Dental professionals are likely aware that periodontal bacteria and systemic health conditions are linked. But why do these links exist, and could treating periodontitis help to reduce rates of other conditions such as dementia?
At the Oral Health Conference 2019, hosted by the British Society of Dental Hygiene and Therapy (BSDHT), Dr Mark Ide gave a lecture on the topic. Entitled ‘Periodontitis, Diabetes, Hearts & Minds’ the seminar was a perfect opportunity for dental hygienists and dental therapists to look at the science behind some of these linked diseases and see what they could do in the future to help patients more. Below is an overview of what was covered.
An ageing population
One of the key points highlighted in the lecture was that we are now living in a fast-ageing population. Due to innovations in healthcare, changes in attitudes to tooth loss and an improvement in the standard of living, people are living longer and also keeping their dentition for a longer period of time. While this is positive news from a functional perspective, it does mean that more people are likely to be attending dental practices with ongoing periodontitis.
One of the key points that Dr Ide put forward in this lecture was that the rates of mild to moderate periodontitis may be going down, but the prevalence of severe disease is, again due to better diagnosis and a tendency to retain teeth, actually on the rise. Even so, levels of disease in all forms are still high in the UK population and this presents a significant public health challenge given our current workforce.
So why is periodontitis such a concern?
The reason that periodontitis remains a concern, beyond the immediate impact on oral health, function and quality of life, is because of evidence from studies showing oral bacteria such as Porphyromonas gingivalis (P. gingivalis) entering the bloodstream. When a patient has periodontitis, actions such as brushing teeth or even chewing gum can transfer these pathogens into the bloodstream through micro-ulcers in the damaged soft tissue.
Here is where the problems begin. As Dr Ide suggested in his session, blood samples taken from patients with severe periodontitis revealed that once these pathogens enter the bloodstream they are then circulated throughout the body. This, in turn, causes the body to produce an inflammatory response, leading to the production of a range of proinflammatory molecules such as C-reactive protein. First linked to oral infection in 1967, C-reactive protein form a part of a normal response to viral and bacterial infections as well as trauma and other causes of tissue damage, and are generally present at low levels in healthy adults, increasing slightly with age. When patients have periodontitis, the body reacts as if it has a constant infection, and therefore continually produces these proteins as a response.
Elevated levels of C-reactive protein have been identified as a risk marker for adverse cardiovascular events, and, according to one study quoted in the lecture, rank well alongside other more commonly known aspects such as cholesterol. Furthermore, periodontal therapy has been shown to have a direct positive impact on markers of blood vessel wall health elsewhere in the body.
Numbers of individuals with diabetes are skyrocketing worldwide, and it’s likely that most professionals will be aware that gum disease progression is much faster in those with the condition. This is because excess glucose sticks to molecules in the blood stream, which either forms fatty acids or C-reactive proteins in the liver, thus causing liver diseases.
Research presented by Dr Ide in the seminar revealed that even a 1% reduction in patients’ blood sugar levels led to a significant improvement in general health. He explained how analysis of research findings has now led NHS England to release Guidelines for Dental care for patients diagnosed with Diabetes (a link to these is available on the BSP website News section), which state that GPs should refer diabetic patients to dental professionals, as treating periodontitis has been shown to help improve metabolic health in patients with type II diabetes.
Periodontitis and cognitive function
One interesting angle raised by Dr Ide’s lecture was an exploration of research surrounding endotoxins and their role in cognitive decline. Dr Ide presented a number of studies that have not only proven that cognitive function can change as a result of an infection, but also that endotoxins, periodontal organisms and proteins produced by these have been found in the brains of Alzheimer’s disease patients. One piece of research that he particularly focused on suggested that when these ideas were tested on mice, exposure to pathogenic periodontal bacteria sped up the progression of Alzheimer’s disease in the affected animals. They also found that if inflammatory responses were suppressed, this slowed down the Alzheimer’s disease progression. Although it is unclear whether a similar improvement would be the case in humans, this still proposes an interesting link that could very well enable dental hygienists and dental therapists to have a huge beneficial impact on people suffering from cognitive disorders.
He ended his session by showing delegates a flow chart that reiterated how inflammation, periodontitis, diabetes, heart diseases and cognitive decline are all linked. This hammered home the point that the impact of oral bacteria may well be more important than anyone previously thought.
Mel Mead, a delegate who attended the lecture, said:
“I found the lecture very informative, and the links to heart disease and diabetes to be very real. This knowledge will help us inform patients in the future.”
Claire Churchett, another delegate in attendance, added:
“This lecture was really informative and potentially very exciting for the future. It is a great way of giving patients information as to how to improve their overall general health.”
More from the BSDHT
Dr Mark Ide’s session was just one of the fantastic lectures at this year’s OHC. If you missed out and want to find out more, please contact the BSDHT for more information today.
For more information about the BSDHT, please visit www.bsdht.org.uk
call 01788 575050 or email email@example.com
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