CHICAGO – November 7, 2005 – Severe periodontal disease causes tooth loss and affects a certain group of people that appear to exhibit increased susceptibility to periodontal destruction, according to a study that appeared in the November Journal of Periodontology. Study Abstract *

Researchers found that tooth loss due to periodontal disease is associated with the risk indicators of age, male gender, smoking, lack of professional maintenance, inadequate oral hygiene, diabetes mellitus, hypertension, rheumatoid arthritis and anterior tooth type.

“In this study we evaluated 1,775 patients who had 3,694 teeth extracted,” said Dr. Khalaf F. Al-Shammari, Ministry of Health, Kuwait. “More teeth per patient were lost due to periodontal disease than for any other reason (those with periodontal disease lost 2.8 teeth versus 1.8 teeth lost for those without periodontal disease).”

Periodontal disease accounted for the majority of tooth extractions in patients older than 35 years (57 percent of teeth were lost for periodontal reasons compared to 43 percent lost for other reasons). Other findings are as follows:

• The most common medical history finding in all patients was diabetes mellitus at 19.2 percent followed by hypertension at 13.6 percent.
• A greater proportion of men lost their teeth due to periodontal reasons than women (33 percent for men versus 27 percent for women).
• Current and past smokers accounted for almost 31 percent.
• 39 percent reported that they have never had a dental prophylaxis or periodontal maintenance visit.
• Self-reported tooth brushing frequency of the patients was low with only 16 percent brushing their teeth twice or more daily,
• Almost 60 percent either never brushed their teeth or used a toothbrush irregularly.

“Risk assessment is an important component of modern dental therapy,” said Kenneth A. Krebs, DMD and AAP president. “Identification of subjects with the greatest risk for periodontal disease severity and progression is essential for the proper allocation of preventive therapeutic measures to those individuals who would benefit most from such measures.”

Periodontal disease is one of the main causes of tooth loss worldwide. Periodontal therapy has proven to be effective in reducing the rate of tooth loss and establish the importance of patient compliance with maintenance therapy and proper oral hygiene measures.

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CHICAGO – February 21, 2006 – People have a new reason to stick to their New Year’s resolution to lose excess weight besides fitting into the latest fashion trends. Researchers from University at Buffalo found that obesity is a significant predictor for periodontal disease, independent of age, gender, race, ethnicity, and smoking. This study printed in a recent supplement to the Journal of Periodontology (JOP).

Furthermore, analysis of this national sample suggests that insulin resistance mediates the relationship between obesity and periodontal disease. It was found that the severity of periodontal attachment loss increased proportionally with increasing insulin resistance. In addition, the number of teeth lost increased significantly with increasing levels of insulin resistance. Individuals in the highest insulin resistance category lost 1.1 more teeth compared to individuals in the lowest category.

“People who have a higher body mass index produce cytokines (hormone-like proteins), that lead to systemic inflammation and insulin resistance,” said Robert J. Genco, vice provost at the University at Buffalo and editor of the JOP. “We propose that chronic stimulation and secretion of proinflammatory cytokines associated with periodontal infection also occurs, contributing to insulin resistance, which may further predispose to diabetes mellitus.”

Genco and his research team recently showed that diabetics with periodontal disease may have greater mortality from diabetic complications such as cardiovascular disease and kidney complications than diabetics with little or no periodontal disease.

“The presence of periodontal infection combined with obesity may contribute to type 2 diabetes and its complications, such as coronary heart disease,” said Kenneth A. Krebs DMD and AAP president. “Although further studies are needed, people should remember that living a healthy lifestyle along with daily brushing and flossing and visiting your oral health care provider is always in fashion.”

Background Information

A total of 12,367 non-diabetic individuals 20 to 90 years old participated in the dental section of the NHANES III study. Of these 53 percent were men and 47 percent were women and 43 percent of all the individuals were overweight.

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO – July 21, 2005 – Postmenopausal women may significantly reduce tooth loss by controlling their periodontal disease, according to a study in the Journal of Periodontology. Study Abstract *

Researchers from the University at Buffalo, School of Dental Medicine did a follow-up evaluation on 106 postmenopausal women and found that during an average of 11.7 years follow-up, 57.5 percent of the participants lost at least one tooth.

“We found that alveolar bone loss (the bone that holds the tooth in the mouth) is the strongest independent predictor of tooth loss in the postmenopausal population,” explained Mine Tezal, DDS and study author. “Each millimeter of alveolar bone loss increased the risk of tooth loss 3 times, and the risk of tooth loss increased 2.5 times for each millimeter of clinical attachment loss, or soft tissue attachment between the tooth and alveolar bone.” (This is also known as loss of gums and bone.)

The health of teeth depends upon the integrity of the alveolar bone holding them in the mouth. Periodontal disease is the major cause of alveolar bone loss and tooth loss in patients over 35.

“The long follow-up period is an advantage of this study since researchers were able to evaluate the same people more than 10 years later,” said Vincent J Iacono, DMD and AAP president. “Since alveolar bone loss has been shown to be a significant factor for tooth loss in postmenopausal women, studies will be needed to determine possible aggravating effects of post menopause on the severity of periodontal disease. Until we know more, postmenopausal women will want to control periodontal disease to significantly reduce their risk of alveolar bone loss and tooth loss.”

Estrogen deficiency after menopause and consequent loss of bone mineral density have been shown to be associated with increased rate of tooth loss. These relationships may be explained by increased severity of periodontal disease in estrogen deficiency.

The participants of this study had participated in a past study in 1989 and 1991. The average follow-up time was 11.7 years. The age ranged from 45 to 73 and all subjects had reached menopause with the average age at 48.8 years.

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CHICAGO–June 2, 2003–A case report published in this month’s Journal of Periodontology reported that minocycline, a commonly prescribed antibiotic in the treatment of acne and rheumatoid arthritis, can cause the teeth and bone to discolor, which may make gum tissue to appear blackish-blue in color. Patients who take this drug or healthcare professionals who prescribe it should be made aware of the possibility of oral discoloration. Case Report Abstract *

Mayo Clinic researchers were presented with a 29-year old white female patient referred to the periodontics department by her dermatologist for an evaluation of the dramatic blue appearance of the gum tissue and bone surrounding her teeth. A review of her medical history indicated that she had been taking 50 mg of minocycline four times a day for the past 17 months.

“We informed the patient that in addition to the bone discoloration, her permanent teeth could also become discolored with continued use of minocycline. And, unlike the periodontal bone, teeth discoloration from minocycline does not always resolve after discontinuation of the therapy,” said Phillip J. Sheridan, D.D.S., Mayo Clinic, Periodontics, Department of Dental Specialties. “In this patient’s case, the dermatologist elected to change antibiotics to treat her acne.”

“This case definitely ‘drives home’ the importance of collaboration between medical and dental professionals,” said Gordon Douglass, D.D.S. and president of the American Academy of Periodontology. “Periodontists have known for awhile that medical drugs can affect a person’s oral health, and this is a reminder for patients to inform their dental professionals of all medications they are taking.”

For example, over 400 medications produce dry mouth, which can be damaging to the gum tissue, including periodontal disease and tooth decay. Other drugs like calcium channel blockers, phenytoin (used for treating seizures) and cyclosporine (used following organ transplants) may also cause gingival overgrowth.

According to this case report, approximately three to six percent of long-term users of minocycline will develop dental staining. This discoloration does not harm the teeth, bone or gum tissue, but is the reason behind the blackish-blue appearance of the gums. The periodontal bone can become discolored from minocycline therapy and show through the gum tissue, causing it to appear discolored as well.

“Like acne, periodontal disease can take away a person’s confidence and smile,” said Douglass. “Also like acne, periodontal disease is a chronic bacterial infection. Whereas acne inflames the walls of the hair follicles causing the walls to inflame and break, periodontal disease destroys attachment fibers and supporting bone that hold the teeth into the mouth.”

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

The American Academy of Periodontology is an 8,000-member association of dental professionals specializing in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants. Periodontics is one of nine dental specialties recognized by the American Dental Association.

For more information, contact the AAP Public Affairs Department at 312/573-3243 or 312/573-3242.

CHICAGO – October 26, 2004 – Research is racing to help healthcare professionals further understand how periodontal diseases are linked to cardiovascular disease. A study published in a recent issue of the Journal of Periodontology explains another reason why people with periodontal diseases are at a significant risk for coronary artery disease (CAD).

The study looked at 108 patients with CAD with a mean age of 59.2 +/- 10.9 years and a group of 62 people without CAD with a similar mean age (57.7 +/- 8.7 years).

“The results of this study showed that periodontitis in cardiac patients was significantly more frequent than in non-cardiac patients.” said Professor E.H. Rompen, Department of Periodontology – Dental Surgery, C.H.U. Liège, Belgium. “We found that 91% of patients with cardiovascular disease suffered from moderate to severe periodontitis, while this proportion was 66% in the non-cardiac patients.”

Periodontitis seems to influence the occurrence and the severity of coronary artery disease and increases the risk of heart attack or stroke, and the study proposes two hypotheses for this occurrence. One hypothesis is that periodontal pathogens could enter the bloodstream, invade the blood vessel walls and ultimately cause atherosclerosis. (Atherosclerosis is a multistage process set in motion when cells lining the arteries are damaged as a result of high blood pressure, smoking, toxic substances, and other agents.)

Another hypothesis is based on several studies that have shown that periodontal infections can be correlated with increased plasma levels of inflammation such as fibrinogen (this creates blood clots), C-reactive protein, or several cytokines (hormone proteins).

“This study supports earlier findings, and even showed a significantly higher prevalence of periodontal diseases in cardiac patients. There is still much research to be done to understand the link between periodontal diseases and systemic diseases, such as cardiovascular, and difficult-to-control diabetes,” said Dr. Michael P. Rethman, DDS, MS, and president of the American Academy of Periodontology. “The data in this study shows the importance of regular dental checkups to ensure a healthy, diseased-free mouth.”

A referral to a periodontist in your area and free brochure samples including one titled Ask Your Periodontist About Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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CHICAGO – May 19, 2005 – Researchers have found evidence that the amount of bacteria in subgingival plaques, the deep plaques in periodontal pockets and around the teeth, may contribute to an individual’s risk of a heart attack, according to two studies appearing in the Journal of Periodontology. These studies further researchers’ understanding that periodontal bacteria may increase the risk for heart disease.

In one study researchers looked at 150 individuals with periodontal diseases and found that the total number of periodontal bacteria in subgingival plaques was higher in individuals that have suffered from an acute myocardial infarction (heart attack). The second study found that the same DNA from different kinds of periodontal bacteria in plaque was also in the patients’ heart arteries. Researchers believe that these findings may help substantiate what they have long known; if there is a sterile pathway, such as a bloodstream, near a periodontally infected area that the bacteria from this infected area cause inflammation in the gums that opens up pores in the surrounding blood vessels, which enables the bacteria to enter the bloodstream and travel to other parts of the body and cause great harm.

“It is like setting up a garbage dump on the edge of a river. You wouldn’t be surprised if the lake downstream ended up polluted with the garbage from the dump,” said Vincent J Iacono DMD and president of the American Academy of Periodontology. “A patient’s bloodstream acts very much like the river in this analogy, in that it carries the bacteria from the periodontal plaques, possibly ‘polluting’ the arteries of the heart with periodontal bacteria, causing inflammation of the arteries which may lead to a heart attack. This potential effect of periodontal bacteria further supports the need for periodic deep cleanings to enhance overall health and wellbeing.”

These studies represent two in a large body of research that investigates the possible link between periodontal diseases and other systemic conditions such as heart disease. “Intervention data is not available to prove a causal relationship between the two. Right now we are currently advising patients that maintaining good periodontal health can only help not hurt,” said Iacono.

Referral to a periodontist in your area and free brochure samples including one titled Ask your Periodontist about Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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CHICAGO – July 18, 2006 – The presence of specific bacteria and combinations of bacteria in periodontal pockets might be an explanation for the relationship between periodontal disease and acute coronary syndrome (ACS), according to a new study published in the Journal of Periodontology. Study Abstract *

The amount of oral bacteria was two times higher in the ACS group for the combination of the bacteria streptococci spp, P. gingivalis, T. forsythia and T. denticola. Specifically, the findings suggest that T. denticola, T. forsythia and streptococci spp are bacteria in a shared infectious etiology for periodontitis and ACS.

“This might be one of several explanations as to why elevated bacteria and the combination of specific pathogens in periodontal pockets can be linked to a history of ACS,” said Stefan Renvert, DDS, PhD and Department of Health Sciences, Kristianstad University. “We also found that the amount of periodontal bacteria results in an inflammatory response that elevates the white blood cell counts and high sensitivity C-reactive protein levels, which has also been linked in past studies to heart disease.”

It was also found that the extent of alveolar bone loss was significantly greater among subjects with ACS. Seventy-seven percent of the participants in the ACS group and 42 percent in the control group demonstrated evidence of periodontitis. The extent of bone loss was more severe in the ACS group than in the non-ACS group.

Another reason people diagnosed with ACS may have higher oral bacteria could be due to their infectious susceptibility and lack of an adequate host inflammatory response, which may induce other systemic vascular effects participating in the onset of ACS.

“Although this study supports past findings, further research is needed to evaluate the effects of reducing specific bacteria such as T. forsythia and T. denticola on reducing the risk for ACS,” said Kenneth A. Krebs, DMD and AAP president. “This data highlights the importance of routine periodontal examinations and at-home dental care.”

Background Information

Researchers evaluated 161 subjects diagnosed with ACS and a control group of 161 participants of not having ACS. Diagnosis of the ACS group was based on chest pain associated with electrocardiogram changes that were combined with typical patterns of cardiac markers (such as creatine kinase). The control group included people without cardiovascular disease. This included the absence of elevated blood pressure, or the use of statins and beta-blockers.

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—September 26 2006—Researchers found an increased risk of coronary heart disease for people below the age of 60 who have more than four millimeters of alveolar bone loss (the bone that holds the teeth in the mouth) from periodontal disease, according to a new study that is printed in the Journal of Periodontology. Study Abstract *

It was found that participants with coronary heart disease had an increase of periodontal disease indicators, including alveolar bone loss, clinical attachment loss and bleeding compared to the group without coronary heart disease.

“This study is distinctive because to our knowledge, it is the first to include both the alveolar bone loss and full mouth recording of clinical attachment loss as measurements of periodontal disease,” explains Dr. Karen Geismar, Department of Periodontology, School of Dentistry, Faculty of Health Science, University of Copenhagen, Denmark. “Alveolar bone loss was recently found to be the periodontal variable that had the strongest association to coronary heart disease.”

The association between periodontal disease and coronary heart disease has been that chronic infections and the inflammatory response from diseases such as periodontal disease may be involved in the initiation and progression of atherosclerosis.

“A number of pathways are suspected to be involved,” said Geismar. “One way is that periodontal bacteria directly invade the arterial wall and another way is that bacterial products from the periodontal pocket exert a systemic effect on atherosclerosis development based on the immune system.”

“This is one of many studies suggesting that the spread of bacteria and bacterial products from the periodontal lesion to the bloodstream may contribute to coronary heart disease,” said Preston D. Miller, DDS and AAP President. “However, it is still uncertain whether or not the association between periodontal disease and coronary heart disease is causal. Until we know more, it is very important that people talk to their dentist or periodontist about their periodontal health.”

Background Information

This study included 110 patients with coronary heart disease and 140 people without coronary heart disease. The mean age was 65 years and 70 percent of the participants were male. All 250 participants received a medical and dental examination. Researchers found a significantly higher odds ratio of 6.6 for individuals below age 60 having being a patient with coronary heart disease when having a mean alveolar bone loss of more than four millimeters.

A referral to a periodontist in your area and free brochure samples including one titled Ask Your Periodontist About Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO – October 10, 2006 – People missing some or all of their teeth or who have significant loss of bone and tissue surrounding their teeth may be at an increased risk for having a stroke, according to a new study that appeared in the October issue of the Journal of Periodontology (JOP). Study Abstract *

Researchers from Boston University investigated the relationship between periodontal disease and history of stroke in patients 60 years of age and older by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III).

“We found that patients 60 years and older who were edentulous, partially edentulous and/or had significant clinical attachment loss were more likely to have a history of stroke compared to dentate adults without significant clinical attachment loss,” said Dr. Martha E. Nunn, Goldman School of Dental Medicine, Boston University. “However, based on the results of this study, it is unclear whether periodontal disease is an independent risk factor for stroke or simply a risk marker that reflects negative effects of risk factors common to both periodontal disease and stroke.”

Age, tobacco use, hypertension, diabetes, serum glucose, C-Reactive protein (CRP) and alcohol intake were also included as additional risk factors in this study. These confounders are independent risk factors for cardiovascular disease and if left untreated, periodontitis has been shown to have harmful effects on the control of diabetes, serum glucose levels and increases CRP levels.

Evidence continues to accumulate associating severe periodontitis with an increased risk of forming atherosclerotic plaques, which are responsible for myocardial infarction and ischemic stroke. According to past JOP studies, this relationship could be due to elevated CRP levels in patients with chronic periodontal disease.

Further investigation is needed to support periodontal treatment intervention as a means of controlling systemic inflammation. Based on findings from another study in the same issue of the Journal, CRP levels may now be reduced by periodontal treatment such as scaling and root planing in patients with severe periodontal disease. Study Abstract *

“Studies evaluating additional treatment methods such as repeated scaling and root planing or surgical treatment are needed to conclusively demonstrate that CRP can be improved by periodontal treatment,” said Preston D. Miller, DDS and AAP president. “Until science presents a definitive direction, the periodontists ultimate goal is to lead patients to the right side of health. What we do know is that eliminating periodontal infection saves teeth.”

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—March 1, 2007—Research presented in a recent paper by Tonetti et al published in the New England Journal of Medicine (NEJM) suggests that intensive periodontal treatment may reverse atherosclerosis by improving elasticity of the arteries, or endothelial function. Findings from previous studies have suggested a link between periodontal disease and atherosclerosis and proposed that periodontal treatment may reduce cardiovascular risk. This study is important because it furthers the understanding of the potential relationship between periodontal disease and cardiovascular disease.

The study examined two groups: a control treatment group and a periodontal treatment group. The control treatment group received supragingival mechanical scaling and polishing, also known as a prophylaxis. According to the study author, the periodontal treatment group underwent four to six hours of scaling and root planing performed by a periodontist, local delivery antimicrobials, and the extraction of hopeless teeth. It is well documented that meticulous scaling and root planing is an essential form of periodontal treatment when compared to supragingival scaling and polishing because the latter is not used to treat periodontitis. This study did not examine the effects of scaling and root planing without local delivery antimicrobials, so the potential added value of local delivery antimicrobials remains unclear. It will be important for future research to examine the cost-benefit analysis of scaling and root planing compared to scaling and root planing and local delivery antimicrobials. In addition, research is necessary to identify how the results of this study would translate when treatment is provided by dental professionals other than periodontists.

According to the American Heart Association, it is estimated that nearly 80 million Americans had one or more forms of cardiovascular disease in 2004. Cardiovascular disease involves a complex interplay of many risk factors. The interesting findings of the Tonetti study support the need for additional research to determine whether the treatment of severe periodontitis could reduce the risk of developing atherosclerosis and cardiovasular events in adults.

Knowledge of the risk factors and possible links to coronary heart disease, such as periodontal disease is the first step towards preventing it. To find out if you are at risk for periodontal disease, please visit the AAP’s Web site at www.perio.org and take a free risk assessment test. To find out if you are at risk for heart disease, visit www.americanheart.org.

NOTE: An article abstract and pay-per-view copy of the New England Journal of Medicine study are available at www.nejm.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for