PERIODONTAL (GUM) DISEASE

1. PERIODONTAL (GUM) DISEASE A PUBLIC HEALTH CONCERN LCDR Nellis D. Patterson, BS, RDH Department of Justice Federal Bureau of Prisons FCI Fort Dix, Fort Dix New Jersey

2. OVERVIEW Periodontal (Gum) Disease • Caused by more than 200 species of bacteria. • This disease is commonly ignored • #1 cause of adult tooth loss in the United States • “The prevalence of periodontal disease in the United States may be significantly higher than originally estimated. Research published in the Journal of Dental Research from the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) suggests that the prevalence of periodontal disease may have been underestimated by as much as 50 percent. The implication is that more American adults may suffer from moderate to severe gum disease than previously thought”(Phys.org)

3. LEARNING OBJECTIVES • What is Periodontal Disease • Associations to overall patient health • Management systems and strategies used to prevent and promote oral health that may improve one’s overall health Define risk factors that may associate Periodontal Disease to Heart Disease and Stroke • Smoking • Diabetes • Genetic factors

4. ORAL INFECTIONS & INFLAMMATION Oral Infections • Potentially stress the immune system • Lowering the body’s resistance to infections Oral Infections cause inflammation • Localized inflammation in the oral cavity is associated with the gums, and a systemic inflammatory response may occur in people who also suffer periodontal disease • Previous research stated that treating the individual's periodontal disease may reduce inflammation, and may alleviate some additional symptoms from other chronic illnesses

5. INFLAMMATION • Inflammation is part of a healthy immune response • Continuous stimulation inflammation ( Periodontal issues that are not addressed May cause acute and chronic infections • Eventually these infections may interfere with the body's healthy tissues, increasing the risk of heart attacks, stroke, diabetes, cancer, and autoimmune diseases

6. STAGES OF GUM DISEASE

7. SUPPORTING AND NON-SUPPORTING EVIDENCE “Periodontal disease and heart disease are both inflammatory conditions. There appears to be an association between periodontal disease and heart disease, but it is not yet clear if having one condition increases the risk of developing the other”. The American Journal of Cardiology in 2009 The correlation between Periodontal Disease and chronic illnesses was made years ago when experts noticed that people with gum disease tended to have more heart attacks or strokes than people in better dental health. The thinking was that the bacteria causing the infection in the gums got into the blood stream and traveled to the fatty plaques in blood vessels where they attached and helped form blood clots which can lead to a heart attack or stroke”. (Newsroom.heart.org) “However in a report dated CHICAGO, April 18, 2012 – The American Dental Association (ADA) Council on Scientific Affairs agrees with the conclusions of a recent report that current scientific evidence does not establish a direct cause and effect relationship between gum disease and heart disease or stroke. Additionally, the evidence does not establish that gum disease increases the rate of heart disease or stroke”.

8. THE MOUTH AND BODY CONNECTION Two separate health problems • Periodontal Disease Cardiovascular Disease Both produce  similar biological signs of inflammation • C-reactive proteins • Risk factors for both diseases include age, diabetes, and smoking status These common factors may help explain why diseases of the blood vessels and mouth occur BACTERIAL INFECTIONS • Bacteria (Streptococcus Viridans) responsible for gum disease may enter the bloodstream • Attach to the fatty plaques causing arteries to clog up Infective Endocarditis • An infection found in the heart • manifest within the valves or chambers • Caused by the same bacteria present in the mouth • May responsible for periodontal disease

9. C-Reactive Proteins and & TESTS Inflammation can damage the inner lining of the arteries and make having a heart attack more likely • C-Reactive Proteins are not normally found in the blood of healthy people • C-Reactive Proteins Blood Tests check for infections A special type of C-Reactive ProteinsTest • high-sensitivity CRP test (hs-CRP) May be done to find out if there may be an increased chance of having a sudden heart problem or an attack

10. C-Reactive Protein range / level • Low Risk for Cardiovascular Disease hs-CRP levels are lower than 1.0mg/L • Average Risk for Cardiovascular Disease hs- levels are between 1.0 and 3.0 mg/L • High Risk for Cardiovascular Disease hs-CRP levels are higher than 3.0 mg/L

11. Periodontal Disease Associated with Blood related Cancers Chronic inflammation • A risk factor in many types of cancers Systemic inflammation • Triggered by periodontal diseases along with high levels of nitrate producing bacteria in the mouth of people with periodontal disease may interact with gastric acids to trigger the development of pancreatic cancer. Advanced Periodontitis • C-Reactive Protein levels 30% higher in people with Perio. Dis. as opposed those with normal healthy gingival tissues • May increase malignancy

12. Periodontal Disease Associated with Diabetes Periodontal Disease and Diabetes Especially Type II Diabetes • Have major inflammatory components • Indicators of periodontal disease, are seen more frequently in diabetic patients. Symptoms • Include increased gingival pocket depth • loss of alveolar bone and tooth loss. • Diabetics have poorer glycemic control Hemoglobin A1CTest and scores • Used to monitor the level of glucose control in people with diabetes. • A1c is frequently used to help newly diagnosed diabetics determine how elevated their uncontrolled blood glucose levels have been

13. Periodontal Dis. Associated with Pre-mature & Low Birth Weight Pregnant women w/Periodontal Disease • 7 times more likely to have a baby that is born too early or too small, due to a labor-inducing chemical found in oral bacteria called prostaglandin • Prostaglandins are produced by the body and are • responsible for inflammation. • Prostaglandinsare hormone-like chemicals that are s significant to our well-being High levels of prostaglandins are found in women with severe cases of periodontal disease A Research team of periodontists, obstetrician-gynecologists and epidemiologists emphasized that their findings, based on a detailed analysis of 124 births, were preliminary and needed to be confirmed by “larger prospective multicenter investigations. “Nonetheless, they estimated from their findings that periodontal infection might be responsible for as many as 18 percent of the 250,000 premature babies that are born weighing less than 5.5 pounds in the United States each year (New York Times Women's Health 1996)

14. COMMUNITY DENTISTRY Prevalence of Periodontal Disease • 85% of adults in the United States are affected with some form of Periodontal Disease. Research also indicates that there is a great percentage of the inmate population who come from lower socioeconomic backgrounds Therefore, the overall oral health of patients in a community environment generally is poor, and they are more likely to have advanced periodontal disease • The Federal Bureau of Prisons along with Joint Commission has set standards for inmates that are consistent with the community, and within the correctional environment, it is imperative to promote oral health education • The average patient within the BOP have had little or no treatment prior to their incarceration, and at the time of intervention, many have poor oral hygiene to include significant signs of gum disease ranging from Gingivitis to Periodontitis. Therefore by the time they actually get to us many times the patient is in an advanced state of Periodontitis • .

15. Although it has not been proven that systemic diseases are caused from Periodontal Disease continually Education, Prevention and Early treatment PATIENT CARE MONITORINGPatients who have had heart attacks or who have a family history of heart attacks or have a tendency toward strokesPatient monitoring of the gum health status of patients who have had heart valve problems or have had heart valve replacements Prevention Dental health professionals play a vital role in improving the quality of life in preventing, controlling and reducing oral diseases and conditions as well as promoting healthy behaviors Oral diseases are a major health concern that affect almost every person in The United States. Dental caries and periodontal diseases have a huge economic and social cost and can result in serious systemic problems, pain, and suffering. Most oral diseases are preventable, and promoting oral health is continuing to make every effort to promote and implement preventive measures for all citizens Conclusion

16. REFERENCES 1. American Heart Association (2012) 2. CHICAGO, April 18, 2012 – The American Dental Association (ADA) 3. www.dentistryiq.com/index/display/article-display/7323600486/articles/dentistryiq/f 4. www.newsroom.heart.org/pr/aha/professional-dental-cleanings-217760.aspx 5. www.perio.org/consumer/mbc.heart.htm 6. MedLine Plus, NIH, C-Reactive Protein 7. New York Times, Womens Health October 1996 8. NIH, Ann N Y AcadSci. 2006 Nov;1088:251-64 9. Phys.Org, September 22, 2010 10. (ScienceDaily (Jan. 16, 2007)