The Health Perils of Gum Disease

Last Editorial Review: 4/6/2005

Gum disease does more than endanger your teeth and gums. It can also lead to and worsen far more dangerous ills.

By Dulce Zamora
WebMD Feature

Reviewed By Charlotte Grayson

The eyes are the windows to the soul, goes the old saying. In the same way, growing research suggests, your mouth may be a kind of window to much of what happens to the rest of your body.

How exactly does the mouth reveal and even influence overall health and well-being? First, the condition of the teeth, tongue, and lips can determine how we talk, how we eat, what we eat, how we kiss, and how we go about our daily lives, says William Maas, DDS, MPH, director of the CDC's Division of Oral Health.

"There are children at school right now who can't quite concentrate on what the teacher is talking about because they have a nagging toothache," says Maas. "Maybe somebody at work is not functioning as well as they could [for the same reason]."

Sally Cram, DDS, a spokeswoman for the American Dental Association (ADA), agrees. "We can no longer think of the mouth as not part of the overall body, because so much that goes on in the mouth can affect the overall health in the body."

Cram cites research that links gum disease with heart disease, diabetes, lung problems, and premature and low-birth-weight babies. Helena Gallant Tripp, RDH, president of the American Dental Hygienists' Association (ADHA), says, "In bulimic patients [who] induce vomiting, you see the acid wearing away the inner surface of their teeth. You can pick up osteoporosis [bone thinning] in dental X-rays."

To further explain how the mouth and the body seem to share such a close relationship, let's start with the basics of oral health and what can go wrong in the mouth.

What Goes Wrong in the Mouth: Gum Disease

Many people worry about cavities, but periodontal disease can also be a big problem for people with poor oral hygiene.

Gum disease is an infection of the tissues supporting the teeth. When plaque develops, bacteria irritate the gums and cause them to swell. In the beginning, the disease is called gingivitis and only affects the gums. In more advanced phases, the disease is known as periodontitis. The bacteria go under the gum line, eventually attacking the tissues and bone around the teeth. This can lead to tooth loss.

Nearly 75% of American adults have some form of periodontal disease, reports the ADHA. The symptoms of gum disease can be so mild that some people don't know they have it. According to the ADA, warning signs include:

  • Gums that bleed easily
  • Red, swollen, tender gums
  • Gums that have pulled away from the teeth
  • Persistent bad breath or bad taste
  • Permanent teeth that are loose or separating
  • Any change in the way your teeth fit together when you bite
  • Any change in the fit of partial dentures

Besides poor oral hygiene, several factors raise the risk of periodontal disease:

Regular professional checkups of the mouth can help detect, prevent, and treat gum disease and the disorders that go along with it.

Preventing periodontal disease may have benefits besides keeping gums and teeth in mint condition.

"There's no question that good periodontal health is good for overall health and well-being," says Gordon Douglass, DDS, past president of the American Academy of Periodontology (AAP).

To show how gum disease can harm the rest of the body, Douglass suggests curving your hand around a pen, and imagining the pen as a tooth, and the hand as the gums. There is normally little space around the gums and teeth.

In gum disease, bacteria break down the tissues around the tooth. The resulting space becomes a niche where periodontal bacteria can breed. The gums then become inflamed and bleed in an attempt to fight the infection. Yet the greater the swelling and the deeper the space between the teeth and gums, the easier it is for the periodontal bacteria to enter the bloodstream, says Douglass.

In a recent study in the journal Circulation: Journal of the American Heart Association, researchers found a link between higher levels of bacteria in periodontal pockets, higher levels of bacteria in the bloodstream, and thickening of the walls of arteries (an early sign of atherosclerosis or hardening of the arteries, which can lead to heart problems, such as heart attacks).

"It appears that just the presence of these bacteria in elevated levels causes inflammation in the bloodstream," says Douglass.

Inflamed arteries and blood clots are hallmarks of heart disease. The AAP reports that people with gum disease are almost twice as likely to have coronary artery disease (heart disease), compared to folks without gum disease.

At the same time, drugs intended to control blood pressure, regulate heart rhythm, and reduce cholesterol levels may make gums larger or more swollen, reports the ADHA. If that happens, people can work with their dentist to treat and reduce gum swelling and then with their doctor to prescribe drugs that don't cause this side effect.

Gum Disease's Effect on Diabetes, Pregnancy

Gum disease also creates problems for people with diabetes, who are twice as likely to develop the condition. Once they have it, periodontal bacteria that makes its way into the bloodstream can make it harder to regulate blood sugar levels. And if their diabetes is not well managed, more oral health breakdown happens. The ADHA reports people with diabetes also tend to have these mouth-related problems: burning sensations, overgrowth of gum tissue, abnormal wound healing, tooth decay, fungal infections, fruity breath, frequent dry mouth, or foamy saliva.

"We know that having chronic infection in the gum and bone around your teeth can affect your body's ability to heal," says Cram. "On the flip side, we see diabetics who, once they find out they have gum infection and get that under control, they find it much easier to get their blood sugar under control."

Gum disease can also complicate pregnancies. According to the AAP, expectant mothers with periodontal bacteria are seven times more likely to have a premature and low-birth-weight baby.

"The bacteria and the toxins from the periodontal disease enter the bloodstream and cause inflammation that induces the pregnancy," says Tripp of the ADHA. "It triggers premature labor."

Babies born before 37 weeks and who weigh less than five-and-a-half pounds are considered premature. Chances of survival depend on how early the baby arrives. At 24 weeks, a baby has about a 10% chance of survival. At 26 weeks, the chance increases to 55%, and at 28 weeks, it is 77%.

Doctors suspect that the risk of having a preterm birth is even higher if gum disease worsens during pregnancy. This is why, experts say, pregnant women or women thinking about becoming pregnant should have a thorough oral exam.

Gum disease may also cause and aggravate problems in the respiratory system. Studies are still ongoing, but scientists suspect that when bacteria in the mouth enter the lungs, they can cause infection or worsen an already weakened system.

"When you have a chronic infection in your mouth, it certainly can put you at higher risk for infections elsewhere in your body," says Cram.

Research also shows that people with a respiratory problem called chronic obstructive pulmonary disease may have poorer oral health. And the ADHA reports that some asthma treatments may cause dry mouth or a fungal infection, which may increase the risk of diseases in the mouth.

Keeping the mouth healthy may, indeed, be a worthwhile investment in overall good health.

"Only brush the teeth you want to keep," jokes Maas. But such advice is not far off from the mark.

The ADA recommends the following for optimal oral health:

  • Brush your teeth twice a day with an ADA-accepted fluoride toothpaste.
  • Clean between teeth daily with floss or an interdental cleaner.
  • Eat balanced mix of foods and limit between-meal snacks.
  • Visit your dentist regularly for professional cleanings and oral exams.

Also, avoid sharing toothbrushes and change brushes often.

"It's been shown that within families, the bacteria from periodontal disease can be transmitted, probably most commonly by picking up someone else's toothbrush," says Douglass. This isn't the same as passing cold germs back and forth, adds Douglass. It also doesn't mean instant infection. People who do acquire the bacteria may or may not succumb to gum disease, depending on how susceptible they are.

That means that everyone in the family should get regular, thorough oral exams. Ask your oral health professional to especially check the gums.

"Those of us who manage patients clinically have found that we'll have someone who appears to do everything right, and they keep getting recurrent periodontal problems," says Douglass. "Then, it turns out, after examining their spouse, the spouse really has significant periodontal disease."

In addition, be aware of certain factors that can raise your risk for periodontal infection:

  • Family history of gum disease
  • Smoking (tobacco alters the gingival or gum tissue, breaks down the seal around the teeth, and makes oral tissue less able to fight bad bacteria.)
  • Poor oral hygiene
  • Exposure to periodontal bacteria

An oral health professional can also help you assess what type of toothbrush, floss, and other gadgets can help you take proper care of your mouth.

Published April 4, 2005.

SOURCES: William Maas, DDS, MPH, director, CDC's Division of Oral Health. Sally Cram, DDS, spokeswoman, American Dental Association. Helena Gallant Tripp, RDH, president, American Dental Hygienists' Association. Gordon Douglass, DDS, past president, American Academy of Periodontology. American Academy of Periodontology. American Dental Association. CDC. WebMD Medical Reference from The High-Risk Pregnancy Sourcebook: "Premature Labor." Circulation, Feb. 8, 2005.

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