An Unhealthy Mouth, an Unhealthy Body
By: Carole Fleck; Source: AARP Bulletin Date Posted: 2006-09-15 14:52:00-04:00
Carole Fleck, senior editor at the AARP Bulletin, asked Bruce Pihlstrom, DDS, acting director of the Center for Clinical Research at the National Institute of Dental and Craniofacial Research (NIDCR), an arm of the National Institutes of Health, about the apparent association between oral health and general health.
Q. Will you explain the emerging evidence linking oral and general health? Much of the research has focused on gum disease and its possible effect on heart and vascular conditions. Could gum infections lead to other types of problems?
A. We don't know. One theory is that when bacteria that cause gum disease get into the bloodstream—and we know that happens—they might cause inflammation in arteries or vessels that supply blood to the heart or brain. The inflammation could contribute to a buildup or rupture of plaque in the blood vessels, which in turn could block the blood supply to the heart or brain. The result is a heart attack or stroke. Another theory is that inflammatory chemicals, called cytokines, produced in response to gum infections might be released into the bloodstream, where they might contribute to inflammation in blood vessels or arteries. The inflammation, in turn, could lead to blockage of the blood supply to the heart or brain. It is important to point out these are just theories, and we don't know if it actually happens or not.
Q. Where does the research stand in establishing this connection?
A. A number of observational studies have looked for an association between gum disease and cardiovascular disease. Some have found that people with periodontal disease are more likely to have cardiovascular problems, while others have found no connection between gum disease and cardiovascular disease. It is worth noting that these kinds of studies cannot tell us whether an observed association is causal—that is, whether periodontal disease causes cardiovascular problems. The bottom line question is, "If you prevent or treat gum disease, will you lower the risk for heart disease or stroke?" The answer is we don't know.
Research has also shown an association between periodontal disease and diabetes, which is not surprising given that diabetes increases a person's susceptibility to infection. And we know that infection can make it harder for the body to regulate insulin. That raises the question of whether treating periodontal disease can bring down blood sugar levels in people with diabetes.
Q. What needs to be done next? Where will this research take us?
A. Clinical trials are needed to determine if controlling periodontal disease will reduce the risk or severity of other diseases such as heart disease, stroke or diabetes. The NIDCR is supporting early studies that will determine if treating gum disease leads to better blood sugar control for people with diabetes. It will be much harder to determine if controlling periodontal disease can prevent heart disease or stroke. We need additional proof of a substantial relationship between gum disease and cardiovascular disease before proceeding to clinical trials. The NIDCR is supporting studies to define the relationship, but a conclusive answer is probably years away, in part because the diseases share risk factors. For example, smoking increases the risk for both periodontal disease and cardiovascular disease, so how much of an observed relationship between the diseases is due to periodontal infection and how much is due to smoking? It is difficult to design a study that teases out the effects of gum disease from those of smoking or other risk factors for heart disease and stroke.
Q. What should people do to protect their health?
A. They should practice good oral hygiene—brush and floss regularly—and have regular dental checkups. I do it because I like having a healthy mouth that enables me to chew comfortably, and teeth that feel and look good. The bottom line is that people should take care of their mouth for its own sake—to avoid tooth loss and to maintain oral comfort and function.
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