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PERIODONTAL (GUM) DISEASE A PUBLIC HEALTH CONCERN

LCDR Nellis D. Patterson, BS, RDHDepartment of Justice Federal Bureau of Prisons

FCI Fort Dix, Fort Dix New Jersey

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OVERVIEWPeriodontal (Gum) Disease

Caused by more than 200 species of bacteria.

This disease is commonly ignored

#1 cause of adult tooth loss in the United States

“The prevalence of periodontal disease in the United States may be significantly

higher than originally estimated. Research published in the Journal of Dental

Research from the Centers for Disease Control and Prevention (CDC) and the

American Academy of Periodontology (AAP) suggests that the prevalence of

periodontal disease may have been underestimated by as much as 50 percent. The

implication is that more American adults may suffer from moderate to severe gum

disease than previously thought”(Phys.org)

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LEARNING OBJECTIVES

What is Periodontal Disease Associations to overall patient health

Management systems and strategies used to prevent and promote oral health that may improve one’s overall health

Define risk factors that may associate Periodontal Disease to Heart Disease and Stroke

Smoking

Diabetes

Genetic factors

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ORAL INFECTIONS & INFLAMMATION

Oral Infections

Potentially stress the immune system

Lowering the body’s resistance to infections

Oral Infections cause inflammation

Localized inflammation in the oral cavity is associated with the gums, and a systemic inflammatory response may occur in people who also suffer periodontal disease

Previous research stated that treating the individual's periodontal disease may reduce inflammation, and may alleviate some additional symptoms from other chronic illnesses

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INFLAMMATION

Inflammation is part of a healthy immune response

Continuous stimulation inflammation ( Periodontal issues that are

not addressed

May cause acute and chronic infections

Eventually these infections may interfere with the body's healthy

tissues, increasing the risk of heart attacks, stroke, diabetes, cancer,

and autoimmune diseases

STAGES

OF

GUM

DISEASE

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SUPPORTING AND NON-SUPPORTING EVIDENCE

“Periodontal disease and heart disease are both

inflammatory conditions. There appears to be

an association between periodontal disease and

heart disease, but it is not yet clear if having one

condition increases the risk of developing the

other”. The American Journal of Cardiology in

2009

The correlation between Periodontal Disease

and chronic illnesses was made years ago when

experts noticed that people with gum disease

tended to have more heart attacks or strokes

than people in better dental health. The

thinking was that the bacteria causing the

infection in the gums got into the blood stream

and traveled to the fatty plaques in blood

vessels where they attached and helped form

blood clots which can lead to a heart attack or

stroke”. (Newsroom.heart.org)

“However in a report dated CHICAGO, April 18,

2012 – The American Dental Association (ADA)

Council on Scientific Affairs agrees with the

conclusions of a recent report that current

scientific evidence does not establish a direct cause

and effect relationship between gum disease and

heart disease or stroke. Additionally, the evidence

does not establish that gum disease increases the

rate of heart disease or stroke”.

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THE MOUTH AND BODY CONNECTION

Two separate health problems

Periodontal Disease

Cardiovascular Disease

Both produce  similar biological signs of inflammation

C-reactive proteins

Risk factors for both diseases include age, diabetes, and smoking status These common factors may

help explain why diseases of the blood vessels and mouth occur

BACTERIAL INFECTIONS

Bacteria (Streptococcus Viridans) responsible for gum disease may enter the bloodstream

Attach to the fatty plaques causing arteries to clog up

Infective Endocarditis

An infection found in the heart

manifest within the valves or chambers

Caused by the same bacteria present in the mouth

May responsible for periodontal disease

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C-Reactive Proteins and & TESTS

Inflammation can damage the inner lining of the arteries and make

having a heart attack more likely

C-Reactive Proteins are not normally found in the blood of healthy people

C-Reactive Proteins Blood Tests check for infections

A special type of C-Reactive Proteins Test

high-sensitivity CRP test (hs-CRP)

May be done to find out if there may be an increased chance of having a sudden

heart problem or an attack

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C-Reactive Protein range / level

Low Risk for Cardiovascular Disease

hs-CRP levels are lower than 1.0mg/L

Average Risk for Cardiovascular Disease

hs- levels are between 1.0 and 3.0 mg/L

High Risk for Cardiovascular Disease

hs-CRP levels are higher than 3.0 mg/L

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Periodontal Disease Associated with Blood related Cancers

Chronic inflammation

A risk factor in many types of cancers

Systemic inflammation

Triggered by periodontal diseases along with high levels of nitrate producing

bacteria in the mouth of people with periodontal disease may interact with

gastric acids to trigger the development of pancreatic cancer.

Advanced Periodontitis

C-Reactive Protein levels 30% higher in people with Perio. Dis.

as opposed those with normal healthy gingival tissues

May increase malignancy

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Periodontal Disease Associated with Diabetes

Periodontal Disease and Diabetes Especially Type II Diabetes

Have major inflammatory components

Indicators of periodontal disease, are seen more frequently in diabetic patients.

Symptoms

Include increased gingival pocket depth

loss of alveolar bone and tooth loss.

Diabetics have poorer glycemic control

Hemoglobin A1C Test and scores

Used to monitor the level of glucose control in people with diabetes.

A1c is frequently used to help newly diagnosed diabetics determine how elevated their

uncontrolled blood glucose levels have been

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Periodontal Dis. Associated with Pre-mature & Low Birth Weight Pregnant women w/Periodontal Disease

7 times more likely to have a baby that is born too early

or too small, due to a labor-inducing chemical found in oral

bacteria called prostaglandin

Prostaglandins are produced by the body and are

responsible for inflammation.

Prostaglandins are hormone-like chemicals that are s

significant to our well-being

High levels of prostaglandins are found in women with severe cases of periodontal disease

A Research team of periodontists, obstetrician-gynecologists and epidemiologists emphasized that their findings, based on a detailed analysis of 124 births, were preliminary and needed to be confirmed by “larger prospective multicenter investigations. “Nonetheless, they estimated from their findings that periodontal infection might be responsible for as many as 18 percent of the 250,000 premature babies that are born weighing less than 5.5 pounds in the United States each year

(New York Times Women's Health 1996)

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COMMUNITY DENTISTRY

Prevalence of Periodontal Disease

85% of adults in the United States are affected with some form of Periodontal Disease. Research also indicates that there is a great percentage of the inmate population who come from lower socioeconomic backgrounds Therefore, the overall oral health of patients in a community environment generally is poor, and they are more likely to have advanced periodontal disease

The Federal Bureau of Prisons along with Joint Commission has set standards for inmates that are consistent with the community, and within the correctional environment, it is imperative to promote oral health education

The average patient within the BOP have had little or no treatment prior to their incarceration, and at the time of intervention, many have poor oral hygiene to include significant signs of gum disease ranging from Gingivitis to Periodontitis. Therefore by the time they actually get to us many times the patient is in an advanced state of Periodontitis

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Although it has not been proven that systemic diseases are caused from Periodontal

Disease continually Education, Prevention and Early treatment

PATIENT CARE MONITORING Patients who have had heart attacks or who have a family

history of heart attacks or have a tendency toward strokes

Patient monitoring of the gum health status of patients who have had heart valve problems

or have had heart valve replacements

Prevention Dental health professionals play a vital role in improving the quality of life in

preventing, controlling and reducing oral diseases and conditions as well as promoting

healthy behaviors

Oral diseases are a major health concern that affect almost every person in The United

States. Dental caries and periodontal diseases have a huge economic and social cost and can

result in serious systemic problems, pain, and suffering. Most oral diseases are preventable,

and promoting oral health is continuing to make every effort to promote and implement

preventive measures for all citizens

Conclusion

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REFERENCES1. American Heart Association (2012)

2. CHICAGO, April 18, 2012 – The American Dental Association (ADA)

3. www.dentistryiq.com/index/display/article-display/7323600486/articles/dentistryiq/f

4. www.newsroom.heart.org/pr/aha/professional-dental-cleanings-217760.aspx

5. www.perio.org/consumer/mbc.heart.htm

6. MedLine Plus, NIH, C-Reactive Protein

7. New York Times, Womens Health October 1996

8. NIH, Ann N Y Acad Sci. 2006 Nov;1088:251-64

9. Phys.Org, September 22, 2010

10. (ScienceDaily (Jan. 16, 2007)