Gums are incredibly revealing when it comes to general health. There are a number of known systemic diseases and conditions that can be affected by the health of your gums – the most well researched associations are diabetes, cardiovascular disease and adverse pregnancy outcomes.
Genetics can also play a part: we all know someone who never visits the dentist and doesn’t have a single filling, while others who, despite being mindful about their oral care, are in and out of the dentist regularly.
The bottom line is if you experience any bleeding when brushing or flossing, see your dentist immediately, as this is a sign of inflammation and gum disease (gingivitis leading to periodontitis) – it could also be a sign of a health condition so should always be checked out.
We spoke to Dr Mitul Shah of the Chelsea Dental Clinic to get the lowdown on gums and your general health.
If we maintain good gum health what health benefits may we expect?There are numerous potential benefits to having healthy gums. Patients can expect a lower risk of heart disease, rheumatoid arthritis, diabetes and its associated complications, and potentially a reduced risk of Alzheimers disease.
People with good oral health can be expected to be much more confident when smiling and to have greater satisfaction when performing day to day activities such as eating, talking and socialising. The impact that poor oral health can have on an individual's mental health cannot be underestimated.
Can genetics play a part in the condition of our gums?Gum disease is ultimately a condition that is characterised by the interplay between an individuals’ immune system and patient/lifestyle factors. In susceptible patients, their immune system may respond to aggravating factors such as bacteria, smoking and stress by creating a more prolonged and destructive inflammatory response around the gums.
Disproportionate and chronic inflammation is associated with more severe gum disease and greater loss of bone around the teeth. Ultimately, the determining factor that dictates how your immune system may react is genetics. It is common to see familial and racial aggregation of gum disease cases – up to 65 genes have been identified as being associated with gum disease. The expression of certain genes and subtle changes to genes (polymorphisms) may explain an increased susceptibility to gum disease.
What’s the link between gum health and diabetes?Research has shown a relationship between diabetes mellitus and advanced gum disease, or periodontitis. Patients with diabetes mellitus exhibit more severe and rapidly progressive forms of gum disease when compared to patients without diabetes. Equally, patients with gum disease tend to demonstrate elevated blood sugar levels and thus may be more prone to developing diabetes.
Knowledge about the biological connection between the two conditions is growing day by day. Patients with diabetes and gum disease express higher amounts of pro-inflammatory mediators. Elevated levels of pro-inflammatory mediators can contribute to insulin resistance, worsening your diabetic health. Furthermore, the release of such mediators into the mouth may worsen your gum health.
Diabetes can alter your immune cell function, reducing the effectiveness of protective cells such as neutrophils. Finally, the presence of high blood sugar (hyperglycaemia) can lead to the creation of harmful products referred to as AGEs (advanced glycation end products). These can promote inflammation and can directly lead to the destruction of bone around your teeth.
Thankfully, we know that treating gum disease has the ability to improve diabetic health. A study that was published in The Lancet showed that the meticulous treatment of gum disease in patients with severe diabetes reduced their HbA1c by up to 0.6 per cent. This is comparable to treatment with some types of medication.
The HbA1c is a long term measure of your diabetic health – for every per cent that the HbA1c is elevated, your risk of complications from diabetes, including death, is raised by 21 per cent.
Why are healthy gums beneficial to heart health?A recent consensus report between the European Federation of Periodontology and the World Heart Federation has shown significant evidence to support an association between advanced gum disease and cardiovascular diseases.
Patients with advanced gum diseases have a greater prevalence of coronary artery disease, heart attacks, stroke, atrial fibrillation and heart failure. It is proposed that the release of bacteria into the bloodstream in patients with gum disease plays a key role in the onset and progression of cardiovascular diseases.
Oral bacteria have been identified within atherosclerotic tissues which can lead to the development of disease. Specific bacteria such as p.gingivalis have been shown to directly induce the formation of fatty streaks within arteries and the formation of coronary lesions.
Why do pregnant women need to be especially mindful?It has been shown that pregnant women with gum diseases are more likely to experience pre-eclampsia, low birth weight babies and premature birth.
Women are much more likely to develop both milder forms of gum disease (gingivitis) as well as more advanced forms (periodontitis).
The exact mechanisms to explain the associations are similar to those explained in cardiovascular disease. Bacteria from the oral cavity have been found within the placenta – it is believed these bacteria may induce inflammation of the foeto-placental unit which may explain the increased risk of adverse outcomes.
Hormonal changes may predispose expectant mothers to increased inflammation of the gums.
Is there a connection between gum disease and Covid-19?Since the onset of the Coronavirus pandemic there have been a number of studies outlining abnormal presentations of Covid-19. Some case reports have shown that Covid-19 may manifest as severe forms of gum disease known as ’necrotising periodontitis’.
Although there is limited evidence on the subject, a case control study in Qatar showed that patients with advanced gum disease were associated with an increased risk of complications related to Covid-19. These include a 3.5x increased risk of admission to ICU, a 4.5x increased risk of requiring assisted ventilation and an 8x increased risk of death.
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