Ask a Doctor: Can gum disease cause other health problems?

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Q.Can gum disease cause other health problems?

A. Medicine and dentistry are often seen as separate fields, leading some to believe that the mouth is somehow disconnected from the body.

Increasingly, though, it is becoming clear that there is a strong link between the health of our mouths and the health of our bodies, with the mouth now referred to as “the window to general health.”

Poor oral health has been associated with an increased risk of death. A recently published analysis in the journal Nature Communications, which pooled the results of 294 studies, showed that dental disease was associated with a higher risk of depression, rheumatoid arthritis, inflammatory disease, obesity, asthma, diabetes, dementia, cancer and chronic conditions of the liver, kidneys and lungs.

The studies were observational, which cannot determine causality, but they do show that patients with gum disease are at a much higher risk for a wide array of serious medical issues.

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Different forms of gum disease

The mouth is coated in a fluid that is a mixture of saliva and bacteria. This fluid coating is referred to as the dental biofilm, and when kept healthy with dental hygiene, the good bacteria prevent the formation of pathologic bacteria.

But if pathologic bacteria replace good bacteria in the biofilm, they can cause gum disease or periodontal disease – a group of conditions that causes chronic inflammation.

The early form of gum disease is called gingivitis. Gingivitis is characterized by red, swollen gums that bleed easily. The bleeding is painless, and many people may not seek treatment for it.

Gingivitis, though, can progress to periodontitis, when pathologic bacteria begin to erode the bone and tissues holding the teeth in place.

This erosion forms deepening recesses around the teeth, which become the breeding place for even more growth of pathologic bacteria as they spread from the roots to the bones holding the teeth together. Left unchecked, periodontitis can cause loss of teeth and is associated with a host of medical conditions.

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Gum disease is linked to heart problems

Poor oral health is most consistently associated with an increased risk of heart disease.

Gum disease is linked with a higher incidence of diabetes and high blood pressure, two of the main risk factors for heart disease. Gum disease is also associated with other life-threatening conditions such as stroke, which is mostly driven by the same process that causes the majority of cases of heart attacks: atherosclerosis.

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Role of inflammation in heart issues

Atherosclerosis refers to the chronic process that results in the buildup of cholesterol-filled plaques inside blood vessels.

Progressive atherosclerosis, depending on which blood vessels it affects, can limit the supply of oxygen to any part of the body, including the brain, the heart, the limbs and the gut. And if any of these plaques rupture, it can lead to the sudden stoppage of blood supply, leading to potentially fatal complications such as heart attacks or strokes.

Both the development of atherosclerotic plaques and their catastrophic rupture are caused by inflammation, activated by the body’s immune system.

When someone has gum disease, pathologic bacteria can transfer from the mouth into the patient’s body, causing chronic inflammation, which can then lead to atherosclerosis.

Bacteria found in the mouth have been found in atherosclerotic plaques, leading to the hypothesis that chronic inflammation caused by gum disease is associated with heart disease and stroke.

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Does treating gum disease reduce the risk of heart disease?

The association between gum disease and general health problems, heart disease in particular, is quite clear.

But there is little evidence that definitively proves that dental scaling and cleaning procedures can reduce the risk of heart disease. This is mostly because of a lack of rigorous studies that assess the impact of treating gum disease on the incidence of heart disease.

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How to prevent gum disease

Regular dental hygiene is key to preventing gum disease. Given the consistent association between gum disease and heart disease and its risk factors, I recommend that all my patients maintain good dental hygiene and receive regular dental care to prevent and treat gum disease. I advise them to:

Brush twice a day for two minutes.

Replace the toothbrush after its bristles become worn, otherwise the brush itself can become a home for bacteria.

Floss to remove plaque built up between teeth.

See a dentist twice a year for a cleaning since that can better remove pathologic bacteria, particularly from crevices or recesses.

If the gums bleed, which can be a sign of gingivitis, see a dentist.

A deep cleaning and enhanced hygiene can easily reverse the course of gingivitis before it progresses toward periodontitis, and may reduce your risk of many health conditions.

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Haider Warraich is a cardiologist at VA Boston Healthcare System and Brigham and Women’s Hospital, assistant professor at Harvard Medical School and author of “State of the Heart: Exploring the History, Science and Future of Cardiac Disease.”