Gum Disease And The Oral Systemic Link

“Periodontal disease has been linked to rheumatoid arthritis, pre-term birth, cardiovascular disease, diabetes, stroke and even cancer.” 

Healthy (Left) vs. Gum Disease (Right)

I see lines written just like this all the time. For someone who has been actively involved in the dental industry, a line like that is pretty easy to digest, but I know a good many people who would stop reading after the word periodontal.  It can be a bit jarring to remember that not everyone understands the oral systemic link, so I want to explain it in a way that makes sense. 

Periodontal disease, also known as gum disease, is an infection of the gums that is caused by a select group of bacteria, and often influenced by other factors, both controllable (dental hygiene, smoking, alcohol use) and uncontrollable (genetics).  The infection begins when bacteria attach to the surface of the tooth and begin to grow into a complex microbial community known as a biofilm. As these networks of bacteria grow and age, they can harden, forming what is commonly known as dental plaque.  Our oral hygiene practices have developed to the point that we can usually deal with the plaque that we can see.  When plaque accumulates below the gumline, however, we face an infection that we can’t address – a very different scenario.  This hidden plaque (known as calculus to dental pros) is the reason that you should see your hygienist on a regular basis.  The deep cleanings they provide are designed to remove large deposits of calculus, directly targeting the disease process that causes bleeding, inflammation, pain, bad breath and receding gums. 

So there was gum disease in a nutshell – bacteria grow on the teeth, and they cause damage.  Seems pretty simple, right?  But how does that relate to all of the ailments (rheumatoid arthritis, pre-term birth etc.) listed at the beginning of this entry?  Let’s go back to the set of symptoms that I listed off.  The last two are mostly cosmetic, and pain can’t really be linked to any systemic effects.  Bleeding and inflammation, however, are two extremely relevant symptoms. 

Bleeding gums are not normal and should not be treated as such – no one would walk around with bleeding cuticles and think it was healthy.  Bleeding gums indicate that there is an opening to the bloodstream in the mouth.  Think about this for a second.  This is why you wear bandages over open wounds – keeping things out is essential to preventing infection.  Unfortunately, we can’t bandage our gums.  To make matters worse, if the gums are bleeding, there is almost certainly an infection right next to the opening to the circulatory system.  It has been shown that bacteria can migrate into this opening, with measurable increases of blood borne bacteria occurring during processes as benign as tooth brushing.  It has also been determined that oral bacteria are often found in the heart tissue and arteries of those suffering from cardiovascular disease[1].  The translocation of bacteria from the mouth could be involved in many more disease processes than we are currently aware of. 

Inflammation can be a misleading symptom, in that it is not always a direct result of the infection, but more often a result of our immune response to the problem.  Unfortunately, our bodies aren’t very familiar with the concept of collateral damage, and the weapons we deploy to eliminate the threat often hurt our own cells.  The innocent bystander in gum disease is the bone structure that anchors the teeth.  As the infection progresses, the waves of immune cells and molecules eventually degrade bone, ultimately resulting in tooth loss.  Interestingly, a number of the inflammatory factors that worsen periodontal disease are found in patients with other inflammatory disorders, such as rheumatoid arthritis.  A recent study has even shown that treating periodontal disease can reduce the severity of rheumatoid arthritis.[2] 

This subject is too vast to discuss in a blog, but I would like to steer readers to a particularly good source of information from Scientific American and Procter & Gamble known as Oral and Whole Body Health.  If you’re looking for an in-depth resource, refer to the recently published Periodontal Disease and Overall Health: A Clinician’s Guide, sponsered by Colgate, and co-edited by Periowave Clinical Advisory Board member Dr. Robert Genco.

  1. Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J Periodontol 2000;71:1554-1560
  2. P. Ortiz, N.F. Bissada, L. Palomo, Y.W. Han, M.S. Al-Zahrani, A. Panneerselvam, and A. Askari.  Periodontal Therapy Reduces the Severity of Active Rheumatoid Arthritis in Patients Treated With or Without Tumor Necrosis Factor Inhibitors.  J Periodontol 2009;80:535-540.
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