Are the Bacteria in Your Mouth Making You Sick?  

Are the bacteria in your mouth making you sick? In the past six years, there have been many studies that strongly associate poor dental health with heart disease, preterm low birth weight infants, and early death from any and all causes. This revelation is nothing new, although we are excited about it. Almost 100 years ago, Sir William Osler (after whom Osler Drive at St. Joseph 's Hospital is named) proposed infection as the cause of heart disease. His idea dropped from the teaching of the causes and treatment of heart disease, but it has been re-examined recently. One of the spurs to the renewed interest in the idea that infection is a cause of heart disease was the discovery that closing and blocking of the arteries (the leading cause of death in the United States ) can be produced in chickens following an infection with a herpes virus.  

Research from Finland , published in 1992 and replicated in the United States , showed a correlation between periodontal disease and coronary disease, primarily in younger rather than older people.  

A study of infection of the heart tissue published in the British Heart Journal stressed that a great effort should be made to encourage people to seek better dental care to reduce the introduction of bacteria that cause disease into the bloodstream (a "bacteremia"). These findings suggest that dental disease and oral hygiene (how you take care of your teeth at home) practices may be more important than dental treatments in causing an asymptomatic bacteremia. In the Journal of Clinical Infectious Disease, Dr. Wahl reviewed the literature on prosthetic joint infections (for example, hip and knee replacements) and concluded that it is not dental treatment but rather dental disease that contributes to joint infections. If one has poor oral hygiene, the numbers of bacteria on the teeth could increase two- to ten-fold. This could lead to the introduction of more bacteria into the tissues and the blood stream.

 It is the ability of dental disease to cause a bacteremia that links dental disease with heart disease. Any bacteremia can cause a host to develop an increase in the white blood cell count, triggering a series of events that affect platelet clotting and changes in blood coagulation. These initiate the formation of raised patches (atheromas) on the walls of blood vessels.

 It has long been known by medicine and dentistry that the bacteria in the mouth can cause a life-threatening infection known as "sub-acute bacterial endocarditis (SBE)". In fact, people with mitral valve prolapse or rheumatic heart disease have been pre-medicated with antibiotics before dental cleanings or preventive appointments for years. This is to prevent pathogenic bacteria from settling on the valves, which are rough from previous infection. If the bacteria settle on the valves, they can start an infection that may kill the person. It has been revealed in recent research that the vast amount of deaths from SBE result not from dental appointments but from simple activities such as brushing one's teeth or eating rough or chewy foods. Again, prevention and elimination of these bacteria is the best way to avoid SBE. The value of antibiotics in dentistry, at least to prevent bacterial problems for the heart, is of dubious value, which gives even more credence to eliminating the bacterial pathogens from the mouth in the first place. The March, 2000 issue of the Journal of the American Dental Association has an article that basically states that the use of antibiotics in dentistry to prevent subacute bacterial endocarditis is hugely unnecessary.

 In a seven-year prospective study in the Journal of Clinical Infectious Disease, only dental disease, the number of previous heart attacks, and, to a lesser extent, the body mass index were significantly associated with the risk of a heart attack or stroke. Traditional risk factors such as diabetes, high blood pressure, smoking, total cholesterol levels, HDL cholesterol levels, triglycerides, socioeconomic status, gender, and age were not significantly related. These findings make dental disease a major risk factor and raise the possibility that certain traditional risk factors such as smoking, age, and socioeconomic status may have been surrogates for dental disease in previous studies. (However, smoking is a major risk factor for periodontal disease and tooth loss).

In 1996, it was reported in the Journal of Periodontology that periodontal disease was seven times more likely to be associated with preterm delivery of a low birth weight infant than age, race, number of live births, use of tobocco or alcohol, history of prenatal care, or bacterial vaginosis. Walther Loesche, DMD, PhD, of the University of Michigan School of Dentistry, has pointed out that the associations between dental disease and medical diseases might seem gratuitous, simply reflecting a negligent lifestyle. An individual who smokes, drinks, and eats excessively is not likely to practice good oral hygiene. Yet, these associations persisted in three major studies after adjusting for one or more of these risk factors. Dr. Loesche concluded that "In fact, when a dental component is included in the modeling procedures, it is often the most significant parameter in the model, and in the Finnish national data, displaced smoking as a risk factor. Clearly something is occurring above and beyond lifestyle behavior and attitudes" (italics added).

In the past few years it has been reported in several sources that some stomach ulcers are caused by the bacterial heliocobacter pylori. This is a bacterium that is often asociated with periodontal disease. It has been successfully eradicated with antibiotics. Treating and healing periodontal disease will not necessarily get rid of stomch ulcers, but it will not make them worse! In fact, to treat stomach ulcers with antibiotics, in my opinion, must be done concurrently with the treatment of periodontal disease. The antibiotic treatment of stomach ulcers has reportedly been very successful; however, if the periodontal disease is not treated, the stomach ulcers are more likely to come back.

It has been reported in several studies that the number one cause of death in nursing homes is "aspiration pneumonia". Bacteria that live without oxygen cause this infection (anaerobic bacteria). Ironic when the infection occurs in the lungs, isn't it? Where do these bacteria come from? Many of us believe that they come from the same anaerobic bacteria that caue periodontal disease. In elderly, debilitated individuals who already have a compromised immune system, this infection is just too much. So, clearing up any periodontal infection (or preventing it in the first place) may be the number one way of prolonging life in the elderly!

The main cause of tooth loss is periodontal disease. Missing teeth are a contributing factor to dietary problems. People with so many missing teeth that they cannot properly chew will often change their food selection. They tend to consume low-fiber, high-calorie, easily chewable food that is low in nutrients. It's no secret that, as the number and quality of teeth decreases, the percentage of people who make poor decisions in their food selection patterns increases. It is well established that, with poor nutrition, all three of the major disease entities mentioned throughout this article are made more likely. Without teeth, you just cannot get a proper diet. So periodontal disease causes major medical problems both directly and indirectly.

Another disease entity that appears to be caused or made worse by periodontal disease is maxillary sinusitis. Abrahams and Glassburg demonstrated a twofold increase in maxillary sinus disease in patients with periodontal disease. Just how is gum disease related to sinus infection? If you were able to see inside your head, you would see that sinuses are holes which are formed by a very thin (about as thick as paper) layer of bone. The roots of the teeth often stick up into this bone; however, they usually don't penetrate the bone. If there is a gum infection, the bacterial toxins can erode through the bone, and the sinus will be infected. Obviously, not all sinus infections are caused by gum disease or abscessed teeth; however, if you are subject to recurring sinus infections, you might want to seek out the opinion of a dentist, especially one equipped with a microscope.

Diabetes is a medical condition that is not caused by periodontal disease, but rather it complicates the treatment of periodontal disease. If you or anyone you know is diabetic, it is extremely important that you prevent, control, or eliminate periodontal disease as soon as possible. Just like diabetes complicates other medical conditions because the body cannot heal itself effectively, diabetes also will not let the body fight periodontal disease, thus complicating even further the medical conditions that already exist. The treatment for a diabetic is no different than for anyone else; however, it may be even more important.

Periodontal disease is a bacterial infection. It can be prevented, and it can be treated. I have addressed the treatment several times in The Baltimore Resources Journal, and you might recall that I am not a fan of periodontal surgery as a primary treatment regimen for a bacterial infection. I also believe that a dentist or hygienist must find signs of the marker bacteria (those that, when found in a microscopie survey, indicate disease) in order to make a diagnosis of early periodontal disease.

All of these ideas of how dental disease affects the rest of our bodies should not be a surprise to those of us who have a "holistic" view of the body. What happens in one part of this wonderful machine that we call the body wil cause certain events to happen in other parts. The really sad part of this is that these dental diseases are so readily accessible to prevention and treatment. Your role as dental clients must be to insist that the dentist be aware of these cause/effect relationships and approach your treatment with a holistic view in mind. Don't wait until the effects are irreversible. And if there are signs or symptoms of any of these problems, get treatment now!

 In summary, Dr. Loesche had it right when he said, "Poor oral hygiene, leading to dental infections, could contribute to adverse medical outcomes such as cardiovascular disease, death, and preterm delivery of low birth weight infants. Put in this context, the maintenance of oral health should receive the highest priority for the maintenance of a healthy life".

Written and published by Thomas E. Baldwin, D.D.S., M.A.G.D., Fall, 1998