Beyond Pocket Depth: Bacteria, Periodontitis, and Systemic Health

OraPharma paid consultants Dr. Tim Donley, DDS, MSD, and Dr. Brett Sealove, MD, FACC, FAHA, RPVI, CPE, are passionate about uncovering this connection and want to educate fellow HCPs on the importance of care collaboration when it comes to treating these diseases and enhancing patient health management. In addition to understanding the connection between periodontitis and heart health, they explain why it is essential to consider how this relationship impacts patients and clinical practice.

Understanding Periodontitis

Periodontitis is a chronic inflammatory disease that affects the tissues surrounding the teeth, including the gums and bone that support the teeth.³ The disease begins in the oral microbiome, which activates a mini-immune system in the mouth.^Four It contains over 700 species of bacteria that have significant effects on promoting health and disease progression.^Five

When the balance of the oral microflora is disturbed, it is called dysbiosis.⁶ In this imbalanced state, certain bacteria, called keystone pathogens, trigger a local inflammatory response, causing collagen destruction and ultimately leading to deterioration of the gums, periodontal ligament and bone.³ This can result in symptoms such as red and swollen gums, loose teeth, and bad breath.⁷

“Some people may think that they are only at risk for periodontitis if they have poor oral hygiene habits,” says Dr. Donley, “but factors such as smoking, genetics and certain health conditions can also contribute to periodontitis, so regular dental checkups are essential for early detection.”⁸

There is no cure for periodontal disease, but it can be managed throughout a patient’s life by regular visits to the dentist, receiving targeted treatment when needed, and consistently brushing and flossing to help keep the oral microbiome healthy.⁸ If left untreated, periodontal disease can lead to more serious conditions, such as gum recession and tooth loss.⁹

The connection between the oral cavity and the whole body and its effects

The balance of the oral microbiome is crucial to overall health.^Five Periodontal disease not only causes destruction of periodontal tissues but can also contribute to related systemic diseases such as cardiovascular disease and diabetes.^2,9 Researchers believe this is because bacteria in the mouth can enter the bloodstream and then travel to the heart.^Ten Some studies even suggest that people with periodontal disease may be at increased risk for heart attack and other serious cardiovascular diseases.¹¹

Although there is no direct causal relationship between periodontal disease and cardiovascular disease and further research is needed, the data is compelling and has a financial impact on patients’ wallets: Insurance claims data shows that among patients with periodontal disease and heart disease, those who receive appropriate treatment for their periodontal disease have 10%-40% lower cardiovascular care costs.¹² This is also impacting how health care professionals like Dr. Sealove talk to patients about whole-body health.

“Since learning about this connection, I have focused on fostering medical collaboration between specialties, including dentistry,” says Dr. Sealove. “I encourage my patients to be proactive about their overall health and wellness by proactively scheduling regular dental checkups rather than waiting until a problem arises.”

Recognizing the connection between the mouth and the body allows healthcare professionals to work together to educate patients about their overall health. Patients are encouraged to take an active role in managing their health. This collaboration fosters a true partnership between healthcare professionals and patients, improving patient outcomes across specialties.

Editor’s note: This article appeared in the May 2024 issue. Dental Economics Magazine. Print subscriptions are available free of charge to dentists in North America. Apply here.

References

1. Cha AE, Cohen RA. Urban-rural differences in dental care utilization among adults aged 18-64 years. NCHS Data Summary. 2021;(412):1-8.
2. Liccardo D, Cannavo A, Spagnuolo G, et al. Periodontal disease: a risk factor for diabetes and cardiovascular disease. International Journal of Molecular Science2019;20(6):1414. doi:10.3390/ijms20061414
3. Kornman KS, Page RC, Tonetti MS. Host response to microbial challenge in periodontitis: bringing together the players. Periodontol 20001997;14:33-53. doi:10.1111/j.1600-0757.1997.tb00191.x
4. Şenel S. An overview of the physical, microbiological and immune barriers of the oral mucosa. International Journal of Molecular Science2021;22(15):7821. doi:10.3390/ijms22157821
5. Deo PN, Deshmukh R. The oral microbiome: unraveling the fundamentals. Oral and Maxillofacial Pathology2019;23(1):122-128. doi:10.4103/jomfp.JOMFP_304_18
6. Maitre Y, Micheneau P, Delpierre A, et al. Do the brain and oral microbiomes interact with each other? A literature review. Medical Journal2020;9(12):3876. doi:10.3390/jcm9123876
7. Periodontal Disease Information. American Academy of Periodontology. perio.org/for-patients/gum-disease-information
8. Periodontal Disease (Gum Disease). National Institute of Dental and Craniofacial Research. Last updated: October 2023. https://www.nidcr.nih.gov/health-info/gum-disease
9. Sedghi LM, Bacino M, Kapila YL. Periodontal disease: the good, the bad and the unknown. Front cell infection microorganisms. 2021;11:766944. doi:10.3389/fcimb.2021.766944
10. Pavlic V, Peric D, Kalezic IS, et al. “Identification of peripheral pathogens in atherosclerotic plaques from carotid and coronary arteries.” Biomedical Research International.2021;2021:9986375. doi:10.1155/2021/9986375
11. Periodontal Disease and Heart Disease: The Common Thread. Harvard Health. February 15, 2021. https://www.health.harvard.edu/heart-health/gum-disease-and-heart-disease-the-common-thread
12. Jeffcoat MK, Jeffcoat RL, Gladowski PA, Bramson JB, Blum JJ. Impact of periodontal treatment on systemic health: evidence from insurance data for five systemic diseases. Am J Prev Med2014;47(2):166-174. doi:10.1016/j.amepre.2014.04.001

Tim Donley, DDS, OraPharma Consultant, Dr. Donley is an internationally sought-after speaker and leader in the fields of periodontics and dental implants. Dr. Donley graduated from the University of Notre Dame, Georgetown University School of Dentistry, and completed his residency at the Indiana Medical Center. His diagnostic and treatment protocols have been adopted by many practices interested in providing the highest level of care to their patients.

Brett Searab, FACC, RPVI, OraPharma Consultant; Dr. Searab is a Partner at Monmouth Cardiology Associates and Medical Director of Monmouth Cardiology’s Non-Invasive Vascular Lab. His areas of expertise are Vascular Medicine/Imaging and Preventive and Clinical Cardiology. He has conducted clinical research in interventional cardiology, advanced lipid testing, cardiac imaging and vascular medicine. Dr. Searab is Chief of Cardiology at Jersey Shore University Medical Center and a Clinical Associate Professor at Hackensack Meridian School of Medicine.