Gum disease causes the body to respond with inflammation and a host of chemical defenses. Recent studies suggest that the infection and inflammation present in gum disease may be connected to other health problems and potentially life threatening conditions such as heart disease, respiratory infections, kidney disease and stroke.

A number of scientific studies have been done to evaluate the possibility that oral bacteria and inflammation specific to gum disease may influence the initiation or progression of other diseases. Many of these studies found a link between gum disease and heart disease. Studies published in The Journal of Periodontology reported a suspected link between gum disease and respiratory infections, kidney disease and stroke. A recent study published in the Journal of the American Dental Association found that people who lost teeth before the age of 35 due to gum disease had an increased risk of dementia. Gum disease has been linked to everything from heart disease to Type 2 diabetes to pancreatic cancer.

Gingivitis is the most common form of gum disease affecting nearly 60% of the population. It causes gums to become red, swollen and bleed easily. Untreated gingivitis can progress to a more serious form of gum disease known as periodontitis. As oral bacteria spread and grow below the gum line, chemicals produced by the bacteria irritate the gums. These bacterial chemicals stimulate an inflammatory response in which the body in essence turns on itself. The chronic (long-term) inflammation associated with gum disease along with the body’s own natural chemical defense reactions may influence other disease pathways.

Plaque and the development of gum disease

Teeth and the surrounding gum tissues are constantly exposed to oral bacteria commonly called dental plaque. Within a few hours of brushing and flossing, these bacteria re-colonize tooth surfaces and the spaces between the gums and teeth. Some dental plaque is normally present and does not cause a health problem. However, in people with poor oral hygiene, dental plaque is not regularly removed. An accumulation of dental plaque leads to the development of gum disease. Pristine gum tissue (Figure 1) is devoid of inflammation and has only some plaque formation.

Early stage gum disease

Early stage gum disease is often undetectable. In this mild form of gingivitis, an accumulation of oral bacteria releases fatty acids and other biologically active substances including lipopolysaccharides (LPS) and chemotactic peptides such as f-MLP. These chemicals are soluble and quickly penetrate the outer layers of the gum tissue entering the epithelium. Chemotactic peptides signal neutrophils (white blood cells) to enter the epithelium and produce pro-inflammatory agents known as cytokines. Salivary glands also begin to produce anti-bacterial agents. See Figure 2.

Established gum disease (Gingivitis)

Established gum disease (Gingivitis) is characterized by widespread dental plaque and inflammation of the gum tissues with symptoms of redness, swelling and bleeding. Increased numbers and increasing diversity of oral bacteria continue releasing biologically active chemicals. More white cells enter the epithelium to release more diverse cytokines and prostaglandins. Lymphocytes (B-cells) also infiltrate the gum tissues releasing antibodies against the spreading oral bacteria. Chronic inflammation triggers the gum tissue and the liver to produce C-reactive protein. See Figure 3.

Advanced gum disease (Periodontitis)

Advanced gum disease (Periodontitis) is associated with extensive dental plaque formation dominated by anaerobic, gram-negative bacteria. Chronic inflammation results in the ulceration of the epithelium which allows bacteria to enter the gum tissue and the bloodstream. Inflamed gum tissue separates from teeth creating deep gum pockets in which the bacteria thrive. The body responds with even more chemical defenses. Aggressive synthesis of cytokines, C-reactive protein, lymphocytes and antibodies leads to the breakdown of collagen, the loss of supporting bone tissue and the subsequent loss of teeth. See Figure 4.

Does gum disease influence heart disease?

Several case-control studies published in the early 1990s found that patients with a history of heart disease had worse oral health than control subjects. This led to a flurry of research to verify these observations. While most of the follow-up studies did support an association between gum disease and the outcomes of heart disease (i.e. myocardial infarction, angina or stroke), several did not. Certain mechanisms are common to both gum disease and heart disease that were not considered in the studies. For example, both diseases share common risk factors including lifestyle habits such as cigarette smoking. Ignorance of such factors, along with the absence of a standard measure for gum diseases, rendered several of these studies inconclusive in terms of linking gum disease to heart disease.

Gum disease and heart disease may be linked because they are both signs of poor circulation, or there could be common bacteria that are involved in both gum disease and plaque build-up inside coronary arteries. The link may also have something to do with the body’s response to prolonged inflammation. Gum disease researchers have long suspected the production of C-reactive protein by the local gingival cells and the liver has an influence on other diseases including atherosclerosis. More scientific research is needed to prove or disprove that gum disease has an influence on heart disease.

Elevated C-Reactive Protein

Clinical studies have shown that patients with gum diseases demonstrate elevated blood levels of C-reactive protein and fibrinogen as well as peripheral white blood cells. The body’s production of inflammatory cytokines may also elevate cytokines in the blood. In turn, this may cause the liver to produce acute-phase proteins including C-reactive protein. Elevated blood levels of C-reactive protein (CRP) have been associated with several health problems including vascular injury, adverse pregnancy outcomes, cardiovascular disease and stroke.

Susceptibility and immune response to gum disease

While an accumulation of oral bacteria (dental plaque) is the cause of gum disease, it is the innate susceptibility and immune response of the host that determines the outcome. In some people with poor oral hygiene, the disease never progresses beyond mild gingivitis. In others, due to a weak immune response or environmental factors, or both, the disease progresses to periodontitis. Those with an overabundance of dental plaque will certainly develop gingivitis, but not all those with untreated gingivitis will progress to periodontitis. Individual differences in susceptibility and immune response to oral bacteria must be considered when evaluating gum disease and its possible connection to other health problems.

Treatment for Gum Disease

Depending on the stage of gum disease, treatment may range from nonsurgical procedures that control bacterial growth to surgery that restores damaged tissue. Most general dentists can evaluate the extent of gum disease and recommend a treatment plan.

Established gum disease or gingivitis can usually be reversed with good oral hygiene and regular, professional cleanings. A nonsurgical procedure called scaling and root planing can be performed to immediately halt the progression of the disease. Scaling removes plaque above and below the gum line. Root planing smooths out the surface of tooth roots to remove bacteria and encourage the gums to regenerate. All gum disease patients should follow a diligent regimen of daily brushing, flossing and routine dental cleanings.

In patients with advanced gum disease or periodontitis, surgery may be part of the treatment plan to prevent further infection and restore damaged tissue. Curettage is a surgical procedure in which diseased gum tissue is scraped away, allowing the infected area to heal. Periodontal flap surgery may be performed to reduce gaps or “pockets” between the teeth and gums. Soft tissue grafts may be done to replace tissue where the gums have receded. Guided tissue regeneration may be performed to stimulate bone and gum tissue growth. Surgical treatments such as these help control the spread of bacteria and prevent the loss of teeth.

Conclusion

Gum disease is a serious health problem, and the trouble doesn’t stop at the gum line. Scientists know that gum disease contributes to pathological inflammatory processes throughout the body. Chronic inflammation has been linked to a host of health problems including cardiovascular disease, stroke and cancer. While not everyone with gingivitis will get cancer or heart disease, averting gum disease is crucial for anyone who wants to live a long and healthy life.