Perioodntal Disease and Alzheimers | Periodontist Long Island

INFLAMMATION LINKED TO ALZHEIMER’S DISEASE

Exposure to inflammation early in life quadruples one’s risk of developing Alzheimer’s disease, said researchers in a presentation on June 19 at the first Alzheimer’s Association International Conference on Prevention of Dementia in Washington.

A research team led by Margaret Gatz, Ph.D. (a professor of psychology at the University of Southern California) and including researchers from the Karolinska Institute in Stockholm, Sweden, sifted through data on the 20,000 participants in the Swedish Twin Registry and found 109 "discordant" pairs of twins in which only one twin had been diagnosed with dementia.

Previous studies by Dr. Gatz and colleagues have shown that Alzheimer’s disease is strongly genetic; if one twin has the disease, his or her identical twin has a 60 percent chance of developing it.

Information about participants’ education, activities and health histories came from surveys they completed in the 1960s, when the registry was created, as well as from hospital discharge records. The surveys included questions about loose or missing teeth. Researchers used the answers to the dental-related questions to build a crude indicator of periodontal disease.

They concluded that an inflammatory burden early in life, as represented by chronic periodontal disease, might have severe consequences later. "If what we’re indexing with periodontal disease is some kind of inflammatory burden, then it is probably speaking to general health conditions," said Dr. Gatz.

If the link between inflammation and periodontal disease is confirmed, researchers said it would add inflammatory burden to the short list of preventable risk factors for Alzheimer’s disease.

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Gum Disease and Diabetes | Periodontist Long Island

Periodontal disease and diabetes go hand in hand. Below s an article that appeared in December 2008 JAMA. If you want to learn how to treat gum disease Long Island conservatively and without cut and stitch surgery visit lilaserperio.com For good information on gum disease on Long Island Suffolk County read here.


Studies Probe Oral Health–Diabetes Link

Tracy Hampton, PhD

PHYSICIANS AND DENTISTS HAVE

long known that the health of an individual’s mouth can have significant effects on the health of the rest

of the body. The link between periodontal disease and heart disease is one of the most commonly known associations, but researchers are finding many more medical reasons to maintain good oral hygiene.

Diabetes, the focus of much attention lately due to its rising incidence, appears to have a particularly close

relationship with conditions within the oral cavity. This relationship seems to go both ways—diabetes can

lead to unwanted changes in the gums and periodontal tissues, and periodontal diseases—including

gingivitis and severe periodontitis— can make it more difficult to control diabetes.

TWO-WAY CONNECTION

A number of recent studies have highlighted the give-and-take relationship between diabetes and oral health (Taylor GW and Borgnakke WS. Oral Dis. 2008;14[3]:191-203). Periodontal disease worsens diabetes when bacteria released into the bloodstream contribute to inflammation.

“There are significant data now to support that if a person has diabetes and they also have periodontal disease that is left untreated, it is very difficult to gain glycemic control of that patient,” said Maria Ryan, DDS, PhD, professor of oral biology and pathology, and director of clinical research at the School of Dental Medicine at Stony Brook University in New York.

For example, an analysis of data from the first National Health and Nutrition Examination Survey (NHANES I) revealed that individuals with periodontal disease were twice as likely to develop diabetes as persons without periodontal disease (Demmer RT et al. Diabetes Care. 2008;31[7]:1373- 1379). Another prospective study, of Pima Indians, a population with a very high rate of type 2 diabetes, found that periodontal disease was a strong predictor of mortality from diabetic nephropathy (Saremi R et al. Diabetes Care. 2005;28[1]:27-32).

When tartar collects above the gumline, it becomes more difficult to thoroughly brush and clean between teeth. This can create conditions that lead to chronic inflammation and infection in the mouth. Researchers suspect that periodontitis may adversely affect glycemic control because the proinflammatory cytokines produced by the infection could enter the bloodstream from the gingival tissues and lead to the development of insulin resistance.

“Periodontal infection affects the health of the teeth and gums, but the body’s response to that infection, we believe, is systemic,” said George Taylor, DrPH, DMD, associate professor of dentistry at the Schools of Dentistry and Public Health at the University of Michigan in Ann Arbor.

These effects may be evident even before clinical diabetes is recognized. As Ryan noted, periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of glycated hemoglobin (HbA1c), which indicates suboptimal glycemic control of diabetes.

Diabetes can contribute to periodontal disease as well. “We also think that the body’s response to infection is exaggerated in people with diabetes—it makes them more susceptible to periodontal disease and makes it more severe,” said Taylor.

Studies looking at the effects of diabetes on periodontal disease have found that diabetes can weaken the connective tissue surrounding the gums and cause various adverse effects in the mouth. An analysis of NHANES III data indicates that women who develop gestational diabetes mellitus during pregnancy are at greater risk for developing periodontal disease than pregnant women who do not develop the condition (Novak KF et al. J Public Health Dent. 2006;66[3]:163-168).

Other oral problems associated with diabetes include salivary gland dysfunction, ulcers, infections, and dental caries. For example, lichen planus, a skin disorder that produces lesions in the mouth, is a condition associated with diabetes. Severe types of lichen planus involve painful ulcers that erode surface tissue. Diminished salivary flow and an increase in salivary glucose levels create an attractive environment for fungal infections such as thrush and oral candidiasis, which occurs more frequently among people with diabetes.

“There are a lot of oral complications of poorly controlled diabetes,” said Ryan. “If your blood glucose levels are high, it also gets into your saliva, which can increase cavities and increase risk of oral candidiasis or yeast infections,” she explained.

Therefore, proper care of the mouth may help patients with diabetes achieve better glycemic control, and appropriate management of diabetes may help prevent periodontal disease and other oral problems. However, while periodontal disease causes significant infection and inflammation of the tissues surrounding and supporting the teeth, individuals often do not know they have the condition because it is usually painless. Therefore, Taylor and others are advocating for a greater awareness of periodontal disease, particularly among physicians whose patients may not regularly visit the dentist.

LINKING HEALTH CARE

Because diabetes can adversely affect oral health and poor oral health can worsen diabetic complications, dentists and physicians are beginning to realize the need to work together to ensure the health of their patients.

“For the first time ever, the American Diabetes Association has recommended to the physician that they ask when their patients last saw a dentist, and if they have not been seen by a dentist in the past year that they should recommend an oral evaluation,” said Ryan. “It’s also important that the dentist inform the physician of any oral infection or inflammation that’s being managed,” she added.

While it is unclear how many physicians and dentists communicate with each other, “as you start to see more information coming out on these connections, more of the medical community is becoming involved in oral care,” said Ryan. For example, Ryan and other dental researchers were invited to speak in June at the American Diabetes Association’s Annual Scientific Sessions in San Francisco, Calif. In addition, Taylor noted that the dentists’ and physicians’ perspectives are also both being represented in continuing education courses.

Health insurers are also realizing the value of linking dental and oral health. For example, Blue Cross Blue Shield of Michigan has created two referral forms, one from dentist to physician and the other from physician to dentist. The insurer also is incorporating preventive dental services into some medical plans.

However, many patients must deal with separate insurers when it comes to their dental and medical care. “Dentists are not reimbursed to screen for diabetes, so from the business side, they’d be spending time for services that cost them but that they’re not reimbursed for,” said Taylor. “The same happens with physicians,” he added.

Taylor noted that this situation highlights the need for more research on the benefits—including cost benefits—of linking medical and dental health. To that end, Taylor and others at the University of Michigan School of Dentistry are collaborating with Blue Cross Blue Shield of Michigan on a research project quantifying the medical savings of good oral care in patients with diabetes.

“We’re looking at costs from submitted medical claims for diabetes patients— physician costs, facility costs, prescription costs—and analyzing what kind of dental services the patient received,” said Carl Stoel, DDS, a senior dental consultant at Blue Cross BlueShield of Michigan. The goal is to compare the medical costs of patients who receive little or no dental services with costs of those who receive routine dental care.

“So far, we’ve found that when diabetic patients are good dental patients, there’s a substantial savings onthe medical side,” Stoel noted.

Specifically, the study has found a cost savings in the range of 3% to 8% for individuals who were receiving regular dental care each year compared with those who were not recipients of any preventive or periodontal services. The cost savings that were seen related to the following diabetes related complications: peripheral vascular disease, coronary heart disease, congestive heart failure, cardiovascular disease, and chronic kidney disease. “I hope that our research will provide the evidence to show that it can make a difference if physicians identify patients at risk for periodontal disease,” said Taylor.

Because many adults have gingivitis or periodontitis, and the incidence of diabetes is increasing, researchers predict that the links between dental disease and diabetes will become even more evident in the years to come. Ongoing studies are anticipated to contribute additional information highlighting the importance of simultaneously treating periodontal disease and optimizing glycemic control to prevent diabetic complications and maintain oral health.




Oral Health Problems Linked to Diabetes

Patients with inadequate blood glucose control appear to develop periodontal disease

more often and more severely, and they lose more teeth than individuals who

have good control of their diabetes. According to the American Dental Association,

the most common oral health problems associated with diabetes are the

following:

• tooth decay

• periodontal disease

• salivary gland dysfunction

• fungal infections

• lichen planus and lichenoid reactions (inflammatory skin disease)

• infection and delayed healing

• taste impairment

Physicians can play a role in encouraging patients’ oral health by recommending

good maintenance of blood glucose levels, a well-balanced diet, good oral care

at home, and regular dental checkups. When glycemia has been difficult to control,

a physician might consider asking patients when they last saw their dentist

and whether periodontitis has been diagnosed.

MEDICAL NEWS & PERSPECTIVES

2472 JAMA, December 3, 2008—Vol 300, No. 21 (Reprinted) ©2008 American Medical Association. All rights reserved.

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Researchers report periodontal disease independently predicts new onset diabetes

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Periodontal disease may be an independent predictor of incident Type 2 diabetes, according to a study by researchers at Columbia University Mailman School of Public Health. While diabetes has long been believed to be a risk factor for periodontal infections, this is the first study exploring whether the reverse might also be true, that is, if periodontal infections can contribute to the development of diabetes. The full study findings are published in the July 2008 issue of Diabetes Care. The Mailman School of Public Health researchers studied over 9,000 participants without diabetes from a nationally representative sample of the U.S. population, 817 of whom went on to develop diabetes. They then compared the risk of developing diabetes over the next 20 years between people with varying degrees of periodontal disease and found that individuals with elevated levels of periodontal disease were nearly twice as likely to become diabetic in that 20 year timeframe. These findings remained after extensive multivariable adjustment for potential confounders including, but not limited to, age, smoking, obesity, hypertension, and dietary patterns.

"These data add a new twist to the association and suggest that periodontal disease may be there before diabetes," said Ryan T. Demmer, PhD, MPH, associate research scientist in the Department of Epidemiology at the Mailman School of Public Health and lead author. "We found that over two decades of follow-up, individuals who had periodontal disease were more likely to develop Type 2 diabetes later in life when compared to individuals without periodontal disease."

Also of interest, the researchers found that those study participants who had lost all of their teeth were at intermediate risk for incident diabetes. "This could be suggestive that the people who lost all of their teeth had a history of infection at some point, but subsequently lost their teeth and removed the source of infection," noted Dr. Demmer. "This is particularly interesting as it supports previous research originating from The Oral Infections and Vascular Disease Epidemiology Study (INVEST) which has shown that individuals lacking teeth are at intermediate risk for cardiovascular disease" said Moïse Desvarieux, MD, PhD, director of INVEST, associate professor and Inserm Chair of Excellence in the Department of Epidemiology at the Mailman School and senior author of the paper.

The contributory role of periodontal disease in the development of Type 2 diabetes is potentially of public health importance because of the prevalence of treatable periodontal diseases in the population and the pervasiveness of diabetes-associated morbidity and mortality. However, observes Dr. Demmer, more studies are needed both to determine whether gum disease directly contributes to type 2 diabetes and, from there, that treating the dental problem can prevent diabetes. In addition to Dr. Desvarieux, David R. Jacobs Jr., PhD, professor in the Department of Epidemiology and Community Health at the University of Minnesota, also contributed to the research.

Source: Columbia University's Mailman School of Public Health

Periodontal Disease and Rheumatoid Arthritis

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Researchers Uncover Higher Prevalence of Periodontal Disease in Rheumatoid Arthritis Patients

Study published in the Journal of Periodontology suggests impaired oral hygiene may only be part of the connection.
CHICAGO—June 5, 2008—Over 1.3 million Americans suffer from rheumatoid arthritis (RA), a chronic, inflammatory disease of the joints. RA is a disabling condition, and can lead to long-term joint damage resulting in persistent pain and loss of function in affected areas. A recent study published in the June issue of the Journal of Periodontology, the official publication of the American Academy of Periodontology (AAP), uncovered yet another potential side effect of RA. Researchers in Berlin, Germany discovered that patients with RA have a higher incidence of periodontal disease compared to healthy controls. Study Abstract *

For some patients, adverse RA symptoms may affect manual dexterity, which can make one’s daily routine quite difficult. One area that may be affected is oral hygiene which can ultimately lead to periodontal disease. However, these research findings indicate that poor oral hygiene alone did not account for the association between RA and gum disease, suggesting that other factors may play a role as well.

The study examined the oral health of 57 RA patients and 52 healthy controls. To determine oral hygiene status, each participant underwent a comprehensive oral examination including an assessment of plaque accumulation and gingival inflammation, both indicators of oral hygiene. Probing pocket depth and clinical attachment loss, two markers of periodontal disease, were also measured. Researchers used questionnaires to gauge the subjects’ risk factors for periodontal disease.

The study findings indicated that RA patients were nearly eight times more likely to have periodontal disease compared to the control subjects. These findings accounted for demographic and lifestyle characteristics such as age, gender, education and tobacco use. Researchers then examined the extent to which poor oral hygiene was connected to the increased occurrence of gum disease in RA patients. The results showed that while oral hygiene was markedly a factor, it did not fully explain the association between the two diseases, suggesting that there may be other parameters responsible for the increased prevalence of gum disease in RA sufferers.

“With results suggesting that rheumatoid arthritis is associated with periodontal disease, it is easy to assume that an RA sufferer is perhaps unable to properly care for his or her teeth and gums due to the debilitating nature of the disease,” says Dr. Kenneth Kornman, editor of the Journal of the Periodontology. “However, this study implies that there are other potential factors involved. For instance, both RA and gum disease are systemic inflammatory disorders which may explain the connection between the two. Inflammation is already thought to link periodontal disease with other conditions such as cardiovascular disease and diabetes. We look forward to future research that may reveal the biological mechanisms that link these two important diseases.”

In an effort to best maintain oral health, RA patients are encouraged to brush and floss on a regular basis and see a dental professional twice a year. If gum disease develops, consulting a periodontist is an effective way to determine the most appropriate course of treatment.

According to Dr. Susan Karabin, President of the AAP, maintaining the complete health of RA patients should be a collaborative effort. “It is critical that dental professionals and medical professionals work together when treating a patient living with rheumatoid arthritis. This partnership will assure that both the oral and overall health of these patients is paramount."