Dental/Medical History

For decades we have known that a prime indicator for future periodontal breakdown is a past history of periodontal disease. By taking a dental history and evaluation previous x-rays, we have a better understanding about the rate of disease progression and can determine what must be done to prevent further breakdown. In the last decade periodontists have also begun to understand that periodontal disease is a result of bacteria interacting with the patient’s defense systems. How the patient’s body responds to the bacterial plaque depends on the “host” resistance. Some people are fortunate and have minor periodontal disease even with poor oral hygiene. For others, the same amount of bacteria may cause advanced periodontal disease and bone loss.

In other words, certain patients are very susceptible to periodontal disease and these patients must be particularly diligent with their oral hygiene and maintenance to reduce the bacteria challenge. By taking a complete medical history we can determine if the patient has certain risk factors and may modify treatment accordingly.

With periodontal disease, a chronic bacterial infection, there is a higher incidence of bacteria in the bloodstream, which circulates to the various organs of the body. These bacteria may also bind with blood platelets, the clotting components of blood, causing an increase in clot formation in arteries and heart issues. Patients with periodontal disease have a higher risk factor with the following diseases: Recently, elevated C-reactive proteins which measure inflammation in the body have been implicated as a major risk factor in heart disease. The spirochetes and some other pathogens in gum disease are major sources of C-reactive proteins. Together, elevated cholesterol and elevated C-reactive proteins increase heart attack risk by NINE times.

Below are the most significant general health considerations that may affect periodontal disease susceptibility.

In the last decade periodontists have begun to understand that periodontal disease is a result of bacteria interacting with the patient’s defense systems. How the patient’s body responds to the bacterial plaque depends on the “host” resistance. Some people are fortunate and have minor periodontal disease even with poor dental care. Other patients may get advanced periodontal disease and bone loss with the same amount of bacteria. In other words, some patients are much more susceptible to periodontal disease and these patients must be particularly diligent with their oral hygiene and maintenance to reduce the bacteria challenge.

Smokers are at an increases risk for periodontal breakdown and have a seven times greater chance of losing their teeth than non-smokers. Also, the bacteria are able to thrive in the environment of smoker’s mouths and it also slows down potential healing.

It is thought that chronic periodontal disease may increase a person’s likelihood of having a fatal heart attack by nearly TWO fold. Persons with periodontal disease are also more likely to be diagnosed with cardiovascular disease. The increases clot formation seems to be the cause of the higher risk.

Diabetics are at an increases risk for periodontal breakdown. People with Type II diabetes are 3 times as likely to develop periodontal disease as non-diabetics. Not only are diabetics more susceptible, the disease can also alter the pocket environment, contributing to bacterial overgrowth. Smokers with diabetes increase their risk of tooth loss by 20 fold. Fortunately, periodontal treatment is generally successful with the controlled diabetic. Untreated periodontal disease results in elevated blood glucose levels, which increases the diabetic’s risk for other systemic complications, such as kidney and heart disease. Treatment of periodontal disease has been shown to reduce blood sugar levels. Increased diligence with plaque control and periodontal maintenance is key.

Reduction in bone mass has been associated with gum disease and related tooth loss particularly in postmenopausal women. However, clinically we have found that with treatment and follow-up periodontal disease can be successfully.

Women are at higher risk for gum inflammation during puberty, menstruation and the second and third trimester of pregnancy, when there are increased levels of estrogen and other sex hormones. Some women notice their gums bleed easily and are red and puffy. Normally these sympotoms disappear when the levels of circulating hormones decrease and with good plaque control, no permanent damage occurs. Women taking oral contraceptives may also experience these changes in their gums.

A number of medications affect the gums. The classic example is Dilantin, which produces a severe overgrowth of gum tissue in some patients. This makes cleaning the teeth difficult, if not impossible, resulting in periodontal breakdown. Surgically trimming the gum back to the normal shape is often the only solution, but unless the medication can be changed, re-growth almost always occurs. While few patients are on Dilantin, similar gum growth is seen in some patients on calcium channel blockers, drugs commonly used for heart condition. This types of medications include Cardizem, Procardia, Verapimil and several others which can result in overgrown gums that can adversely affect periodontal health and must be closely monitored.

It has been found that one person in four carries a genotype that makes them more susceptible to periodontal disease. Because a periodontist sees advanced cases, he may be reasonably certain that a patient is susceptible and treat accordingly. Being susceptible does not mean teeth will be lost, but rather that plaque control must be ideal and that pockets must be eradicated as completely as possible so daily oral hygiene will access all areas.

If a case is not severe, genetic testing is now available and may be useful to evaluate the patient’s resistance. If he or she is not susceptible, less surgery may be needed, with minor pockets being treated with scaling and root planing and maintained with regular cleaning. If the test is positive, more aggressive treatment and pocket elimination is needed.

Genetic testing is done by taking samples of saliva, which is then submitted for analysis. It is a one-time expense and in certain cases can help formulate the best treatment plan.

When under stress, our bodies produce hormones, like adrenaline and cortisone, which can worsen periodontal disease. An obvious example is “trench mouth”, named because of the severe breakdown experienced by troops in trenches in World War One. This stressful environment often resulted in acutely infected and bleeding gums that were very painful. We now know that under this high stress the normal mouth bacteria composition changed, resulting in an overgrowth of spirochetes that produced the disease. Acute Necrotizing ulcerative Gingivitis (ANUG), is sometimes seen in students during finals or in other high stress situations. These acute conditions are generally easy to treat but the long term stress under which many of us live may make us more susceptible to chronic periodontal breakdown.

Recent research has shown chronic periodontal disease can increase the risk of premature, low birth weight infants by SEVEN times. This risk factor seems to be even greater than that posed by tobacco or alcohol. Pre-term, low birth weight babies are 30 times more likely to die, have much higher incidence of congenital deformities and are much less likely to be healthy. The American Academy of Periodontology recommends a periodontal examination as part of routine prenatal care.

While research is ongoing, it had been shown that the same bacteria found in periodontal disease may cause pulmonary disease. One study found that people with advanced periodontal disease are 4.5 times more likely to have a chronic respiratory disease. It has been suggested that dental plaque buildup creates a source of bacteria that can be inhaled into lungs, leading to pulmonary diseases.

To sum it all up, it can be said that to maintain good general health you must also maintain good periodontal health.

Click here for a PDF of the 21 risk factors associated with periodontal disease and the benefits of treatment