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Forsyth Research in The Washington Post

  • Monday, October 3, 2016
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Oral health research can tell us a great deal about overall health. Learn more in the article in this article in The Washington Post


Does gum disease have a link to cancer, dementia, stroke?

Open wide. There’s a host of researchers peering inside your mouth, and you may be surprised at what they hope to find. They’re looking for a connection between gum disease and illnesses such as breast cancer and even dementia.

What they’re seeing in there is intriguing: possible relationships between gum or periodontal disease and diabetes, heart disease, stroke and at-risk pregnancies. Some studies have been pursuing an association between bleeding gums and pancreatic cancer. Others are looking at whether there’s a connection between mouth bacteria and Alzheimer’s.

But experts are far from understanding what these links might mean. Studies’ conclusions are carefully phrased to avoid implying that they are definitive, because the exact role of our gums in overall health has yet to be determined. It could be that gum disease exacerbates other diseases, or gum disease might be a symptom of other conditions.

Gum disease, or periodontitis, starts with a slimy film of bacteria. This plaque sticks to teeth and gums, and if not brushed or flossed away, it can burrow below the gumline. Some people are genetically inclined toward it.

Signs of gum disease include bleeding, red or swollen gums; areas where the gum seems separated from the teeth; bad breath; and loose teeth, which can cause changes in your bite, according to the American Dental Association. Gingivitis is a mild form of the condition. Sometimes the disease is very advanced even though there are no symptoms.

Left untreated, periodontitis can cause tooth loss, painful chewing and may increase the risk of various conditions.

While not definitive, the links between gum disease and diabetes, at-risk pregnancy, heart disease and stroke have been so consistent that some insurers offer extra preventive periodontal care at little or no cost to people with those conditions.

Treating periodontitis in such patients resulted in fewer hospitalizations and lower medical costs than those who did not receive follow-up periodontal care, according to an analysis of dental insurance claims published in 2014 in the American Journal of Preventive Medicine.

For example, over the study period, the average annual cost of medical care for Type 2 diabetics with untreated periodontal disease was $7,056; for diabetics with treated periodontal disease, the average was $4,216 — a 40 percent savings, with 40 percent fewer hospital admissions. Cerebral vascular disease patients whose gum disease was treated saw a 41 percent cost savings and 21 percent fewer hospital admissions. For coronary artery disease, the cost savings was 11 percent, with nearly 30 percent fewer hospital stays. The study also included rheumatoid arthritis patients, for whom no gum disease treatment effects were found.

The conclusions are gathered through large-scale data analysis, or data mining, a research process that’s still in its infancy in dentistry, said lead author Marjorie Jeffcoat, a professor and dean emeritus of the University of Pennsylvania School of Dental Medicine.

“These databases essentially show that getting more care reduces costs. That’s different from a causal relationship,” said Steven Offenbacher, a distinguished professor and chairman of periodontology and director of the Center for Oral and Systemic Diseases at the University of North Carolina at Chapel Hill School of Dentistry. It will take researchers a while to dig deeper into cause, Offenbacher said.

Roots of research

More than a century ago, doctors theorized that oral infections damaged the heart and caused other illnesses, a concern that incited a wave of tooth extractions for decades. Eventually, attention to the lack of scientific evidence stopped the practice.

Since the 1980s, studies have been investigating relationships between gum disease and other conditions. In 2012, the American Heart Association issued a scientific statement after reviewing the studies.

The AHA noted that an association exists between gum disease and heart disease beyond the shared risk factors such as smoking, age and diabetes. But there was no evidence that treating gum disease would prevent heart disease or modify its outcomes. The AHA indicated more research needed to be done.