Category Archives: Periodontal Disease

Periodontal Disease Connection to Rheumatoid Arthritis

Recently I wrote about a study that established a connection between Alzheimer’s Disease and periodontal disease. The key finding in the study was the discovery of Porphyromonas gingivalis in the brains of Alzheimer’s patients.

I wanted to give this bacterium a little more attention and reveal its association to a harmful disease: rheumatoid arthritis.

Porphyromonas gingivalis

P. gingivalis is one of many bacteria in the mouth, but when it comes to gum disease it is the prime suspect.  It is known as one of the keystone bacterium which leads to periodontal disease. It has several qualities and tools which aid in destroying the supporting structures of teeth.

One of those tools is an enzyme called collagenase that injures the fibers that attach the teeth to the bone.

P. gingivalis is also very stubborn to antibiotics, due to several features of the bacterium. Specialized enzymes called gingipains help create a food supply engine for the bacteria, and cleverly impair the immune system’s attempts to eradicate it.

In its attempt to invade the structures of the mouth it also clears the way for other bacteria. It does this partly by changing the chemical stability of the oral cavity, which makes the environment more hospitable to infection by other damaging microbes. In this way, P. gingivalis works together with other bacteria known to cause periodontal disease and damage to the supporting structures of teeth.

Connection to Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease where the immune system attacks the body by creating systemic inflammation. It is commonly known to affect flexible joints, but also affects tissues and organs. It can also produce inflammation in the lungs, the membrane around the heart, and the whites of the eyes.

P. gingivalis is linked to Rheumatoid arthritis through an enzyme contained in the bacterium: PAD. One of the things PAD does is convert an amino acid called arginine into another amino acid called citrulline.

RA patients tend to have significant levels of antibodies to citrulline, which reflects a presence of this amino acid, and an immune response to it. Patients with RA tend to also have periodontal disease.

Interestingly, citrulline is also found among the destroyed cells found in Alzheimer’s disease, and in smokers.

Bacteria Must Be Removed by Periodontal Intervention

Gum disease, simplified, is a disease of bacterial infection and inflammation, both which attack and damage the supporting structures of the teeth.

It is becoming more established, year after year, that the damaging effects of periodontal disease are not limited to tooth loss. Exact cause and effect mechanisms are unclear, but the associations between gum disease and systemic diseases such as diabetes, heart disease, Alzheimer’s disease, and rheumatoid arthritis are clear.

Treatment of periodontal disease is not only critical  for keeping and maintaining healthy teeth, it is also an important contributor towards overall systemic health. Regular periodontal cleanings to remove harmful bacteria such as P. gingivalis are also crucial to both oral and systemic health.

Ten Oral Health Reasons to Quit Smoking

Naples Periodontist Smoking Article

Everyone Knows They Should Quit Smoking. Here Are Some Specific Oral Health Related Reasons Why

Regarding Periodontal Disease

  1. The number one risk factor for chronic destructive periodontal disease is smoking.
  2. Smoking is associated with acute necrotizing ulcerative gingivitis (ANUG), otherwise known as trench mouth. This aggressive bacterial infection destroys the gums and is also seen in HIV patients and soldiers who are subjected to long periods of combat stress.
  3. Smoking is associated with periodontal treatment failures and the relapse of oral disease.
  4. The nicotine in smoke decreases vascularity and blood flow to the gums which results in poor healing and nutrition.
  5. Smoking initiates a process of bone loss, attachment loss, pocket formation and eventually tooth loss.
  6. Smoking impairs the immune response to infection which allows periodontal infections to cause more damage.
  7. Smoking interferes with salivary flow, which reduces its antimicrobial property.

Cancer Related Risks

  1. Smoking can mutate and damage invaluable tumor suppressor genes. One known as p53, is sometimes called the “guardian of the genome”, because it can recognize a cell with damaged DNA (which in many cases becomes a cancer cell) and cause it to repair itself, self destruct (apoptosis) or stop multiplying.
  2. Immunosurveillance, the ability of the immune system to seek and destroy initial clones of cancer cells, is diminished in smokers.
  3. Tobacco use is estimated to account for over 90 percent of oral cancer deaths and often results in disfigurement to survivors, which in some cases creates a social death of its own.

Source: Oral Health in America: A Report of the Surgeon General

Gum Disease is More Prevalent Than You Might Think

Periodontal Survey

Periodontal disease is much more prevalent than many people think. Fifty percent of adults over 30 and seventy percent of adults over 65 have periodontal disease.

Periodontitis can lead to tooth loss and there is a systemic connection between gum disease and inflammatory diseases such as diabetes and heart disease.