Periodontitis Is A Risk Factor@ Reward Me

Importance of Oral Health & Hygiene and General Health

Learn how your oral health can affect your general health. Recent studies have pointed to periodontitis as a risk factor for other diseases.


The idea that infections of the oral cavity (mouth) are capable of causing systemic (body) disease is not a new concept. Although for many years it was believed that this relationship was mainly due to tooth decay & lack of healthy teeth, recent research has indicated periodontitis (a disease characterized by loss of tooth support) as a risk factor for a number of systemic diseases.

There is increasing evidence that individuals with periodontal disease may be at risk of contracting certain systemic diseases, but the opposite also seems to have significance, i.e. the action that systemic diseases can cause to the periodontium has also been reported over the last number of years.

A possible cause suggested for this relationship was thought to be only found in the oral bacteria and their entry into the bloodstream, but recent studies have shown that the main link between the mouth and the rest of the body is the inflammation present in periodontitis. Thus, treating inflammation not only helps treat periodontitis but also assists in the treatment of chronic inflammatory illnesses in the realm of general health.

Infections induce clotting and increased blood viscosity, phenomena that hinder the supply of defense cells and the factors responsible for inflammation.

Periodontitis and age

Periodontal disease has long been described as a condition seen in the aging process of an individual, but over time it has been observed that not all individuals have the same risk for developing this disease. Age seems to be an important factor in this process, since the common chronic diseases such as cardiovascular disease, stroke and diabetes affect more individuals with advanced age and it is in these same individuals that is a greater relationship between periodontal disease and systemic disease.

Periodontal disease is a risk factor for cardiovascular disease
Atherosclerosis and ischemic heart disease are major causes of death in developed countries. Atherosclerosis is a degenerative disease with a progressive course, its advanced lesions are an atheroma which consists of a plaque of dead cells, among other components. The presence of an atheroma increases the risk of thrombosis.

Several epidemiological studies have identified multiple risk factors associated with cardiovascular disease and there are a number of mechanisms that characterize the role of infection and inflammation in the development of heart disease. Cardiovascular disease risk factors such as hypertension, hypercholesterolemia (high cholesterol), obesity and smoking, do not explain all the variation in the incidence of cardiovascular disease. There is increased evidence that one of the other factors may be periodontal disease. Cardiovascular disease and periodontal disease have several characteristics in common because both are more common in older people, men, individuals with a lower level of education, people with fewer economic resources in smokers with hypertension, in individuals with higher stress and in those that are more socially isolated, which puts periodontitis as a qualitative risk factor for cardiovascular disease. It is also important to highlight the behavioral component in the pathogenesis of periodontal disease, since poor oral hygiene can indicate individuals with unhealthy habits, that is, who have other risk factors for cardiovascular disease, such as poor diet, high levels of stress, lack of regular exercise and smoking habits.

Bacteria originating in the oral cavity may play an important role in the formation of plaque or thrombosis, and the association between periodontal disease and cardiovascular disease may be in part due to the potential that these oral bacteria have to induce the formation of plaque and obstruction of the coronary arteries and thus cause cardiac ischemia, and evolve to a possible heart attack or myocardial infarction.

Smoking and periodontal disease
There have been many studies showing the adverse effects of smoking on periodontal health and consequently the role of tobacco as a risk factor for periodontal disease.

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Smokers may have an increased incidence and severity of periodontal disease. This was attributed to inadequate levels of oral hygiene, a high accumulation of plaque and severe gingivitis. An increase of periodontal disease among smokers was also associated with reduced gingival bleeding caused by nicotine.

When there is an imbalance between bacteria and the host's defense, periodontal disease can occur as a result of a dominant bacterial infection or a decrease in defense mechanisms. Smoking can alter the host's response and thereby slow the healing process.

Smokers also have less favorable results in the regeneration of infections and the success rates of dental implants, compared to nonsmokers.

Periodontal disease and diabetes mellitus
Diabetes mellitus is the most common endocrine disease, and it is that which has the most systemic effects. Periodontitis was called the sixth complication of diabetes and severe periodontitis is a risk factor for decompensated diabetes.

Diabetes is characterized by a set of changes to levels of blood glucose (hyperglycaemia), and when associated with elevated blood lipids (hyperlipidemia) it leads to complications such as degenerative vascular changes, delayed healing process, decreased efficacy of the immune system and retinopathy.

Despite the factors that promote periodontal disease are not sufficiently clarified, in individuals with diabetes mellitus, the explanatory mechanisms appear to include vascular changes, changes in the host's inflammatory and immune response and hereditary factors.

Individuals with diabetes exhibit greater loss of tooth supporting structures than those without diabetes, but increased periodontal risk is often related to the duration and adequate control of the diabetic state. Patients with poor metabolic control have a greater insertion loss of tooth supporting structures when compared to well controlled individuals, despite similar levels of oral hygiene. It was also suggested that periodontal treatment could lead to improvement in metabolic control in individuals with diabetes as a result of decreasing the number of bacteria, inflammation and gingival health stabilizing conditions.

Other conditions such as aspiration pneumonia, osteoporosis, rheumatoid arthritis, Alzheimer's disease, obesity, stress, metabolic syndrome and even adverse complications in pregnancy have also been getting some attention for their connection with periodontal disease.

Dr. Fátima Duarte, Hygienist, APHO

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