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The Oral-Systemic Connection

You may have heard about all the oral health-systemic health connections in the media recently. What is that all about? Recent research has revealed that Gum Disease can elevate your risk for more serious health problems such as Heart Disease, Diabetes Mellitus, Alzheimer’s disease, Dementia, Obesity, Rheumatoid Arthritis, Kidney Disease, pregnancy complications and Osteoporosis. Patients with Gum Disease also have more difficulty controlling these health problems they are already present. This is mainly because the oral infection Periodontitis, also known as Gum Disease, causes your body’s immune system to respond in much the same way as it does that leads to the other health problems mentioned earlier. Also, people who have these diseases are at increased risk for developing, or worsening, gum disease, which in turn, makes controlling their present disease more difficult, and, again, increases their risk for other health problems.

At Saratoga Dental, we strive to continually update our treatment protocol to reflect the most current research and state-of-the-art technology.

Based on this new information revealing the intimate connection between oral health and systemic diseases, we are treating dental health problems more aggressively in order to help our patients achieve and maintain the best oral and overall health.  

Below is a collection of research articles supporting the oral-systemic health connection. Follow the links or copy and paste into your web browser to view the articles.

Oral Diabetes & Oral Renal Connection References

1.       American Diabetes Association, www.diabetes.org
2.       A Prediction Model For Chronic Kidney Disease Includes Periodontal Disease, Monica A. Fisher, George W. Taylor, Journal of Periodontology  2009; 80; 16-23
3.       Center for Disease Control and Prevention. National Diabetes Fact Sheet. http://www.cdc.gov/diabetes/pubs/estimates.htm, Accessed October 2007.
4.       Clinical and Metabolic Changes After Conventional Treatment of Type 2 Diabetic Patients With Chronic Periodontitis, Ricardo Faria-Almeida, ­Ana Navarro, and ­Antonio Bascones, Journal of Periodontology 2006, Vol. 77, No. 4, Pages 591-598
5.       Diabetes and its Complications: Designing New Therapies for this Epidemic, CDC http://www.cdc.gov/OralHealth/conferences/periodontal_infections11.htm, Accessed Oct 2007. 6.       Diabetes and Periodontal Disease: Current Concepts, Robert Genco, DDS, PhD, www.cdc.gov/OralHealth/conferences/periodontal_infections09.htm, Accessed Oct 2007 7.       Diabetic periodontitis: possible lipid-induced defect in tissue repair through alteration of macrophage phenotype and function. PMID: 8705829 [PubMed - indexed for MEDLINE] NCBI
8.       Effect of Periodontitis on Overt Nephropathy and End-Stage Renal Disease in Type 2 Diabetes, Wendy A. Shultis, PHD, E. Jennifer Weil, MD, Helen C. Looker, MBBS, Jeffrey M. Curtis, MD, MPH, Marc Shlossman, DDS, MS, Robert J. Genco, DDS, PHD, William C. Knowler, MD, DRPH and Robert G. Nelson, MD, PHD,  Diabetes Care 30:306-311, 2007, DOI: 10.2337/dc06-1184
9.       Gum disease as a Potential Risk Factor for Gestational Diabetes Mellitus, AP Dasanakaye, New York University College of Dentistry JADR Poster, 2009
10.   Heightened gingival inflammation and attachment loss in type 2 diabetics with hyperlipidemia, Cutler CW, Machen RL, Jotwani R, Iacopino AM, J Periodontol. 1999 Nov;70(11):1313-21.
11.   International Federation of Diabetes Guidline on Oral Health for People with Diabetes,  Sept 2009, OralHealth_EN2.indd 2 16/09/09 15:18
12.   National Institute for Dental and Cranial Research (NIDCR) Diabetes/Perio Overview, www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/OralSystemicHealthConnection
, Accessed Oct 2007
13.   Periodontal Changes in Children and Adolescents With Diabetes, Evanthia Lalla, DDS, Bin Cheng, PHD, Shantanu Lal, DDS, Sid Tucker, DDS, Ellen Greenberg, MS, Robin Goland, MD and Ira B. Lamster, DDS, Diabetes Care 29:295-299, 2006.
14.   Periodontal disease and diabetes mellitus: a two-way relationship, Grossi SG, Genco RJ, Department of Oral Biology, School of Dental Medicine, State University of New York at Buffalo, USA.  Ann Periodontol. 1998 Jul;3(1):51-61.
15.   Periodontal Disease and Mortality in Type 2 Diabetes, Aramesh Saremi, MD, Robert G. Nelson, MD, PHD, Marshall Tulloch-Reid, MB, BS, DSC, Robert L. Hanson, MD, MPH, Maurice L. Sievers, MD, George W. Taylor, DMD, DRPH, Marc Shlossman, DDS, MS, Peter H. Bennett, MB, FRCP, Robert Genco, DDS, PHD and William C. Knowler, MD, DRPH,  Diabetes Care 28:27-32, 2005.
16.   Periodontal Disease in Hispanic Americans with Type 2 Diabetes, MJ Novak, RM Potter, J Blodgett, JL Ebersole, Journal of Periodontology 2008 Apr: 79(4):629-36
17.   Periodontal Disease And Other Nontraditional Risk Factors For CKD, Fisher MA, Taylor GW, Shelton BJ et al., Am J Kidney Dis, 2008; 51:45-52
18.   Periodontal Pathogens and Gestational Diabetes Mellitus, A.P. Dasanayake, N. Chhun, A.C.R. Tanner, R.G. Craig, M.J. Lee, A.F. Moore, and R.G. Norman, J Dent Res 87(4):328-333, 2008
19.   Periodontitis and diabetes interrelationships: role of inflammation, Dr. Anthony M. Iacopino, Ann Periodontol. 2001 Dec;6(1):125-37.  
20.   Periodontitis Is Associated With Aggravation of Prediabetes in Zucker Fatty Rats, Carla C. Pontes Andersen, ­Allan Flyvbjerg, ­Karsten Buschard, and ­Palle Holmstrup, Journal of Periodontology, 2007, Vol. 78, No. 3, Pages 559-565
21.   Relationship Between Periodontal Disease and Diabetic Retinopathy, Hidetaka Noma, MD, Ikuo Sakamoto, PHD, Hideki Mochizuki, MD, Hidetoshi Tsukamoto, PHD, Atsushi Minamoto, PHD, Hideharu Funatsu, PHD, Hidetoshi Yamashita, PHD, Shigeo Nakamura, PHD, Ken Kiriyama, PHD, Hidemi Kurihara, PHD and Hiromu K. Mishima, PHD,  Diabetes Care 27:615, 2004
22.   Serum markers of periodontal disease status and inflammation in hemodialysis patients, Rahmati MA, Craig RG, Homel P, Kaysen GA, Levin NW, Am J Kidney Dis. 2002 Nov;40(5):983-9.
23.   Severe periodontitis and risk for poor glycemic control in patients with non-insulin-dependent diabetes mellitus, Taylor GW, Burt BA, Becker MP, Genco RJ, Shlossman M, Knowler WC, Pettitt DJ., J Periodontal 1996 Oct; 67(10 Suppl):1085-93
24.   The Relationship Between Diabetes and Periodontal Disease,  Debora C. Matthews, DDS, Dip Perio, MSc,  J Can Dent Assoc. 2002; 68(3):161-4.
25.   The Short-term effectiveness of non-surgical treatment in reducing levels of interleukin 1β and proteases in gingival crevicular fluid from type 2 diabetes patients with chronic periodontitis, Fernanda O. B. Correa, PhD, ­Daniela Gonçalves, PhD, ­Carlos M. S. Figueredo, PhD, ­Anders Gustafsson, PhD and ­Silvana R. P. Orrico, PhD, Journal Of Periodontology (doi:10.1902/jop.2008.080132), Accessed  online July 23, 2008
26.   Treating Gum Disease Linked To Lower Medical Costs For Patients With Diabetes, Science Daily (Jan. 8, 2009)Website, Accessed Jan 2009, http://www.sciencedaily.com/releases/2008/12/081223172745.htm

Oral Fetus Connection References

1.       Detection of Porphyromonas gingivalis in the Amniotic Fluid in Pregnant Women With a Diagnosis of Threatened Premature Labor, Rubén León, ­Nora Silva, ­Alfredo Ovalle, ­Alejandra Chaparro, ­Alexis Ahumada, ­Marta Gajardo, ­Maria Martinez, and ­Jorge Gamonal, Journal of Periodontology, 2007, Vol. 78, No. 7, Pages 1249-1255. 
2.       Distribution of anaerobic bacteria among pregnant periodontitis patients who experience preterm delivery, Urbán E, Radnai M, Novák T, Gorzó I, Pál A, Nagy E, .Anaerobe, 2006 Feb;12(1):52-7. Epub 2005 Sep 30.
3.       Gum disease linked with gestational diabetes risk, New York (Reuters Health), Apr 9, 2008, http://in.reuters.com/article/health/idINCOL87030020080408
4.       Effects of Maternal Campylobacter rectus Infection on Murine Placenta, Fetal and Neonatal Survival, and Brain Development, S. Offenbacher, ­E.L. Riché, ­S.P. Barros, ­Y.A. Bobetsis, ­D. Lin, and ­J.D. Beck­,  Journal of Periodontology. 2005, Vol. 76, No. 11-s
5.       Higher Risk of Preterm Birth and Low Birth Weight in Women with Periodontal Disease Journal of Dental Research, N.J. López, P.C Smith and J. Gutierrez,  Journal of Dental Research, Vol. 81, No. 1, 58-63 (2002)
6.       Maternal periodontal disease, systemic inflammation, and risk for preeclampsia, Ruma M, Boggess K, Moss K, Jared H, Murtha A, Beck J, Offenbacher S., American  Journal of Obstetrics and Gynecology. Volume 198, Issue 4, 2008 Apr, pages 389.e1-5.
7.       Maternal Periodontal Disease Is Associated With an Increased Risk for Preeclampsia, Kim A. Boggess, MD, Susi Lieff, PhD, Amy P. Murtha, MD, Kevin Moss, James Beck, PhD, Steven Offenbacher, DDS, PhD,  Obstetrics & Gynecology. 2003;101:227-231
8.       Periodontal disease increases the risk of severe pre-eclampsia among pregnant women, Varol Canakci, Cenk Fatih Canakci, Abdulkadir Yildirim, Metin Ingec, Abubekir Eltasand Ayşe Erturk, J Clin Periodontol. 2007; 34: 639–645
9.       Periodontal Pathogens and Gestational Diabetes Mellitus, A.P. Dasanayake, N. Chhun, A.C.R. Tanner, R.G. Craig, M.J. Lee, A.F. Moore, and R.G. Norman, J Dent Res 87(4):328-333, 2008
10.   Potential Impact of Maternal Periodontitis on Reproductive Outcomes, Steve Offenbacher, DDS, PhD, James Beck, MS, PhD, www.cdc.gov/OralHealth/conferences/periodontal_infections12.htm
11.   Potential Public Health Implications of Associations Between Periodontitis and Reproductive Outcomes, Susan Reed, DDS, MPH, DrPH,  www.cdc.gov/OralHealth/conferences/periodontal_infections14.htm
12.   Treatment of Periodontal Disease and the Risk of Preterm Birth, the OPT Study, The New England Journal of Medicine, Volume 355:1885-1894, Nov 2, 2006, Number 18

Oral Heart Connection References

1.       Age-Dependent Associations Between Chronic Periodontitis/Edentulism and Risk of Coronary Heart Disease, Thomas Dietrich, DMD, MD, MPH; Monik Jimenez, SM; Elizabeth A. Krall Kaye, MPH, PhD; Pantel S. Vokonas, MD; Raul I. Garcia, DMD, MMSc, Circulation 2008;117;1668-1674
2.       American Academy of Periodontology. http://www.perio.org.
3.       American Heart Association. Risk Factors in Heart Disease, www.americanheart.org/presenter.jhtml?identifier=500
4.       The American Journal of Cardiology and Journal of Periodontology Editor’s Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease,  Vincent E. Friedewald, MD, Kenneth S. Kornman, DDS, PhD, et al., Am J Cardiol 2009;104:000-000, May 2009
5.       Antibodies to Periodontal Pathogens and Stroke Risk, Pirkko J. Pussinen, PhD; Georg Alfthan, PhD; Harri Rissanen, MSc; Antti Reunanen, MD; Sirkka Asikainen, DDS Paul Knekt, PhD, Stroke. 2004;35:2020.
6.       Anaerobic Dental Flora and The Acute Coronary Syndrome, Coronary Artery Disease. 18(2):111-116, March 2007, (C) 2007 Lippincott Williams & Wilkins, Inc, Accessed Dec. 6, 2007
7.       Association Between Periodontal Disease and Left Ventricle Mass in Essential Hypertension, Hypertension. 2003;41:488.
8.       Atherosclerosis:The New View, Peter Libby, Scientific American, A fire within, May 2002, p50-59
9.       C-Reactive Protein – A Predictor of Heart Disease – Is Elevated in Patients with Periodontal Disease September 20, 2001 http://www.perio.org/consumer/CRPheart.htm
10.   Chronic Inflammatory Periodontal disease, A Risk Factor For Caridovascular Disease and Ischemic Stroke? Ricardo Gapski, DDS, MS and Charles M. Cobb, DDS, PhD, Ground Rounds in Oral-Systemic Medicine, February 2006, http://gr.pennnet.com
11.   Comparison of C-Reactive Protein and Low-Density Lipoprotein Cholesterol Levels in the Prediction of First Cardiovascular Events Paul M. Ridker, M.D., Nader Rifai, Ph.D., Lynda Rose, M.S., Julie E. Buring, Sc.D., Nancy R. Cook, Sc.D.http://content.nejm.org/cgi/content/short/347/20/1557
12.   Elevation of Systemic markers related to cardiovascular disease in peripheral blood periodontitis patients,  Loos B G, Craandijk, et al ., J. Periodontology, 2000, Oct:71(10) 1528-34
13.   Evaluation of the Incidence of Periodontitis-Associated Bacteria in the Atherosclerotic Plaque of Coronary Blood Vessels, Maciej Zaremba, ­Renata Górska, ­Piotr Suwalski, ­Jan Kowalski, Journal of Periodontology, 2007, Vol. 78, No. 2, Pages 322-327
14.   Heart Attack Risk and Periodontal Disease Share Identical Gene, European Society of Human Genetics, Germany, May 2009
15.   Human Atherosclerotic Plaque Contains Viable Invasive Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis, Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:e17.
16.   Identification of periodontal pathogens in atheromatous plaques,  Haraszthy VI, Zambon JJ, Trevisan M, et al, J Periodontol. 2000; 71 (10): 1554-60
17.   Identification of Periodontal Pathogens in Atherosclerotic Vessels, Dr. Nils-Erik Fiehn, Tove Larsen, ­Natalia Christiansen, Palle Holmstrup., Torben V. Schroeder Department of Vascular Surgery, Rigshospitalet, University Hospital, Copenhagen, Denmark. Journal of Periodontology, May 2005, Vol. 76, No. 5, Pages 731-736.
18.   Identification of a Shared Genetic Susceptibility Locus for Coronary Heart Disease and Periodontitis,  Schaefer AS, Richter GM, Groessner-Schreiber B, et al, Feb 2009, PLoS Genet 5(2):e1000378. Doi:10.1371/journal.pgen.1000378
19.   Impact of infectious burden on progression of carotid atherosclerosis, Espinola-Klein C, Rupprecht HJ, Blankenberg S. Stroke. 2002:33(11):2581
20.   Innate Immune Signaling and Porphyromonas gingivalis-accelerated Atherosclerosis, F.C. Gibson, III,  H. Yumoto, Y. Takahashi, H.-H. Chou, and C.A. Genco,  J Dent Res 85(2):106-121, 2006
21.   Invasion of Human Coronary Artery Cells by Periodontal Pathogens, Brian R. Dorn, William A. Dunn Jr., and Ann Progulske-Fox,  http://iai.asm.org/cgi/content/abstract/67/11/5792
22.   Joint Effects of C-Reactive Protein and Glycated Hemoglobin in Predicting Future Cardiovascular Events of Patients with Advanced Atherosclerosis, Circulation. 2003;108:2323, © 2003 American Heart Association, Inc.
23.   New Study Finds Positive Association Between Periodontal Disease and Coronary Heart Disease, American Academy of Periodontology, September 2006, www.perio.org/consumer/coronary-risk.htm
24.   Oral and Whole Body Health: Heart Health in the Inflammation Age, Peter Libby. Scientific American, Custom Published in collaboration with Procter &/Gamble Co.; 2006.
25.   ORAL HEALTH, ATHEROSCLEROSIS, AND CARDIOVASCULAR DISEASE, Jukka H. Meurman, Mariano Sanz , Sok-Ja Janket; Crit Rev Oral Biol Med 15(6):403-413 (2004)    
26.   Oral health: A window to your overall health, MayoClinic.com, Tools for healthier live, By Mayo Clinic Staff,  Feb 7, 2007, http://www.mayoclinic.com/health/dental/DE00001
27.   Oral Health and Peripheral Arterial Disease, Hsin-Chia Hung, DDS, DrPH; Walter Willett, MD, DrPH; Anwar Merchant, DMD, DrPH; Bernard A. Rosner, PhD; Alberto Ascherio, MD, DrPH; Kaumudi J. Joshipura, ScD,  Circulation. 2003;107:1152. 
28.   Periodontal Disease and Risk of Cerebrovascular Disease, Tiejian Wu, MD, PhD; Maurizio T.revisan, MD, MS; R.. Genco, DDS, PhD; J. P. Dorn, PhD; Karen L. Falkner, PhD; C. T. Sempos, PhD, Arch Intern Med.  2000;160:2749-2755.
29.   Periodontal Disease as a Risk Factor for Ischemic Stroke, Grau, Armin J. MD; Becher, Heiko PhD; Ziegler, Christoph M. MD, DDS; Lichy, Christoph MD; Buggle, Florian MD; Kaiser, Claudia; Lutz, Rainer MD; Bultmann, Stefan MD; Preusch, Michael Cand Med; Dorfer, Christof E. DDS,  Stroke. 35(2):496-501, February 2004.
30.   Periodontal disease as a risk factor for acute myocardial infarction. A case-control study in Goans highlighting a review of the literature, S. Kaisare, J. Rao & N. Dubashi, British Dental Journal 203, E5 (2007)
31.   Periodontal Disease Is Associated With Brachial Artery Endothelial Dysfunction and Systemic Inflammation, Salomon Amar; Noyan Gokce; Sonia Morgan; Mariana Loukideli; Thomas E. Van Dyke; Joseph A. Vita,  Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:1245, May22, 2003
32.   Periodontal Disease, Tooth Loss and Incidence of Ischemic Stroke, Kaumudi Joshipura, BDS, MS, ScD; et., al,. Stroke. 2003; 34 (1):47-52
33.   Periodontal health improves systemic inflammatory and haemostatic status in subjects with coronary heart disease, L. Montebugnoli, D. Servidio, RA. Miaton, C. Prati, P Tricoci, C. Melloni, G. Melandri (2005), Journal of Clinical Periodontology 32 (2), 188–192. doi:10.1111/j.1600-051X.2005.00641.x
34.   Periodontal Infections and Coronary Heart Disease, Axel Spahr, DDS; Elena Klein, DDS; Natalie Khuseyinova, MD; Clemens Boeckh, PhD; Rainer Muche, PhD; Markus Kunze, MS; Dietrich Rothenbacher, MD, MPH; Gita Pezeshki, PhD; Albrecht Hoffmeister, MD; Wolfgang Koenig, MD,  Arch Intern Med. 2006;166:554-559.
35.   Periodontal Infection Is Associated With Endothelial Dysfunction in Healthy Subjects and Hypertensive Patients, Yukihito Higashi; Chikara Goto; Daisuke Jitsuiki; Takashi Umemura; Kenji Nishioka; Takayuki Hidaka; Hiroaki Takemoto; Shuji Nakamura; Junko Soga; Kazuaki Chayama; Masao Yoshizumi; Akira Taguchi, Hypertension. 2008;51:446.
36.   Periodontal Microbiota and Carotid Intima-media Thickness: The Oral Infections and Vascular disease Epidemiology Study (INVEST). Circulation. 2005;111:576-582.
37.   Periodontitis and myocardial infarction: a shared genetic predisposition, Dr Arne Schaefer, Christian-Albrechts-Universität zu Kiel, Kiel University, Institute for Clinical Molecular Biology, Feb 13, 2009 Press Release
38.   Periodontitis: Complications- MayoClinic.com, Tools for healthier lives, Nov 2006, http://www.mayoclinic.com/health/periodontitis/DS00369/DSECTION=6
39.   Periodontitis and Cardiovascular Diseases—Co-morbid Conditions?, Philippe Hujoel, LTH, MSD, MS, PhD, Professor, http://www.cdc.gov/OralHealth/conferences/periodontal_infections06.htm
40.   Poor oral health associated with coronary heart disease, Circulation: Journal of the American Heart Association, Journal Report February 17, 2004, www.americanheart.org/presenter.jhtml?identifier=3019073
41.   Relationship Between Periodontal Disease, tooth Loss, and Carotid Artery Plaque The Oral Infections and Vascular Disease Epidemiology Study (INVEST), Moïse Desvarieux, MD, PhD; Ryan T. Demmer, MPH; Tatjana Rundek, MD, PhD; Bernadette Boden-Albala, DrPH; David R. Jacobs, Jr, PhD; Panos N. Papapanou, DDS, PhD Ralph L. Sacco, MD, MS, Stroke.2003;34:2120.
42.   Relationship of Periodontal Disease to Carotid Artery Intima-Media Wall Thickness,The Atherosclerosis Risk in Communities (ARIC) Study, James D. Beck;