More Evidence Ties Gum Disease With Heart Disease

New research offers further evidence of a link between gum disease and heart disease.

The ongoing Swedish study previously found that gum disease (“periodontitis”) was much more common in first-time heart attack patients than in a group of healthy people.

In this follow-up study, the researchers examined whether gum disease was associated with an increased risk of new heart problems in both heart attack survivors and healthy people the same age and sex, and living in the same area.

“The risk of experiencing a cardiovascular event during follow-up was higher in participants with periodontitis, increasing in parallel with the severity. This was particularly apparent in patients who had already experienced a [heart attack],” said study author Giulia Ferrannini, from the Karolinska Institute in Stockholm.

The researchers suspect that damage to the gum tissue in people with gum disease may allow germs to enter the bloodstream. “This could accelerate harmful changes to the blood vessels and/or enhance systemic inflammation that is harmful to the vessels,” Ferrannini added.

In total, the study included nearly 1,600 participants with an average age of 62. Dental examinations between 2010 and 2014 showed that 985 had good dental health, 489 had moderate periodontitis and 113 had severe periodontitis.

During an average follow-up of just over six years, people with gum disease were 49% more likely to die from any cause, have a nonfatal heart attack or stroke, or to develop severe heart failure.

The risk of those outcomes increased with the severity of gum disease, according to the study presented Friday at a virtual meeting of the European Society of Cardiology. Such research is considered preliminary until published in a peer-reviewed journal.

When assessed separately, the relationship between gum disease severity and the risk of negative outcomes was significant only for those who had experienced a heart attack in the past.

“Our study suggests that dental screening programs including regular check-ups and education on proper dental hygiene may help to prevent first and subsequent heart events,” Ferrannini concluded in a meeting news release.

Source: HealthDay

Research Shows Links Between Gum Disease and Alzheimer’s

Don’t forget to floss: New research adds to evidence linking gum disease with Alzheimer’s disease.

The mouth is home to both harmful bacteria that promote inflammation and healthy, protective bacteria, the study authors explained.

In the new study, the researchers found that people who have more harmful than healthy gum bacteria were more likely to also have a protein marker for Alzheimer’s disease, known as amyloid beta, in their cerebrospinal fluid (CSF).

“To our knowledge, this is the first study showing an association between the imbalanced bacterial community found under the gumline and a CSF biomarker of Alzheimer’s disease in cognitively normal older adults,” said lead author Dr. Angela Kamer. She’s associate professor of periodontology and implant dentistry at New York University College of Dentistry, in New York City.

“We found that having evidence for brain amyloid was associated with increased harmful and decreased beneficial bacteria,” she said in a university news release.

About 70% of adults aged 65 and older have gum disease, which involves chronic and systemic inflammation.

Alzheimer’s is marked by two proteins in the brain: amyloid beta and tau. Amyloid beta clumps together to form plaques and is believed to be the first protein deposited in the brain as Alzheimer’s develops. Tau builds up in nerve cells and forms tangles.

According to senior study author Mony de Leon, “The mechanisms by which levels of brain amyloid accumulate and are associated with Alzheimer’s pathology are complex and only partially understood.” He is director of the Brain Health Imaging Institute at Weill Cornell Medicine in New York City.

The new study adds support to the understanding that pro-inflammatory diseases disrupt clearance of amyloid from the brain, de Leon said.

“Amyloid changes are often observed decades before tau pathology or the symptoms of Alzheimer’s disease are detected,” he added.

For the study, 48 patients aged 65 or older with normal thinking abilities had oral exams and spinal taps.

The researchers analyzed DNA in bacterial samples taken from under the participants’ gumlines. Then a lumbar puncture was done to obtain CSF to determine levels of amyloid beta and tau.

The investigators looked for lower levels of amyloid beta, which translate to higher brain amyloid levels, and higher levels of tau, which reflect higher brain tangle accumulations.

The results showed that individuals with more harmful than healthy bacteria were more likely to have reduced amyloid levels in their spinal fluid.

The researchers hypothesized that because high levels of healthy bacteria help maintain bacterial balance and decrease inflammation, they may be protective against Alzheimer’s.

Kamer said, “Our results show the importance of the overall oral microbiome — not only of the role of ‘bad’ bacteria, but also ‘good’ bacteria — in modulating amyloid levels. These findings suggest that multiple oral bacteria are involved in the expression of amyloid lesions.”

The team did not find an association between gum bacteria and tau levels in this study.

Additional research will include a long-term study and clinical trial to test if deep cleanings to remove deposits of plaque and tartar from under the gumline can modify brain amyloid and prevent Alzheimer’s, the authors said.

The findings were published in the journal Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring.

Source: HealthDay

People with Severe Gum Disease May be Twice as Likely to Have Increased Blood Pressure

Adults with periodontitis, a severe gum infection, may be significantly more likely to have higher blood pressure compared to individuals who had healthy gums, according to new research published today in Hypertension, an American Heart Association journal.

Previous studies have found an association between hypertension and periodontitis, however, research confirming the details of this association is scarce. Periodontitis is an infection of the gum tissues that hold teeth in place that can lead to progressive inflammation, bone or tooth loss. Prevention and treatment of periodontitis is cost effective and can lead to reduction of systemic markers of inflammation as well as improvement in function of the endothelium (thin membrane lining the inside of the heart and blood vessels).

“Patients with gum disease often present with elevated blood pressure, especially when there is active gingival inflammation, or bleeding of the gums,” said lead study author Eva Muñoz Aguilera, D.D.S., M.Clin.Dent., senior researcher at UCL Eastman Dental Institute in London, United Kingdom. “Elevated blood pressure is usually asymptomatic, and many individuals may be unaware that they are at increased risk of cardiovascular complications. We aimed to investigate the association between severe periodontitis and high blood pressure in healthy adults without a confirmed diagnosis of hypertension.”

The study included 250 adults with generalized, severe periodontitis (≥50% of teeth measured with gum infection) and a control group of 250 adults who did not have severe gum disease, all of whom were otherwise healthy and had no other chronic health conditions. The median age of the participants was 35 years, and 52.6% were female. The research was completed in collaboration with the department of dentistry at the Universitat Internacional de Catalunya in Barcelona, Spain.

All participants underwent comprehensive periodontal examinations including detailed measures of gum disease severity, such as full-mouth dental plaque, bleeding of the gums and the depth of the infected gum pockets. Blood pressure assessments were measured three times for each participant to ensure accuracy. Fasting blood samples were also collected and analyzed for high levels of white blood cells and high sensitivity C-reactive protein (hsCRP), as both are markers of increased inflammation in the body. Additional information analyzed as confounders included family history of cardiovascular disease, age, body mass index, gender, ethnicity, smoking and physical activity levels.

The researchers found that a diagnosis of gum disease was associated with higher odds of hypertension, independent of common cardiovascular risk factors. Individuals with gum disease were twice as likely to have high systolic blood pressure values ≥140 mm Hg, compared to people with healthy gums (14% and 7%, respectively). Researchers also found:

  • The presence of active gum inflammation (identified by bleeding gums) was associated with higher systolic blood pressure.
  • Participants with periodontitis exhibited increased glucose, LDL (“bad” cholesterol), hsCRP and white blood cell levels, and lower HDL (“good” cholesterol) levels compared to those in the control group.
  • Nearly 50% of participants with gum disease and 42% of the control group had blood pressure values for a diagnosis of hypertension, defined as ≥130/80 mmHg.

“This evidence indicates that periodontal bacteria cause damage to the gums and also triggers inflammatory responses that can impact the development of systemic diseases including hypertension,” said corresponding author Francesco D’Aiuto, D.M.D., M.Clin.Dent., Ph.D., professor of periodontology and head of the periodontology unit at the UCL Eastman Dental Institute. “This would mean that the link between gum disease and elevated blood pressure occurs well before a patient develops high blood pressure. Our study also confirms that a worryingly high number of individuals are unaware of a possible diagnosis of hypertension.”

D’Aiuto added, “Integration of hypertension screening by dental professionals with referrals to primary care professionals and periodontal disease screening by medical professionals with referrals to periodontists could improve detection and treatment of both conditions to improve oral health and reduce the burden of hypertension and its complications. Oral health strategies such as brushing teeth twice daily are proven to be very effective in managing and preventing the most common oral conditions, and our study’s results indicate they can also be a powerful and affordable tool to help prevent hypertension.”

This study did not account for other factors that may also impact blood pressure, such as abdominal obesity, salt intake, use of anti-inflammatory medications, hormone treatments or stress, or any other oral health conditions.

Source: American Heart Association

Changing the Stem Cell Response to Inflammation May Reverse Periodontal Disease

Periodontal disease, also known as gum disease, is a serious infection that affects nearly 50 percent of Americans aged 30 years and older. If left unchecked, periodontal disease can destroy the jawbone and lead to tooth loss. The disease is also associated with higher risk of diabetes and cardiovascular disease.

The current treatment for periodontal disease involves opening the infected gum flaps and adding bone grafts to strengthen the teeth. But in new research published recently in the journal Frontiers in Immunology, Forsyth Institute scientists have discovered that a specific type of molecule may stimulate stem cells to regenerate, reversing the inflammation caused by periodontal disease. This finding could lead to the development of new therapeutics to treat a variety of systemic diseases that are characterized by inflammation in the body.

For the study, Dr. Alpdogan Kantarci, his PhD student Dr. Emmanuel Albuquerque, and their team removed stem cells from previously extracted wisdom teeth and placed the stem cells onto petri dishes. The researchers then created a simulated inflammatory periodontal disease environment in the petri dishes. Next, they added two specific types of synthetic molecules called Maresin-1 and Resolvin-E1, both specialized pro-resolving lipid mediators from omega-3 fatty acids. The scientists found that Mar1 and RvE1 stimulated the stem cells to regenerate even under the inflammatory conditions.

“Both Maresin-1 and Resolvin-1 reprogrammed the cellular phenotype of the human stem cells, showing that even in response to inflammation, it is possible to boost capacity of the stem cells so they can become regenerative,” said Dr. Kantarci, Associate Member of Staff at the Forsyth Institute.

This finding is important because it allows scientists to identify the specific protein pathways involved in inflammation. Those same protein pathways are consistent across many systemic diseases, including periodontal disease, diabetes, heart disease, dementia, and obesity.

“Now that we understand how these molecules stimulate the differentiation of stem cells in different tissues and reverse inflammation at a critical point in time, the mechanism we identified could one day be used for building complex organs” said Dr. Kantarci. “There is exciting potential for reprogramming stem cells to focus on building tissues.”

Source: The Forsyth Institute


Read also at Mayo Clinic:

Stem cells: What they are and what they do . . . . .

Are Your Gums Saying Sonething About Your Dementia Risk?

Gum disease, especially the kind that is irreversible and causes tooth loss, may be associated with mild cognitive impairment and dementia 20 years later, according to a study published in the online issue of Neurology®, the medical journal of the American Academy of Neurology.

“We looked at people’s dental health over a 20-year period and found that people with the most severe gum disease at the start of our study had about twice the risk for mild cognitive impairment or dementia by the end,” said study author Ryan T. Demmer, Ph.D., M.P.H., of the University of Minnesota School of Public Health in Minneapolis. “However, the good news was that people with minimal tooth loss and mild gum disease were no more likely to develop thinking problems or dementia than people with no dental problems.”

The study involved 8,275 people with an average age of 63 who did not have dementia at the start of the study. The participants were assessed for mild cognitive impairment and dementia. Participants received a full periodontal exam that included measuring gum probing depth, amount of bleeding and recession.

Then participants were put into groups based on the severity and extent of their gum disease and number of lost teeth, with implants counting as lost teeth. At the start of the study, 22% had no gum disease, 12% had mild gum disease, 12% had severe gum inflammation, 8% had some tooth loss, 12% had disease in their molars, 11% had severe tooth loss, 6% had severe gum disease, and 20% had no teeth at all.

A total of 4,559 people was assessed at the end of the study, when they had been followed for an average of 18 years.

Overall, 1,569 people developed dementia during the study, or 19%. This was the equivalent of 11.8 cases per every 1,000 person-years. The study found that of the people who had healthy gums and all their teeth at the start of the study, 264 out of 1,826, or 14%, developed dementia by the end of the study. For those with mild gum disease, 623 out of 3,470, or 18%, developed dementia. For participants with severe gum disease, 306 out of 1,368, or 22%, developed dementia. And 376 out of 1,611, or 23%, developed dementia in the group that had no teeth. This was equal to a rate of 16.9 cases per 1,000 person-years.

When looking at both mild cognitive impairment and dementia, the group with no teeth had about twice the risk compared to participants with healthy gums and all their teeth. People with intermediate or severe gum disease, but who still had some teeth, had a 20% greater risk of developing mild cognitive impairment or dementia compared to the healthy group. These risks were after researchers accounted for other factors that could affect dementia risk, such as diabetes, high cholesterol and smoking.

“Good dental hygiene is a proven way to keep healthy teeth and gums throughout your lifetime. Our study does not prove that an unhealthy mouth causes dementia and only shows an association. Further study is needed to demonstrate the link between microbes in your mouth and dementia, and to understand if treatment for gum disease can prevent dementia,” Demmer said.

A limitation of the study is the fact that initial gum examinations were made when the participants had an average age of 63, and it is possible that cognitive decline might have been begun before the start of gum disease and tooth loss.

Source: American Academy of Neurology