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Gum disease is easy to ignore. There's not much to see. And it's rarely painful or even uncomfortable.
But subtle doesn't equal benign.
A chronic mouth infection - that's what gum disease is, in fact - can play out in several serious ways. It's thought to:
-Increase the risk of heart attack and stroke.
-Increase the incidence of premature, low-birthweight babies.
-Exacerbate diabetes, which now affects 17 million Americans.
-Possibly contribute to grave lung disorders such as pneumonia and emphysema.
"People tend to see (periodontal disease) as a local problem," said Marjorie Jeffcoat, dean of the University of Pennsylvania School of Dental Medicine. She has studied the impact of oral infection on low birthweight. "As the evidence is coming in, it may be that it can have serious ramifications for certain people."
Aside from colds and flu, periodontal disease is the most common infection in the United States. It's estimated that 25 percent to 35 percent of people 35 to 60 years old have the disease to at least a modest extent. Among people older than 60, that rate escalates to 60 percent to 75 percent.
It makes sense that an infection in the mouth, like an infection anywhere else in the body, can spread and become a systemic problem, Jeffcoat said. After all, the blood that circulates through the mouth also travels throughout the body.
The connection between gum disease and fetal health is well established. A pregnant woman with periodontal disease is more likely than a noninfected woman to give birth prematurely and to deliver a small baby, Jeffcoat said. In a severe case of periodontitis, she is about seven times more likely.
There also are signs that treating periodontal disease in a pregnant woman can greatly improve the odds of her delivering a full-term, normal-weight infant.
"If we treat it very simply, by cleaning above and below the gum line, we can cut that risk," she said.
A study by Jeffcoat that was published a few months ago in the Journal of Periodontology reported that a simple cleaning cut premature delivery and low birthweight by about 84 percent.
The connection between periodontal disease and heart trouble is also strong. About 90 percent of the studies done to date point to significantly more heart disease and strokes among people with periodontitis, said John Rapley, chairman of the periodontology department at the University of Missouri-Kansas City School of Dentistry.
"It's not 100 percent," he said, "but we're getting close."
Bacteria growing in the mouth produce a toxin that triggers inflammation. Inflammation leads to a hardening of the blood vessel walls and a boost in the level of C-reactive protein, a compound produced by the inflammation. Both contribute to heart attacks and/or stroke.
Periodontal disease and diabetes do a troublesome tango in which each fuels the other. Diabetes increases the risk of developing periodontal disease, and diabetics generally have more severe cases of it than other people, according to UMKC's Rapley. Their elevated blood sugar fosters more toxic mouth bacteria, he said.
Once diabetics develop periodontitis, their fluctuating blood-sugar levels and their generally depressed immune systems make it harder to rein in gum disease, Rapley said.
Finally, there are indications that chronically infected gums and/or teeth may lead to lung infections. With every breath, oral bacteria get a free ride into the lungs. Pathogenic bacteria that tend to inhabit the lungs have been found in the mouth, and vice versa, Rapley said.
Michael Rethman calls the emerging connections between gum disease and a raft of other chronic diseases a "revolution in medicine." Rethman is president of the American Academy of Periodontology.
He even wonders whether oral infections may turn out to contribute to certain cancers. Given that H. pylori, a bacterium that afflicts the stomach and causes ulcers, has been implicated in stomach cancer, he said it could follow that bacteria in the mouth could lead to cancers as well.
Although a proven cancer connection is far down the road, Jeffcoat considers the other evidence compelling enough that people need to think more seriously about their oral health.
"It is time for us not to think of our mouths as somehow disconnected from the rest of our bodies. The same blood flows through them, the same nerves go to them. To have a healthy body, you need a healthy mouth."
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WARNING SIGNS
Indicators of developing periodontal disease
-Bleeding gums when you brush your teeth or eat hard food
-Swollen or tender gums
-Mouth pain
-Persistent bad breath
-Spaces developing between your teeth
-Receding gums
-Teeth that seem to be getting longer
-A change in the way your teeth come together when you bite
WHAT TO WATCH OUT FOR
Factors that contribute to periodontal disease
-Poor dental hygiene. You should brush and floss daily to maintain healthy gums.
-Cigarette smoking. It's been identified as one of the leading causes of periodontal disease.
-Genes. About 30 percent of people have an inherited susceptibility.
-Stress. It interferes with the body's ability to fight periodontitis and other infections.
-Diabetes. Diabetics are more susceptible to all infections, including those in the mouth.
-Some drugs. They can fuel gum infection, including oral contraceptives, anti-depressants and some heart medications.
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(c) 2003, The Kansas City Star. Distributed by Knight Ridder/Tribune News Service.
