- The Washington Times - Monday, June 4, 2007

A person can know his pulse rate and blood pressure range as well as his cholesterol count but never learn the importance of his periodontal score.

That may be his downfall, given what researchers are learning about the impact of gum disease on a person’s overall health, and how, in many cases, a person’s health is reflected in the condition of the mouth.

A periodontal number tells the health, or lack of it, of each tooth tested by a probe in a dentist’s office. The higher the number, the worse off is the gum that supports the tooth. The likelihood is that bacteria found in plaque, the sticky, whitish film attached to tooth surfaces — what dental experts prefer to call “oral biofilm” — are eating away at the pockets between tooth and gum.

Left unchecked, it could cause loss of the tooth. The problem erroneously is assumed to be associated only with people of advancing age. Some portion of the population, however, ends up with infections in their gums in spite of following the recommended daily routine of brushing and flossing.

Dr. Sally Cram, a District periodontist, says only a small subset of her patients probably have a genetic predisposition to gum disease.

“Most don’t do preventive care, and the great thing about periodontal disease is that it is preventable,” she says. “It just takes five minutes a day to do a good job: two or three minutes in the morning and again before bed saves you a tremendous amount of time in dental care.”

Thirty-five percent of people with periodontal disease may walk around not knowing they have it, she estimates.

“Fifty percent come in as referrals and have no clue. ‘My dentist thinks I have a problem,’ they say. And you may not know it unless you have a good dentist picking up that probe, measuring the gum and taking X-rays to check the bone levels.”

The trouble is that most people don’t know they have a problem until there is pain or swelling , she says.

“It’s amazing, despite the fact we live in a very educated area, that we still see periodontal disease at a young age because people don’t take care of their teeth. … We see more people in their forties developing problems. Maybe it’s just a trend in Washington, where we have a lot of high-pressure people.”

Stress and other unhealthy pressures are known to affect people’s general health, and possible correlations have been shown between cardiac issues and gum disease, says Dr. Cram, who is a national spokeswoman for the American Dental Association in addition to being an ADA consumer adviser.

“We do know from studies there is a definite correlation between diabetes and smoking and gum disease. We just don’t know how to prove cause-and-effect relationships. It could be important for folks who know they have a family history of cardiac problems and strokes,” she adds.

The correlation makes sense, she says, because periodontal disease “is all caused by bacteria that get into the bloodstream and that is going throughout the body. Certain chemical mediators are released whenever an infection is anywhere in the body, and particularly with those adults who have periodontal disease, we know there is a thickening of blood vessels.”

However, the findings have not proved that bacteria cause cardiovascular disease, directly or indirectly, according to a 2005 study on the subject supported by four agencies of the National Institutes of Health; it wasn’t possible to know whether the gum disease or thickening of the carotid artery came first.

Another study, announced in 2004, was a three-year project by the National Institute of Dental and Craniofacial Research to create the first catalog of genes found in oral biofilm. Using tools gleaned from molecular advances, scientists have learned that “oral microbial communities are more complex than we once thought; that they are more variable in the same person and among different persons,” says Dr. David Relman, associate professor of microbiology and immunology and of medicine at Stanford University, who is working on the project.

“No one size fits all,” he notes, saying “right now we only have crude measures like antibiotics that we give locally in the mouth or treatments to obliterate organisms.” The ideal would be to understand what he calls the predictive features about who will develop gum disease in ways similar to what researchers are trying to determine about various cancers.

On April 11, the National Institute of Dental and Craniofacial Research announced the invention of a portable, phone-size device that can measure within minutes certain proteins in saliva. It “may indicate a developing disease in the mouth or possibly elsewhere in the body,” according to the institute. Saliva as a diagnostic tool is not as effective at present as blood, the investigators cautioned, but the device, called the IMPOD, shows promise and one day may replace needle sticks.

Also in April, a group of Boston researchers reported evidence of a link between periodontal disease and pancreatic cancer, a usually fatal type of cancer.

“It’s an epidemiological study only, not clinical,” says Dominique S. Michaud, assistant professor in the department of epidemiology at the Harvard School of Public Health.

“It’s still very preliminary,” she says, adding that “people shouldn’t worry, but at the same time, there is good reason to take care of your oral health.” Further work is planned. Other studies, she confirms, are looking at connections between periodontal disease and cancers of the lung and throat, where smoking plays a big role.

“If you treat patients with diabetes who have periodontal disease, their need for insulin goes down,” says Dr. Preston D. Miller of Memphis, Tenn., president of the American Academy of Periodontology. Major medical centers are increasingly aware of such linkages, he reports, and he cites the case of two of his patients about to undergo invasive surgery who had been asked to provide information about the status of their periodontal disease before the surgeries could take place. In one case, Dr. Miller had to certify the pre-op patient had been treated.

“I think they were concerned about the inflammatory burden involved,” he says.

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