have long noticed that women with bad teeth seem more likely to give birth prematurely. Offenbacher studied 124 women and found those with gum disease were about eight times more likely than usual to deliver dangerously small premature babies.

There are three main theories about a possible connection between gum disease and trouble elsewhere in the body:
  • Gum bacteria escape from the mouth, perhaps when people brush, then travel through the bloodstream and release dangerous toxins. A chief suspect, the dental bug Porphyromonas gingivalis, can make blood clot and may help clog heart arteries. Gum germs have been found inside artery-plugging plaque.
  • Bacteria-fighting blood cells give off proteins that could have unintended harmful effects thought out the body. Among these are such potent chemicals as tumor-necrosis factor and prostaglandin's. Some of these may trigger too-early labor by making the uterus contract.
  • Gum disease itself is not the trouble. Instead, a tendency to have gum disease, heart attacks and premature labor all result form the same underlying deficiency.

"Like everything else, it's probably a combination of these, said Dr. Robert Genco, a dental researcher at the State University of New York at Buffalo

So, the bottom line is there is a MUCH better reason to perform good hygiene at home and have regular hygiene appointments. We'll do our job to inform you of the periodontal condition present and now we might say a relationship to your heart health.

Are Spouses at Risk of Being Infected with Periodontal Disease ?

by Trisha E. O'Hehir, RDH

Research is providing information about the specific bacteria associated with destructive periodontal disease. Porphyrmonas gingivalis is one species specifically associated with severe periodontal infection. When measuring bacteria within infected pockets, this particular bacteria often comprises a large proportion of the microbial flora. In healthy sites, a small proportion of the bacteria are P. gingivalis.
What researchers don't know is whether this bacteria in undetectable numbers is part of the normal oral flora and simply increases during disease or if it is only found in disease. If this bacteria only appears during periodontal infection, the question must be asked as to the source of these bacteria. If the bacteria must come from a source outside the individual, is it possible that bacteria can be transmitted between spouses?

Husbands, wives participate in study
Researchers in the Netherlands attempted to answer this question by analyzing bacteria between husbands and wives. They evaluated a small group of eight married couples. All 16 patients had severe periodontal disease as measured by pocket depth greater than or equal to 5 millimeters. None of the study participants underwent periodontal therapy. In addition, non of them had taken antibiotics during the past six months. After a clinical examination, bacterial samples were taken from several of the periodontal pockets. Samples were also taken from the dorsom of the tongue, buccal mucosa and the tonsilar area.
Several laboratory tests were done to cultivate bacterial growth. After identifying the P. gingivalis bacteria, a highly sensitive chromosomal DNA fingerprinting analysis was carried out. This recently developed test is capable of determining distinct DNA patterns. The identification of distinct patterns of bacterial strains can be useful in obtaining evidence of bacterial transmission.
All of the individuals tested were found to have P. gingivalis. Six of the eight couples studied showed identical DNA patterns. The patterns between couples were distinct and identical. It was clear that the husband and wife of each of these couples had the same bacteria.
In the other two couples, each person demonstrated a clearly distinct enzyme pattern for P. gingivalis. One possible explanation for the difference could be that at one time they had identical bacteria which then formed mutation strains of P. gingivalis. They may have been identical at one time, but are now distinctly different. It must also be considered the bacterial variations measured were due to breakdown during testing. The testing process itself may be responsible for the differences.
Although these findings strongly suggest that bacteria were transmitted between husband and wife, the direct effects are still unknown. Since both spouses in the couples had signs of periodontal disease, there are two possible explanations.
First, it can be concluded that one spouse had the infection, and it was transmitted to the other resulting in periodontal breakdown. The transmission would therefore be from an infected partner to a healthy partner.
The second explanation identifies one spouse with periodontal disease and the other with a susceptibility to the colonization of these bacteria. Transmission in this case would be from an infected spouse to a susceptible spouse.

Children not susceptible
When comparing the transmission of periodontal bacteria to the transmission of bacteria causing caries (decay), we know that Streptococcus mutans are transmitted from mother to infant at a relatively early age. P. gingivalis is not measured in children, except occasionally in cases of juvenile periodontitis. Transmission is only between adults and not from parents to children.
Researchers have been able to implant P. gingivalis into periodontal pockets of monkeys with gingivitis. This action resulted in progression of the disease to periodontitis. A pilot study involving two adult volunteers also demonstrated the possibility of implanting P. gingivalis in already inflamed pockets. Colonization of the bacteria was measured by the researchers.
Further research is needed in this areas to determine if the spouses of periodontal patients are at risk for developing destructive periodontal disease because of the transmission of P. gingivalis.


Trisha E. O'Hehir, RDH, BS. lives in Flagstaff, Arizona. She is editor of Perio Reports, a newsletter for dental professionals that addresses periodontics.

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