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The dangers of poor oral hygiene

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A "healthy smile" means much more today than merely having white, straight teeth. Oral hygiene is directly related to general health. New findings reveal that poor oral hygiene (such as gum disease) is strongly associated with numerous disorders including heart attack, stroke, diabetes and systemic inflammation.

The dangers of poor oral hygiene

Gum disease is observed as red, swollen and bleeding gums (gingivitis) in its mildest form and chronic inflammation, infection and bone loss in its advanced stages. Plaque build-up around the gum line causes gingivitis, however when plaque formation is significant, bacteria is ready to thrive, breeding chronic inflammation and infection. Irritation and inflammation lead to wearing down of gum tissue, which gradually increases the pocket depth (gap where gum meets tooth), allowing more bacteria to get nestled in to the widening gap, and passing in to the bloodstream where it can lead to systemic disease. Theory has it that bacteria bred in the oral cavity and related chronic gingival inflammation, once in the bloodstream, can activate immune responses (i.e. white blood cells) capable of provoking systemic inflammation, arterial blockages and infection. Below are a few examples of how gum disease may translate into some chronic, life-threatening conditions.

Recent research has put forth evidence that individuals with gum disease are more likely to suffer a heart attack than others with healthy gums, because oral bacteria and related gum inflammation could cause arterial inflammation, along with increase plaque build-up and encourage dangerous clotting. Some cardiovascular risk factors, such as C-reactive protein (CRP) and fibrinogen levels seem to correlate with the amount of gum disease present, suggests data from the Third National Health and Nutrition Examination Survey (1989 to 1994), collected from over 10,000 people. Risk patterns with periodontal disease were similar throughout the age span. Contrarily, treating periodontal diseases successfully lowers levels of C-reactive protein, and may thereby also lower the risk of heart disease

Another telling study made headlines after reporting that gum disease raises the risk of having a stroke as well. How? Columbia University researchers discovered that the severity of gum disease related proportionally to the amount of arterial plaque present in carotid arteries (in the neck). Presented at the American Academy of Neurology 51st Annual Meeting, April 17-24, 2003 in Toronto, their findings revealed that, among 62 test subjects, arterial plaque was two times as thick in those with the worst cases of gum disease than in those with the least oral damage. The suspicion is always that increased blockages of those arteries stemming from gum disease may reduce blood flow to the brain and/or promote blood clots. Harvard researchers confirmed such findings earlier this year, when their 12-year follow-up study of more than 41,000 healthy men, free of cardiovascular disease and diabetes at baseline, showed that those with periodontal disease and fewer than 25 teeth had a higher risk of ischemic (clot-related) stroke.5

Additionally, a few years ago, dental medicine researchers at the State University of New York found that severe periodontal disease often accompanies severe diabetes mellitus. They also demonstrated that treating gum infection with antibiotics resulted in better blood-sugar control. They recommended that controlling severe gum infection is "essential for achieving long-term control of diabetes mellitus." Not surprisingly, periodontal disease is frequently considered the sixth complication of diabetes.

Results from a five-year study of more than 800 expectant women, which was presented at the 80th General Session of the International Association for Dental Research, showed that women with moderate to severe periodontal (gum) disease while pregnant are at increased probability of having pre-term babies and babies with low birth weight. The investigators, at the University of North Carolina-Chapel Hill, believe that the connection may stem from oral disease triggering increased levels of biological fluids that can induce labor.

It's also suspected that periodontal disease may cause respiratory disease, particularly lung infections such as pneumonia, or exacerbate existing respiratory conditions (i.e. chronic obstructive pulmonary disease or COPD). That is because oral bacteria can be breathed into lungs, particularly in people with periodontal disease.

While much research to date, though, has been tinged with some skepticism regarding whether dental-disease links are just coincidental or if gum disease actually causes or exacerbates certain diseases, evidence is certainly mounting to explain just how a cause-and-effect connection might exist. A recent study in the Journal of Periodontology by Belgian researchers demonstrated how it is quite likely that harmful bacterial components from the oral cavity, by way of the gums and bloodstream, can travel to various organs in the body, such as the heart and lungs and wreak havoc.  Researchers found that diseased gums released significantly higher levels of bacterial pro-inflammatory components, such as endotoxins, into the bloodstream in patients with severe periodontal disease (42 patients) compared to healthy patients (25 controls). Test subjects were required to chew gum 100 times, 50 times per side. Blood samples revealed that while 6% of them had endotoxemia before the chewing, four times as many (24%) did so afterwards, showing that harmful bacterial components can enter the bloodstream from the oral cavity through even normal activity. Moreover, those with periodontal disease had four times the amount of endotoxemia in their blood than others with healthy mouths or moderate gum disease.