How gum and tooth care affects health, from Alzheimer’s to diabetes

Your teeth and gums have a wide impact on your health – from your risk of Alzheimer’s disease to diabetes and cardiovascular disease.

Crowded, misaligned, full of cavities and inflamed gums, our teeth are known for their imperfections. The modern human being is unique in terms of the level of painstaking daily interventions we need to make to ensure that our teeth and gums don’t get sick.

Far from being restricted to toothaches and inflamed gums, our oral health affects everything from our diet to our general well-being and the risk of death for other reasons.

This is because oral diseases are not always restricted to the mouth. A close relationship between oral health and some of the world’s most concerning diseases, such as cardiovascular disease, diabetes and Alzheimer’s, is being discovered, reiterating the mouth’s role as a mirror of health and disease and as a sentinel of our general well-being.

But, unfortunately, perhaps the most salient feature of oral health is the one most often overlooked.

Periodontitis is the second most common oral disease in the world (after cavities) and the 11th most common disease on the planet. It affects more than 47% of adults over 30 years of age. And among people age 65 and older, 64% have severe or moderate periodontitis.

Periodontitis is an infection located not on the surface of the gum, which you can see when you smile, but far below it. After an initial phase of superficial inflammation on the visible part of the gum (gingivitis), the bacteria move down under the gum line to form pockets at the roots of the teeth, where they erode the structures that hold the teeth in place.

Due to the hidden nature of periodontitis, many people do not know they have the disease until it reaches very advanced stages. Periodontitis has a genetic component and is also influenced by oral hygiene.

For most people, the disease cannot be seen until age 40 or 50, according to Sim K. Singhrao, a senior fellow at the School of Dentistry at the University of Central Lancashire in the UK. At this age, serious damage may have already damaged the tooth structure, subjecting the person to losing teeth.

By this time, the infection will have provided a steady stream of bacteria like dental treponema and Porphyromonas gingivalis into the bloodstream for decades. And it’s this continual presence of disease-causing bacteria in the gums and blood flow that affects our health far beyond the mouth.

Blood as a means of transport

“If you think of blood flow as a bus, it will take passengers – like bacteria in the mouth – to all parts of the body,” explains Singhrao. “Some will land in the brain, some in the arteries and some in the pancreas or liver.”

If these organs have vulnerabilities or the microbes are not effectively killed, the bacteria cause inflammation and initiate or worsen other inflammatory diseases.

In fact, periodontitis is linked to a huge list of the most common non-communicable diseases in the world: cardiovascular disease, diabetes, Alzheimer’s, obesity, various types of cancer, rheumatoid arthritis, Parkinson’s, pneumonia and pregnancy complications.

For many of these conditions, it’s a two-way street. Periodontitis can worsen conditions such as arteriosclerosis (hardening of the arterial walls), and the presence of arteriosclerosis also predisposes patients to periodontitis, for example.

There are no randomized controlled clinical trials (RCTs) – considered the gold standard of medical research – that examine this correlation, because it would be difficult to conduct them ethically, denying a group the treatment of periodontitis for an extended period to see how it would affect your arteriosclerosis.

But the periodontitis-causing bacteria normally found in the mouth were once found in atherosclerotic plaques.

Periodontitis and diabetes

Of all chronic health conditions, diabetes has the strongest two-way link with periodontitis. People with type 2 diabetes are three times more likely to develop periodontitis. Among people who have type 2 diabetes and periodontitis, the infection worsens the body’s ability to control blood sugar levels.

But what is behind this correlation?

The reason is the continuous flow of bacteria from the pockets at the bottom of the gum into the bloodstream.

When the immune system detects bacteria or other pathogens, immune cells release a barrier of cellular messenger molecules known as inflammatory markers. These markers help the immune system attack and destroy invading pathogens.

The swelling and redness that appears moments after a wound is the result of this efficient inflammatory reaction. In the short term, inflammatory markers act as excellent guides for the immune system to the site of the likely infection. But when these sentinels remain in the body, they cause a host of problems.

Most conditions related to periodontitis have a well-established inflammatory element. About 30 years ago, for example, an inflammatory marker called tumor necrosis factor alpha was discovered to increase insulin resistance in diabetic patients.

That revelation was quickly followed by the discovery of a number of other inflammatory markers that exacerbate obesity and type 2 diabetes. And this dense network of inflammatory markers has led to research trying to treat diabetes by suppressing chronic inflammation.

But the constant flow of bacteria from a hidden gum infection does just the opposite.

“All inflammatory diseases are connected and influence each other,” says Palle Holmstrup, professor emeritus in the department of dentistry at the University of Copenhagen, Denmark. “Periodontitis is one of the most common, if not the most common, inflammatory diseases of the human body.”

“It’s the same inflammatory mediators that are active in different types of inflammatory diseases – rheumatoid arthritis, heart disease, diabetes and so on. If you have periodontitis, you have an increased level of low-grade systemic inflammation,” says Holmstrup.

In humans, it is difficult to directly research how treating periodontitis can reduce conditions such as diabetes, for the same ethical reasons as atherosclerosis: you cannot deny a patient treatment for their disease, especially if you suspect it may worsen their other conditions. conditions.

This makes studying this complex knot of connected inflammatory diseases especially difficult and identifying their causal relationships.

But Holmstrup’s group measured the effect of periodontitis on diabetes in rats. His group investigated the difference in the reaction on blood sugar between diabetic rats that had conditions similar to periodontitis and diabetic rats that did not have these conditions. Periodontitis generated a 30% increase in sugar peak after meals.

Periodontitis and the risk of dementia

The outcome of periodontitis, when aggressive and untreated, is loss of teeth. After decades of chronic inflammation, tooth loss causes a host of new health risks, including cognitive decline and dementia.

Bei Wu, professor of Global Health at New York University’s Rory Meyers School of Nursing, found a dose-dependent relationship: the more teeth you lose, the greater your risk of dementia and cognitive decline.

In the largest study of its kind, Wu studied the health data of 34,000 patients in the United States and concluded that for every tooth lost by a person, there is a 1.4% increased risk of cognitive impairment and a 1.1% increased risk. of the risk of dementia. Altogether, those who had lost teeth had a 48% higher risk of cognitive impairments and a 28% higher risk of dementia, compared with individuals who had all their teeth.

Tooth loss has been largely neglected as a risk factor for dementia. Wu says that she is usually met with surprise when she indicates the relationship between the two.

“Oral health is the missing piece,” says Wu. “We are trying to provide the evidence that demonstrates that it should be part of the equation.”

While periodontitis can be a common cause of tooth loss, there may be other causes of these effects besides inflammation. So far, Wu’s studies of tooth loss have only looked at correlations and not causes, but she wants to investigate the role of nutrition in this relationship, among other factors.

“Good tooth health can improve nutrient intake and also better chewing,” explains Wu. “This has the potential to increase blood flow, which could impact cognitive functions – but it’s still just a hypothesis.”

The discovery of links between oral health and this set of other conditions has a very significant aspect: it’s easy to reduce your risk of getting periodontitis or treat it effectively if you already have the disease.

“If we brush our teeth properly and have good oral hygiene, we can prevent periodontitis from developing,” says Wu.

But if the disease does arise, it can be treated in the early stages with scaling and root planing, which removes microbes from the undersurface of the teeth, above and just below the gum line.

In case of severe periodontitis, the solution may include surgical treatment, “which means you loosen the soft tissue from the gum, clean the root surfaces and put the tissue back in,” according to Holmstrup.

The problem really lies in detecting the disease, due to its often symptomless nature, coupled with the common misconception that you only need to go to the dentist if you experience severe toothaches.

In this case, the solution is again simple: be sure to consult with your dentist.

Text originally published here