by Seymour L. Gottlieb, BS, BDS, DDS, member of NOHA's Professional Advisory Board

Research in recent years has broadened the understanding of the relationship of the oral cavity to medical illnesses. Some of these findings are highlighted:

Stroke is the third leading cause of death in the United States. Approximately 40% of the strokes are fatal. Thrombi and emboli are formed at the split between the common carotid and the internal carotid arteries and are the most common cause of strokes (60% of all cases). This area of the neck region, containing these arteries, is visible on dental panoramic X-rays. Calcium deposits inside these blood vessels (arteriosclerosis) show up on these X-rays.⁵ A study of 1,000 male volunteers identified 2% with calcifications, who were then referred to their physicians.

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. . . evidence was presented that people with periodontal disease are 2.7 times more likely to suffer a heart attack than those with healthy gingiva.

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At a recent International Academy of Dental Research meeting⁶ evidence was presented that people with periodontal disease are 2.7 times more likely to suffer a heart attack than those with healthy gingiva.

The role of stress is clear in heart disease. Now a link has been shown between daily stress, coping behavior, and the severity of periodontal disease. Studies by the Universities of Michigan, North Carolina, and New York at Buffalo on 140 individuals ages 25 to 74 found that people with financial strain have more periodontal disease than did others. They concluded that increased stress may weaken natural defense mechanisms making the individual more prone to gingival infection.

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Studies by the Universities of Michigan, North Carolina, and New York at Buffalo on 140 individuals ages 25 to 74 found that people with financial strain have more periodontal disease than did others.

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Pneumonia is a pulmonary infection caused by a wide variety of infectious organisms—bacteria, viruses, mycoplasms, or parasites. The lower airway is normally sterile. Some organisms that comprise the normal bacteria of the mouth (over 300 to 400 different types have been isolated) can be inhaled into the lower airway and cause pneumonia. Dental plaque is a source of concern for these bacteria, especially in patients with periodontal disease. Improved dental hygiene could reduce this risk factor for bacterial pneumonia.^7-9

The human stomach has long been thought to be unsuitable for microorganisms to grow in, due to its acidity. We now know that the bacteria, Heliobacter pylori is especially adapted to live in the stomach and that peptic ulcers and chronic gastritis are strongly associated with the presence of this organism. Treatment consists of antibiotic therapy. However, as many as 80% of the cases relapse and show a return of H pylori. This organism has been found in dental plaque.^10,11 It is not associated with any disease in the mouth but researchers believe that its presence in the mouth could explain the relapse after ulcer treatment. Further studies are in progress to verify this relationship.

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Studies now show that periodontal disease and oral bacterial infections may be risk factors in 18% of all babies born preterm.

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Ten percent of the infants that are born in the United States are at a low birth weight. Numerous factors are associated with this condition. They include age, prenatal care, drug abuse, tobacco and alcohol use, hypertension, diabetes, and multiple pregnancies. Studies now show that periodontal disease and oral bacterial infections may be risk factors¹² in 18% of all babies born preterm.¹³ The way this occurs is that the oral bacterial infection produces increased amounts of endotoxins (formed by bacteria in our bodies) and inflammatory mediators resulting in preterm delivery.¹⁴

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⁵Beck, J. et al, "Periodontal disease and cardiovascular disease," Journal of Periodontal Disease , 67:138-42, 1996.

⁶Genco, R., "identification of periodontal pathogens in atheromatous plaque,"Journal of Dental Research, 76, Abstract #3159, 1997.

⁷Bonten, M. et al, "The stomach is not a source for colonization of the upper respiratory tract and pneumonia in ICU patients," Chest, 105:878-84, 1994.

⁸Yuan, A. et al, "A Actinobacillus actinomycetemcomitans pneumonia with possible septic embolization," Chest, 105:646, 1994.

⁹Zijlstra, E. et al, "Pericarditis pneumonia and brain abscess due to a combined Actinomyces - A. actinomycetemcomitans infection," Journal of Infectious Diseases, 25:83-7, 1992.

¹⁰Keasden, J. et al, "Examination of human stomach biopsies, saliva, and dental plaque for Campylo bacterpylori," Journal of Clinical Microbiology, 27:1397-8, 1989.

¹¹Matmudar, P. et al, "Incidence of Helicobacter pylori in dental plaque of healthy volunteers," Indian Journal of Gastroenterology, 9:271-2, 1990.

¹²Minkhoff, H. et al, "Risk factors for prematurity and premature rupture of the membranes," American Journal of Obstetrics and Gynecology, 150:965-72, 1984.

¹³Offenbacher, S. et al, "Periodontal infection as a possible risk factor for preterm low-birth weight," Journal of Periodontal Disease, 67:1103-13, 1996.

¹⁴Gibbs, R. et al, "A review of premature birth and subclinical infections," American Journal of Obstetrics and Gynecology, 166:1515-28, 1992.