The Bad News About Gum Disease

Periodontal disease (gum disease) is prevalent in over 90% of the American adult population.  It has very serious health consequences that go well beyond cavities, tooth loss, and halitosis (bad breath).  Healthy gums are required in order to avoid more serious systemic health consequences.  Many years ago, Dr Mayo of Mayo Clinic fame said that a person with a healthy mouth will live on average 10 years longer. 

The damage of gum disease to overall health is dose related, which means that the worse the gum disease, the greater the risk.  Periodontal disease is a known factor for increased heart attacks (#1 cause of death), strokes (#3 cause of death), arteriosclerosis,  rheumatoid arthritis, can worsen diabetes, and even contribute to lung disease by breathing in (aspirating) pneumonia-causing organisms.  With expectant mothers,  with as few as one or two diseased sites ,  one in five pre-term births and low birth-weight deliveries  are attributed to periodontal disease. 

Oral disease is not removed from the rest of the body.  A person with bleeding gum tissues, bone loss, and pus around even one tooth is systemically ill.  If gum disease were painful, it might get more attention.  Unfortunately, it is generally silent and painless until it is well advanced. 

There are approximately 400 microorganisms normally found in the mouth, and not normally circulating throughout the body causing inflammatory mischief wherever the body is susceptible.  Healthy gums are meant to provide a barrier to these microorganisms entering the bloodstream.  We can control most of the factors that cause gum disease.  Either the gums are healthy and sealed creating a barrier, or it is diseased causing an opening in the gum-tissue barrier allowing microorganisms to enter the circulatory system.  A person with periodontal disease has inflammed and infected tissue wrapped around their teeth. Under the gums, there are up to 400 types of microorganisms numbering in the trillions, food debris, as well as the surface layer of cells that are continuously sloughing off as new cells are generated.  All of this is living, dying, and swimming in this necrotic stew under the gum around the teeth, creating major inflammation, odor, and bone destruction.  While we can’t see this infected tissue, it is nonetheless there.  This fact brings to light how serious the problem really is.  It is the toilet bowl, in a sense, found under the gums.  If people could see what is really going on, they would take gum disease far more seriously.

Unfortunately, the skin cells that are continuously sloughing off under the gum provide a food source for the microorganisms living in the same space, as does the food particles we have ingested.  As these cells decompose under the gums, they produce odors known as volatile sulfur compounds (VSCs).  This toxic stew of VSC gases under the gums consists primarily of  methyl mercaptan (sewer gas odor) and hydrogen sulfide (rotten egg odor).  Both gasses have been shown to activate protein-dissolving (proteolytic) enzymes that work to destroy the barrier, thus initiating periodontal disease.  Unfortunately, as vital as they are, current home care techniques of brushing and flossing alone are not enough.  They cannot adequately clean under the gums where the stew is, nor can they neutralize VSC, or increase gum-tissue resistance to the proteolytic enzymes.

Once the proteolytic enzymes have initiated the inflammation of gum-disease, this inflammation creates circulating substances called pro-inflammatory cytokines.  The liver modifies these cytokines into C-reactive protein (CRP), a very hazardous entity.  CRP causes clotting and, depending on where the clot occurs, can cause heart attack, stroke, deep vein thrombosis in a leg, or even a pulmonary embolus.  Since CRP is inflammation-induced, any source of inflammation, such as arthritis, can increase CRP levels.  And since gum disease is a major contributor to increased CRP levels in the majority of people, today’s dentist should focus his attention to reducing levels of CRP. 

The Medical profession is currently coming to the conclusion that high CRP levels are as serious a threat to health as cholesterol, and doctors are beginning to screen for this blood element as part of regular health check-ups.  It is a highly predictive marker for signs of inflammation. 

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