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The Oral Systemic Connection

15 March 2012

I attended a presentation by Gregory Seymour of the University of Otago who is editor of the journal Periodontology 2000. He was relating how many lifestyle diseases have been found to be caused by bacterial infections. 

Gastric ulceration which was thought to be caused by lifestyle was found to be caused by Helicobacter pylori (for which the two Perth based scientists won their Nobel prize). Chlamydia pneumoniae was the first infectious agent to be linked with cardiovascular disease and now Cytomegalovirus (CMV) has been linked with both cardiovascular disease and various autoimmune diseases.

Over the last few decades periodontal organisms have been associated with cardiovascular disease and a range of other diseases and include things like pre-term low birth weight, diabetes, respiratory disease and can present in the young as chronic cough and in the elderly as pneumonia.

Rheumatoid arthritis has been associated with periodontal disease. Cardiovascular disease  including coronary heart disease, peripheral vascular disease and stroke all been associated with periodontal diseases and oral infections. These cardiovascular diseases are all manifestations of atherosclerosis. It all depends on where the atherosclerosis presents. They account for 40% of deaths worldwide and not associated with traditional risk factors eg. the 30 year old jogger that drops dead after a run.

In short, the research he presented showed that the pathological burden presented by the volume and presence of several common periodontal bacteria in those that present a high level of antibody titres to specific proteins and these bacteria have the highest mortality. eg the risk of death from Type 2 diabetes in those with severe periodontal disease is 3x those without periodontal disease. 

Cochrane review has shown that the improvement from periodontal treatment could result in a 10% reduction in mortality in diabetes. Therefore periodontitis should be considered a modifiable risk factor for diabetes, obesity and cardiovascular disease. Many diabetics still remain undiagnosed.  Increasingly I hope that we will see cardiovascular patients being be referred to dentists for periodontal maintenance by their physicians and work with them to look after their patients.