Beyond pocket depth: Bacteria, periodontitis, and total body health

As connections between various areas of health are revealed, total body wellness has increasingly become a topic of interest for both health-care providers (HCPs) and patients. While patients may be able to easily find information surrounding the gut-mind connection through mainstream media, data highlighting the mouth-body connection has yet to gain the same traction. In fact, oral health is often overlooked, as more than a third of Americans skip their dental visits.¹ Despite many Americans deprioritizing dental care, oral health is often recognized as a window to overall health, with studies suggesting that periodontal disease may be connected to chronic illnesses such as cardiovascular disease and diabetes.²

Tim Donley, DDS, MSD, and Brett Sealove, MD, FACC, FAHA, RPVI, CPE, both paid consultants for OraPharma, are passionate about shedding light on this connection in hopes of educating fellow HCPs about the importance of medical collaboration when it comes to treating these conditions and empowering patients to take control of their health. In addition to understanding periodontitis and its tie to heart health, they explain why it’s essential to consider how this connection can impact patients and health-care practices.

Understanding periodontitis

Periodontitis is a chronic inflammatory condition that affects the tissues surrounding the teeth, including the gums and bones that support them.³ The condition begins with the oral microbiome. This microbiota activates the mouth’s mini immune system⁴ and contains more than 700 species of bacteria that critically influence the promotion of health or progression toward disease.⁵

When the oral microbiome is imbalanced, it’s referred to as dysbiosis.⁶ In this imbalanced state, certain bacteria called keystone pathogens can initiate a local inflammatory response that results in the destruction of collagen, ultimately leading to the deterioration of the gingiva, periodontal ligament, and bone.³ This can lead to symptoms like red, swollen gums, loose teeth, and bad breath.⁷

“People may think that they’re only at risk for periodontitis if they have poor oral hygiene habits,” says Dr. Donley. “But factors like smoking, genetics, and certain health conditions can also contribute, which is why regular dental visits are vital for early detection.”⁸

While there is no cure for periodontal disease, it can be managed over the lifetime of a patient. Patients can help maintain a healthy oral microbiome by consistently brushing their teeth and flossing, along with their regular dental visits and site-specific treatment when needed.⁸ If left untreated, gum disease can lead to more serious symptoms like gum recession and tooth loss.⁹

The oral-systemic connection and its impact

A balanced oral microbiome is crucial to overall health.⁵ In addition to causing periodontal destruction, periodontal disease may play a role in associated systemic diseases such as cardiovascular disease and diabetes.^2,9 Researchers attribute this to bacteria in the mouth crossing into the bloodstream and entering the heart.¹⁰ Some studies even suggest that people with periodontal disease may have an increased risk for heart attack or other serious cardiovascular events.¹¹

While there isn’t a direct cause-and-effect relationship between periodontal and cardiovascular disease, and additional studies are needed, the data is compelling and has an economic impact on patients’ wallets. Insurance claims data shows that among patients with periodontal disease and heart disease, those who receive adequate care for periodontal disease have 10%–40% lower cardiovascular care costs.¹² It’s also influenced the way HCPs like Dr. Sealove speak with their patients about total body health.

“Since learning about this connection, I’ve been focused on encouraging more medical collaboration across specialties, including dentistry,” said Dr. Sealove. “I encourage my patients to be proactive in staying up to date on their routine dental visits to ensure they are engaged in their overall health and wellness, rather than waiting until they are experiencing issues.”

By recognizing the mouth-body connection, HCPs can work together to educate patients about their overall well-being. Patients, in turn, are encouraged to take an active role in their health care. This type of collaboration promotes a true partnership among HCPs and patients to improve patient outcomes across specialties. 

Editor's note: This article appeared in the May 2024 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Cha AE, Cohen RA. Urban-rural differences in dental care use among adults aged 18–64. NCHS Data Brief. 2021;(412):1-8.
2. Liccardo D, Cannavo A, Spagnuolo G, et al. Periodontal disease: a risk factor for diabetes and cardiovascular disease. Int J Mol Sci. 2019;20(6):1414. doi:10.3390/ijms20061414
3. Kornman KS, Page RC, Tonetti MS. The host response to the microbial challenge in periodontitis: assembling the players. Periodontol 2000. 1997;14:33-53. doi:10.1111/j.1600-0757.1997.tb00191.x
4. Şenel S. An overview of physical, microbiological and immune barriers of oral mucosa. Int J Mol Sci. 2021;22(15):7821. doi:10.3390/ijms22157821
5. Deo PN, Deshmukh R. Oral microbiome: unveiling the fundamentals. J Oral Maxillofac Pathol. 2019;23(1):122-128. doi:10.4103/jomfp.JOMFP_304_18
6. Maitre Y, Micheneau P, Delpierre A, et al. Did the brain and oral microbiota talk to each other? A review of the literature. J Clin Med. 2020;9(12):3876. doi:10.3390/jcm9123876
7. Gum disease information. American Academy of Periodontology. perio.org/for-patients/gum-disease-information
8. Periodontal (gum) disease. National Institute of Dental and Craniofacial Research. Last reviewed 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 Infect Microbiol. 2021;11:766944. doi:10.3389/fcimb.2021.766944
10. Pavlic V, Peric D, Kalezic IS, et al. Identification of periopathogens in atheromatous plaques obtained from carotid and coronary arteries. Biomed Res Int. 2021;2021:9986375. doi:10.1155/2021/9986375
11. Gum 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 therapy on general health: evidence from insurance data for five systemic conditions. Am J Prev Med. 2014;47(2):166-174. doi:10.1016/j.amepre.2014.04.001

Tim Donley, DDS, OraPharma consultant, is a sought-after international speaker and a leader in the areas of gum disease and dental implants. Dr. Donley graduated from the University of Notre Dame, Georgetown University School of Dentistry, and did his residency at Indiana Medical Center. His diagnostic and treatment protocols have been adopted by numerous offices interested in providing the highest level of care to their patients.

Brett Sealove, FACC, RPVI, OraPharma consultant, is a partner at Monmouth Cardiology Associates and the medical director of the noninvasive vascular lab at Monmouth Cardiology. His subspecialties include vascular medicine/imaging and preventive and clinical cardiology. He has done clinical research in interventional cardiology, advanced lipid testing, cardiac imaging, and vascular medicine. Dr. Sealove is the chief of cardiology at Jersey Shore University Medical Center and a core associate clinical professor at Hackensack Meridian School of Medicine.