Current News and Research in Perio-Systemics

Spring 2010

Study Strengthens Association of Gum Disease to CRP

Several studies have shown a relationship between periodontal disease and C-reactive protein (CRP) a biomarker protein often associated with increased risk of heart disease and heart attacks.  Several past studies have shown that subjects with periodontal disease were more likely to have CRP levels higher than their disease-free counterparts.   Now a study in the Journal of Periodontology by Yoshi, et al, shows that patients without high CRP at the beginning of the study had higher CRP levels one year later if they had gum disease.  Moreover, the increase in CRP levels was correlated with the degree of periodontal infection.   This study not only confirms prior studies that found a perio-CRP relationship, but shows that changes in CRP can be predicted by periodontal status.

Blood Sugar Levels Correlate with Pervasiveness of Periodontal Disease

A study out of the Netherlands and published in the Journal of Clinical Periodontology, shows that the more teeth affected by gum disease, the higher the HbA1c.  HbA1c is the most common measure of long-term average blood surga levels.

Gum disease can be localized, affecting only one tooth or a few isolated teeth, or it can be generalized, affecting the entire mouth.  Nesse, et al, found that the larger the surface area of gum tissue infected by periodontal disease, the higher the HbA1c scores were.  This result strengthens and expands our understanding of the relationship between diabetes and gum disease.

Antioxidants and Periodontal Disease

Two studies published last fall discuss antioxidants and gum disease.  The first, by Gumus, et al., shows that Type 1, or insulin-dependant, diabetics had a statistically significant decrease in the antioxidant gluthione.  Further, patients with reduced levels of gluthione had higher probing depths than those with normal antioxidant levels, regardless of their diabetic state.  The authors conclude that lower antioxidant levels may have a roll in gum tissue destruction.

The second paper, by Linden, et al, shows that 60-70 year old Western European men with periodontal disease had significantly lower levels of beta carotene (vitamin A) than those without gum disease.  We’ve all learned that vitamin A is good for your eyes, but it has also been shown to help reduce the risk for cancer and heart disease. 

Together, the studies illustrate that inflammatory diseases such as periodontal disease create oxidative stress, and this reduces the levels of available antioxidants.

Fall 2009

Periodontal Disease Linked to Oral Cancer RiskA study published this September in Cancer Epidemiology, Biomarkers and Prevention provides the first definitive evidence establishing an independent link between chronic periodontal disease and head and neck cancer.  Surprisingly, periodontal disease was more strongly predictive of oral cancer than smoking.  Tizel, et al evaluated 473 patients with squamous cell head and neck cancer (SCCHN) and found that the correlation between periodontal disease was the strongest for cancer in the mouth, followed by cancers found in the throat.  Each millimeter of bone lost around the teeth increased the risk of cancer four fold. 

Chemical Markers Found That Identify Gum Disease

A company called Metabolon has recently completed a study with the Forsyth Institute and Colgate-Palmolive Technology Center that identifies a major pathway for inflammation due to periodontal disease.  According to Lining Guo, and his colleagues, the study identified biomarkers that show tissue destruction is caused by hydrogen peroxide produced by through the “purine degradation pathway.”  Hydrogen peroxide is a chemical often released by white blood cells called macrophages as they attempt to fight infection.  The biomarkers Guo and his team discovered may eventually lead to a saliva test that could predict the aggressiveness of periodontal destruction.

In Genetically Identical Twins, Periodontal Disease Predicts Heart Disease Periodontal disease and tooth loss can be predictive of cardiovascular disease, even after adjusting for genetics which could predispose an individual to heart problems.  A study out of the Harvard School of Public Health compared the risk of having cardiovascular disease between twins from the Swedish Twin Registry.  They found that twins who had lost more teeth than their counterparts had a twofold increase in risk for heart disease.

Summer 2009

Oral Inflammation Linked to Preterm Births

Heimonem, et al reported in the June issue of the Journal of Periodontology that women with oral inflammation were 85% more likely to deliver preterm babies.  Unlike previous studies, this one, conducted on 328 Finnish women, used markers for several oral inflammatory diseases and not just periodontal disease.  The risk reported is in line with several previous studies assessing the risk of just periodontal disease.

Laboratory Study Highlights Diabetes’ Effect on Periodontal Bone Loss

The Journal of the International Academy of Periodontology published a study in its February issue that described the results of inducing periodontal disease and diabetes in laboratory rats.  In the study, the amount of bone loss was significantly higher in the rats with periodontal disease and diabetes than in any other group, including the rats with induced periodontal disease alone.  According to the authors, Gomez, et al, the study highlights the contribution of diabetes to periodontal bone loss.  This study is valuable because it isolates the two diseases in ways that human trials cannot.

Small Study Ferrets Out Link Between hs-CRP and Blood Sugar Levels

A small study from the Tokyo Medical and Dental University Graduate School investigated the effect of periodontal treatment on HbA1C levels, a common measure of average blood sugar levels.  Tatagir, et al reported in the March edition of Diabetes Research in Clinical Practice that unless periodontal treatment lowered hs-CRP levels, the effect on HbA1c levels was not statistically significant.  This agrees with conceptual models that show hs-CRP is a marker for systemic inflammation, which has been shown to increase insulin resistance.  The small sample size used for this study (49 patients) limits the study’s predictive abilities.