Numerous studies have found a strong association between poor oral health and a heightened risk for cardiovascular disease, type 2 diabetes, and serious respiratory infections. In pregnant women, periodontitis (gum disease) is also linked to a higher risk of adverse pregnancy outcomes such as preterm birth.

By Maria Ryan, Chief Dental Officer
May 2021

When most people think about how to improve their health, stepping up their oral care regimen doesn’t often come to mind. Although many patients say they want a whiter smile or fresher breath, these are considered cosmetic issues. Even those who’ve lost teeth or have bleeding gums rarely realize that these problems are closely linked to their overall health and well-being. Let’s explore the connections.

Physicians with minimal training  in oral health don’t generally focus on it, looking right past the teeth and oral cavity to examine the throat. Many physicians are often surprised to learn that poor oral health can increase the risk of many commonly managed medical conditions. So perhaps it shouldn’t be surprising that numerous studies have found a strong association between poor oral health and a heightened risk for cardiovascular disease, type 2 diabetes, and serious respiratory infections. In pregnant women, periodontitis (gum disease) is also linked to a higher risk of adverse pregnancy outcomes such as preterm birth.

Luckily, you’re not powerless. If you’ve been falling behind on our oral hygiene routine or putting off dental checkups, becoming more diligent about oral care is absolutely worth it for you and your family. Here’s why. 

The cardio-dental connection

It’s a fact: People with severe periodontal disease are twice as likely to have a heart attack and three times more likely to have a stroke compared to those with healthy gums. Research has shown that bacteria such as P. gingivalis, a major player in periodontal disease, causes changes in gene expression that lead to inflammation in the mouth as well as in the blood vessels and heart. has been found in atherosclerotic plaques known to play a role in cardiovascular disease and strokes.

Periodontitis is a chronic disease initiated by bacteria and driven by an excessive inflammatory response leading to  gum tissue to break down and bone loss, resulting in the development of deep pockets or spaces around the teeth. P. gingivalis grows best in an anaerobic environment where there isn’t much oxygen.  The deeper the pockets, the more anaerobic the environment allowing for P. gingivalis and other periodontal pathogens to thrive These pockets also present an entry point through which  the periodontal pathogens can seep into the bloodstream and travel throughout the body. Research has confirmed that oral bacteria can actually settle in athersclerotic plaques that clog and harden arteries and lead to heart attacks and strokes.  The chronic inflammation caused by periodontal disease and these athersclerotic plaques can be measured in the blood by an inflammatory marker known as high sensitivity C Reactive Protein or hs CRP.  It is known that elevations in CRP may be an even greater marker of risk for heart attacks than the well known marker of cholesterol.

Oral health and diabetes - a two way street

If you have diabetes, you may already know that you’re more prone to dental problems including gum disease. Saliva contains glucose, so when blood sugar levels are consistently high you also have too much sugar in your mouth. That sugar feeds oral bacteria and changes protein structures which, in turn, can increase your risk for cavities and periodontal diseases.  Periodontal diseases cause inflammation making it difficult to improve your long term markers of diabetic control or hemoglobin A1C levels (which indicate average blood sugars over the prior 2-3 months). 

This connection should also matter to those who don’t have diabetes but are susceptible to it. It’s well-known that obesity causes inflammation that often leads to insulin resistance, meaning your body doesn’t use the insulin it produces efficiently. It is similarly likely that the inflammation caused by periodontitis could contribute to insulin resistance, which is a precursor to type 2 diabetes. The risk of developing diabetes over 20 years is twice as likely in people with varying degrees of diabetes.

Again, the reverse is also true: People with insulin resistance (as well as those with full-fledged diabetes) are more apt to have periodontitis. It’s a two-way street.

Oral plaque and respiratory health

Thanks to the COVID-19 pandemic, respiratory ailments are a chief concern for many of us. Although research in this area is still emerging, there’s reason to believe that good oral health may play a role in reducing the likelihood of suffering severe complications from the virus.

Long before the pandemic started, researchers discovered that oral plaque harbored respiratory pathogens.  Oral plaque found throughout the oral cavity, in people with poor oral hygiene and  periodontal diseases, can be aspirated into the lungs and cause pneumonia. This is a common occurrence in nursing home residents and in people in Intensive Care Units (ICUs). Studies have shown that mouthwashes can result in a 60% reduction of cases of pneumonia in medical and surgical ICUs.  If you become ill enough with COVID that you need to be intubated, you may aspirate (inhale) fluid; that’s especially dangerous and likely to cause pneumonia if the fluid contains dangerous bacteria.

Meanwhile, you may have heard that good oral hygiene—and, in particular, using mouthwash—can reduce the load of COVID-19 virus in the oral cavity. That concept stems from the knowledge that “the oral cavity represents a robust site for COVID-19 infection" and that saliva which is used to test for COVID-19, likely plays a key role in transmitting the virus.

A preliminary study conducted by Colgate found that COVID patients who rinse with a mouthwash containing CPC plus zinc, hydrogen peroxide, or chlorhexidine have significantly lower amounts of the virus in their mouth for up to 60 minutes. More research is needed, but it’s possible that rinsing with a virus-killing mouthwash (before donning a mask) could further reduce the chances that someone carrying COVID will spread it to others.

Pregnancy outcomes

Getting as healthy as possible before having a baby is a smart way to increase the odds of your baby being healthy. While it’s wise to see your ob-gyn or internist before conception, a trip to the dentist should also be in order. 

Nearly 60 to 70% of pregnant women have gingivitis (early-stage gum disease), and hormonal changes during pregnancy can prompt it to worsen. If left untreated, the same oral bacteria that cause gum disease, increasing your risk of various health problems, can also make their way into the amniotic fluid that surrounds your baby,causing inflammation and  increasing the chances of going into labor prematurely. For these reasons, serious gum disease has been associated with a higher risk of having a low birth-weight baby.

How to protect yourself

While the link between gum disease and a variety of systemic health problems is certainly alarming, there’s a lot you can do about it. For starters, make sure you brush your teeth at least twice a day, floss at least once a day, and use mouthwash as needed. You should also see your dentist for a professional cleaning and checkup; most people need to go twice a year.  Although periodontal disease isn’t always preventable (there’s a genetic component), these simple measures can go a long way to reduce your risk

It’s important to note that periodontal disease is an often silent disease with few signs and symptoms. If you’ve already developed signs of gum disease—such as redness, tenderness, or bleeding when you brush or floss—see your dentist or a periodontist. Antibiotics, a procedure such as scaling and root planing (which removes plaque and bacteria from the tooth surface), and, in some cases, surgery, can all be used to treat the condition and may help you dodge some of the most serious consequences.

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