Did You Know... People with the human papilloma virus have a 60% chance of getting oral cancer. Periodontal Disease: Associations With Heart Disease, Stroke, Diabetes and Premature Births Fact: Ranked 1st, 3rd and 6th as leading causes of death, heart disease, stroke and diabetes account for almost 40 percent of ail deaths in the United States. The classic risk factors for heart disease and stroke include hypertension, smoking, obesity, stress, genetic predisposition and high cholesterol, yet a large number of patients with heart disease and stroke have none of these traditional risk factors. Fact: One of 10 newborns in the United States is classified as a premature low birth weight baby. These infants account for 5 million neonatal intensive care unit hospital days at an annual cost exceeding $5 billion, and surviving infants often suffer long-term medical and developmental problems. While advances in neonatal medicine have dramatically improved the survival of premature infants - and despite the widespread use of drugs to control the onset of preterm labor - little progress has been made in reducing the proportion of premature low birth weight babies. The scientific search for additional risk factors for each of these serious medical conditions has produced a growing body of evidence that strongly suggests periodontal disease is a contributing risk factor in their development. In study after study, a positive connection has been found between oral disease and heart disease, stroke, diabetes and preterm low birth weight infants. Among adults age 30 years and older, it is estimated that at least 35 percent have periodontitis, and 13 percent have a moderate or severe form. Bacterial infection, often associated with poor oral hygiene, is essential for periodontal disease to occur, although other factors (age, smoking, stress, obesity, diabetes and genetic predisposition) affect the onset, development and severity of periodontal disease, as well. The bacteria that cause periodontal disease can trigger a systemic inflammatory response that may initiate or contribute to other disease conditions and lead to serious health problems. The Pregnancy Factor Hormonal changes that occur during pregnancy can worsen gingival inflammation, lower defense mechanisms against bacterial plaque and promote periodontal disease. Periodontal disease can also lead to adverse pregnancy outcomes. A landmark study found that mothers of preterm low birth weight infants had significantly worse periodontal disease than mothers of normal birth weight infants and that periodontal disease increased the risk for having a preterm low birth weight baby more than seven-fold. Recent studies have also confirmed the association between periodontal disease and preterm low birth weight babies, while other research suggests that periodontal disease, even in mild forms, can dramatically increase the risk of pregnancy loss. Periodontal disease triggers the release of inflammatory mediators (cytokines) and other compounds that in turn cause the synthesis and release of prostaglandin, which initiates preterm labor and low birth weight infants. Periodontal Disease and Other Diseases Population studies have consistently reported a 1.5 to 2.0 times greater risk of fatal heart disease and stroke in patients with periodontal disease. Specifically, periodontal disease has been identified as a risk factor in the development and build-up of plaque on artery walls. In response to oral infection, the release of high levels of inflammatory mediators into the blood causes platelet coagulation and can result in the formation of atheromas (fatty deposits on artery walls) that can lead to heart disease and stroke. In addition, bacteria responsible for periodontal disease have been isolated from plaque on artery walls. Further studies have consistently reported evidence of a greater incidence and severity of periodontal disease in diabetics. This relationship is so well accepted that periodontitis is often considered the sixth complication of diabetes (after heart disease and stroke, retinal damage and blindness, lower extremity amputation, nerve damage, and kidney failure). Recent evidence has established that periodontal disease plays a role in the control of diabetes and may be a contributing risk factor for the development of diabetes. In addition, elevated cytokine levels that occur with periodontal infection can amplify the inflammatory response that also occurs in diabetics. The inflammatory response in turn results in the increase in oral tissue destruction seen in diabetics with periodontal disease. This also explains how periodontal infection may complicate the severity of diabetes and the degree of metabolic control, as high levels of inflammatory mediators cause changes in lipid regulation and play a role in insulin resistance. What to Do Since periodontal disease is both preventable and treatable, identification of periodontitis as a modifiable risk factor raises the opportunity for the identification of high-risk individuals and also the possibility of oral therapy as an intervention strategy. Intervention studies have shown that treatment of periodontal disease using a combination of mechanical periodontal therapy (scaling and root planing) and systemic antibiotics improves glycemic control in diabetic patients and reduces adverse pregnancy outcomes. Aetna: Dental Dialog, Fall 2003