Friday, June 10, 2005

Trail Markers

Many people take their teeth and dental health for granted. However, there are an increasing number of studies in medical journals and in the media about the wide-ranging and potentially fatal consequences of gum disease, also known as periodontal disease. You think your dentist is just nagging about flossing, right? The truth is that gum disease has been repeatedly linked to risks of heart disease, stroke, the development of type 2 diabetes and even elevated cholesterol. What is it about gum disease that makes it so dangerous in so many ways? To find out, I called Michael P. Bonner, DDS, coauthor of The Oral Health Bible. Dr. Bonner's explanation was simple. "Let's connect the dots," he said.
Dot One. Gum disease is, of course, an infection, said Dr. Bonner, and infections produce inflammation. Inflammation elevates a molecule produced in the liver called C-reactive protein, or CRP.
Dot Two. Elevated CRP is a known cause of heart attack and stroke and is implicated in type 2 diabetes.
Dot Three. When gum disease is left untreated, the infection it produces spreads throughout the body.
Dot Four. Treatment for gum disease can lower CRP, and thus lower risk for other, potentially fatal conditions, such as heart attack and stroke.
To put all this together, Dr. Bonner said, think of it this way -- any condition ending in "itis," such as gingivitis, gastritis, sinusitis, pancreatitis, is nothing more than a chemical cascade caused by inflammation and processed by the liver, which in turn creates CRP. Often, this cascade begins in the mouth, with periodontal disease. Dr. Bonner disagrees with the notion that more studies are necessary to prove the links between gum disease and heart health and stroke. For him, there already is enough existing evidence. When he discovers a patient with periodontal disease, Dr. Bonner likes to test him/her -- via a blood test -- for CRP or for glycated hemoglobin (HbA1C) or both. HbA1C is another molecule in the body that may be elevated by inflammation. "That gives me a baseline to work with," he said. "Then, after a course of treatment, I retest. You can see the risk levels of CRP and HbA1C actually drop after treatment." In 1910, the Mayo brothers said that a clean mouth will help a person live 10 years longer. With all that we now know, Dr. Bonner recommends that we take their good advice.

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