Oral Health

What causes periodontal “gum” disease?

If you are an adult then there is a good chance that you have some form of periodontal disease.  It is estimated that 47% of adults are affected by periodontal disease.  Periodontal disease is a disease of the gums of our mouths.  It can range from a simple form with local inflammation to severe forms that can cause significant damage to the tissues around the teeth and the bones.

oral health, gum disease, gingivitis, peritonitis, implantation

What causes periodontal “gum” disease?

All along our teeth and throughout our mouth are bacteria.   Bacterial growth together with debris, food particles, and mucous forms plaque on our teeth.  We can remove the plaque film with brushing and flossing our teeth.  Once the plaque hardens it becomes tartar and needs to be removed by our dentist or dental hygienist.

If plaque and tartar are not removed from our teeth, our gums become inflamed.  If this has happen your gums become red, swollen, and fragile and often will bleed easily.  If the disease progresses the gums pull away or recede from the teeth and leave spaces that become infected.  The bacterial toxins break down the tissues of the mouth and bone.

The teeth can become loose and then have to be removed.  All the gum injury, pockets of infection, and lost teeth and bone structure become avenues in which the bacteria can invade the body.  The body responds by raising the systemic inflammatory proteins and cells to fight off the local infection.

Periodontal disease and heart disease

Periodontal disease results in higher levels of body inflammation that can be measured with blood tests of the inflammatory proteins and cells.  These blood tests are CRP, TNF-a, IL-6, the white blood count, and sedimentation rate.

These inflammatory markers when chronically elevated are also associated with atrial fibrillation and abnormal heart rhythm in the upper heart chambers, coronary atherosclerosis, and risk of myocardial infarction or a heart attack.  In fact, the bacteria found in the mouth that causes periodontal disease have also been found in the atherosclerotic plaques of people with coronary artery disease.  This last finding suggests that heart harm can be caused not only from the body’s reaction to the disease in the mouth, but from the bacterium invading the body itself.

Treatment of periodontal diseases helps the body and potentially the heart

In a trial of approximately 300 patients seen in cardiac or heart clinics, and referred for community dental care, were randomized to aggressive dental care and hygiene versus the patient’s standard dental care.  Those that received aggressive care for their periodontal disease had lower levels of body inflammation at 6 months and this was felt to be associated with a lower risk of heart disease progression.  Unfortunately, to date no studies have shown that aggressive periodontal care can reduce the risk of worsening of heart disease.  Right now this is assumed since body inflammation results in worsening heart disease and treatment of periodontal disease reduces body inflammation.

Statin Therapy for the Heart and Gums

The drugs called HMG-CoA reductase inhibitors are also called statins.  These drugs lower our body total body cholesterol and in particular the bad cholesterol (LDL).  They lower the risk of coronary artery disease as well as the progression of atherosclerosis in those people that already have the disease.  Statins also reduce the risk of myocardial infarction or heart injury related to the coronary atherosclerosis.

For a long time we have known these drugs do much more than lower cholesterol.  In nearly all trials they lower risk of all types of death or total mortality.  They also reduce abnormal heart rhythms from the upper and lower heart chambers, stroke, and heart failure.  Important to this topic, statins lower systemic or body inflammation and the inflammatory markers of the body.

Can statins reduce periodontal disease?

In a recent study of 71 patients with severe periodontal disease the role of statins as a therapy for their disease was assessed.  Patients were randomized to receive a very high dose of a statin (atorvastatin or Lipitor) at 80 mg versus a lower dose at 10 mg.  After 12 weeks of therapy, those patients treated with high dose atorvastatin had low levels of periodontal inflammation and bone loss.

Essentially they had less of all types of periodontal disease.  As important, those treated with high dose atorvastatin also had less inflammation in the large carotid arteries in the neck.  Carotid artery disease and its’ progression is typically felt to be strongly associated with coronary artery disease and its’ progression.  This study showed that statin therapy was a potent treatment for both periodontal disease and vascular disease.

 

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