CHICAGO – November 27, 2002 – Austrian researchers found that learning about a patient’s stress coping strategies could help physicians with proper diagnosis and treatment of some medical conditions.

The study, published in the Journal of Periodontology (JOP), found that patients with defensive coping skills are more likely to refuse all responsibility and downplay their conditions in comparison with others, thus making it difficult for physicians to determine the severity of the medical condition and inhibiting their ability to counsel patients on possible prevention methods. Study Abstract *

“Should these results be confirmed, they would constitute an important means of enhancing the patient’s compliance during medical examinations and treatment,” said Gernot Wimmer, D.M.D, study author and lector at the Karl Franzens University of Graz in Austria. “In such cases, care should be taken to ensure that patients receive information in such a way that it does not cause them to become defensive, and that proper access to the disease is established.”

He continued, “Either consciously or unconsciously, individuals use coping measures as a response to stress, in order to reduce its intensity or to overcome stress altogether. Thus, the individual’s concept of stress coping appears to be particularly an important determinant of the general tenor on his/her health.”

The study looked at coping behavior in 89 men and women with periodontitis, an inflammatory gum infection at its most aggressive and destructive form, and 63 healthy persons. All study participants underwent a periodontal examination and took one of the most comprehensive stress questionnaires in German-speaking countries to determine their coping behavior. Results showed that those with periodontal disease were less likely to use active coping strategies, such as situation control, than those in the control group. They were also more likely to cope with stress situations by means of averting blame.

“This Investigation further demonstrates a correlation between emotional and psychosocial stress factors and medical treatment success,” said Gordon Douglass, D.D.S., and president of the American Academy of Periodontology. “It is important that both patients and their therapists understand ways to improve their stress coping ability.”

In terms of differentiating the various stressors, earlier reports indicate that work-related issues are coped with in a rather problem-oriented fashion, whereas disease-related situations are handled emotionally. Concerning family issues, no specific style is given preference; both patterns are used to an equal extent.

Problem-oriented coping is practiced in those situations that are considered changeable. For example, previous research in the JOP found that people with financial worries were at a higher risk of periodontal disease. However, authors recommended problem-based coping behaviors, such as taking charge and tackling the situation head first, to reduce the stress-associated risk. Emotional coping is more common in situations that have to be accepted and in which the individual feels helpless.

A referral to a periodontist in your area and free brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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CHICAGO, July 9, 1998 – A new analysis of recent research has revealed gum disease may represent a far more serious threat to the health of millions of Americans than previously realized. These studies found that periodontal (gum) infection may contribute to the development of heart disease, the nation’s number one cause of death, increase the risk of premature, underweight births, and pose a serious threat to people whose health is already compromised due to diabetes and respiratory diseases.

“It seems clear that gum disease, far from being just an oral health problem, actually represents a significant health risk to millions of people,” said Robert Genco, D.D.S., Ph.D., editor-in-chief of the Journal of Periodontology.

The article, a first in the oral health field, is a comprehensive analysis of research on periodontal disease and its link to systemic conditions. It supports what many scientists have suspected for years — that oral infections such as periodontal disease can adversely affect conditions outside the mouth. This compilation of current research studies on this link is being published in the Annals of Periodontology concurrently with the article in the Journal of Periodontology.

To help people learn more about this health concern, The American Academy of Periodontology (AAP) is launching a national public education campaign which will include a toll-free consumer information number (1-800-FLOSS-EM), interactive Web site (www.perio.org) where questions about oral health and gum disease will be answered by an Academy periodontist, and educational materials on the link between gum disease and heart disease, diabetes, respiratory disease and premature, low birthweight births.

Dr. Genco noted the goal of the campaign will be to educate Americans about periodontal infection and its associated general health risks.

“Periodontal disease is characterized by inflammation and bacterial infection of the gums surrounding the teeth. The bacteria that are associated with periodontal disease can travel into the bloodstream to other parts of the body, and that puts health at risk,” said Dr. Genco. “People think of gum disease in terms of their teeth, but they don’t think about the fact that gum disease is a serious infection that can release bacteria into the bloodstream. The end result could mean additional health risks for people whose health is already affected by other diseases — or lead to serious complications like heart disease.”

According to Hal Slavkin, D.D.S., director of the National Institute of Dental Research (NIDR), studies supported by the NIDR have shown an intriguing association between periodontal infections and a number of systemic disorders. “We’re very interested in these findings because of the potential significance to public health if it turns out periodontal infection is a risk factor for other diseases. The Institute will continue to support this promising line of research into the connection between oral and systemic health,” said Dr. Slavkin.

“Many Americans have oral exams each year to check for cavities and tooth decay. This research shows it is equally important to pay attention to gums. Having a periodontal screening and evaluation could help protect the overall health of millions,” said Timothy Rose, D.D.S., M.S., president of The American Academy of Periodontology. “There are often no symptoms of gum disease in its early stages, so people need to make sure their dentist or periodontist checks their gums regularly.”

According to Dr. Rose, research establishing the link between periodontal disease and systemic conditions is compelling, and additional research will help to further define the nature of these links.

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CHICAGO – July 19, 1999 – High levels of financial stress and poor coping abilities increase twofold the likelihood of developing periodontal (gum) disease, according to a study released today in the July 1999 issue of the Journal of Periodontology. Study Abstract *

After accounting for other risk factors – such as age, gender, smoking, poor dental care and diabetes – those who reported high levels of financial strain and poor coping behaviors had higher levels of attachment loss and alveolar bone loss (signs of periodontal disease) than those with low levels of financial strain.

“Financial strain is a long-term, constant pressure,” said Dr. Robert Genco, chair of the Oral Biology Department at The State University of New York at Buffalo, who carried out the studies with the periodontal research group at Buffalo and behavioral scientist Dr. Lisa Tedesco of the University of Michigan. “Our studies indicate that this ever-present stress and a lack of adequate coping skills could lead to altered habits, such as reduced oral hygiene or teeth grinding, as well as salivary changes and a weakening of the body’s ability to fight infection.”

However, people who dealt with their financial strain in an active and practical way (problem-focused) rather than with avoidance techniques (emotion-focused) had no more risk of severe periodontal disease than those without money problems.

“The good news is that many of the risk factors for periodontal disease, such as poor oral hygiene and infrequent professional care, can be controlled with minimal personal time and financial resources,” said Dr. Robert Schoor, president of the American Academy of Periodontology. “And because eliminating periodontal disease also eliminates a risk factor for heart disease, respiratory disease, and diabetes complications, it is especially important for people to do what they can to protect their oral health.”

Genco and his colleagues are following more than 1,400 people between the ages of 25 and 74 in the ongoing study, which is one of the first to examine the relationship of periodontal disease to stress, distress and coping in a large population.

Psychological tests were given to identify and weigh the causes of stress (children, spouse, financial strain, single life and work stress) in participants’ daily lives and to measure the ability to cope with stress. To measure financial strain, study participants answered nine questions, including:

• At the present time, are you able to afford a home that is large enough?
• Do you have difficulty in meeting monthly payments of your family bills?
• How often is it that you don’t have enough money to afford the kind of food, clothing, medical care, or leisure activities you and your family need or want?

Further studies are needed to help establish the time course of stress in respect to the onset and progression of periodontal disease and the mechanisms that explain the association. Intervention studies also are needed to determine the extent to which controlling stress will influence periodontal disease and its treatment.

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Disease: 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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Chicago – October 13, 1997 – Several recent studies support the association between periodontal (gum) disease and family members:

• Periodontal (gum) disease may be passed from parents to children and between a couple, according to an article in the September 1997 issue of the Journal of the American Dental Association. Researchers suggest bacteria that cause periodontal disease pass though saliva. This means that the common contact of saliva in families puts children and couples at risk for contracting the periodontal disease of another family member. Periodontal disease can lead to tooth loss.M
• Up to 30% of the population may be genetically susceptible to developing severe periodontal disease, according to a study published in the Journal of Clinical Periodontology. These findings could result in the early identification and treatment of at-risk patients.

Based on this research, The American Academy of Periodontology (AAP) recognizes that treatment of gum disease may involve entire families. If one family member has periodontal disease, the AAP recommends that all family members see a dental professional for a periodontal disease screening.

A referral to a periodontist in your area and free brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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CHICAGO – May 26, 2000 – Oral health issues have been put in the spotlight with the release today of the Surgeon General’s Report on Oral Health. A key goal of the report is to educate the public on the relationship between oral health and general well being. Since 1996, when the American Academy of Periodontology (AAP) first began disseminating information to the media and the public on the newly discovered links between periodontal disease and systemic health conditions, this also has been a top AAP priority.

“We hope this Surgeon General’s Report will heighten the public and medical community’s perception of the importance of oral health, just as past reports on tobacco use and more recently mental health have,” said Jack Caton, D.D.S., M.S., president of the AAP. “As research continues to strengthen the links between periodontal disease and heart disease, diabetes, respiratory disease and preterm births, it’s important to spread the message that periodontal disease is far from being just an oral health problem. It represents a significant health risk to millions of people.”

In addition, the AAP is involved in many other issues highlighted in the report.

The report addresses disparities in oral health status between different ethnic groups. A study published in the January, 1999 issue of the Journal of Periodontology reported that 35 percent of Mexican Americans aged 30 to 54 have periodontitis, compared to 25 percent of whites in the same age group. To address this disparity, the AAP recently launched a Spanish-language media campaign to educate Hispanic Americans on periodontal disease and research linking it to other health problems. “Many of my Hispanic patients are not aware that by not maintaining oral health, they may be jeopardizing more than just their teeth,” said Gilbert Barajas, an AAP spokesperson for the campaign. “This is an opportunity to educate them and call attention to the importance of periodontal health.” Later this year, the Academy will launch a campaign targeted at African Americans to address the same goal.

In addition to public education outreach, the AAP has looked at ways to improve access to dental care for people who may not be able to afford it. Last year, the AAP endorsed Donated Dental Services, a program in which volunteers donate millions of dollars worth of dental care to needy patients across the United States. According to a 1998 AAP survey, three out of four AAP members have provided free or reduced-fee periodontal services to patients who cannot afford treatment.

The AAP provides patient education materials on a variety of other topics touched on in the report, including tobacco use and oral health, oral health issues for women and older people, and treatment and prevention of periodontal disease. A referral to a periodontist in your area and free brochure samples are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

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CHICAGO – January 21, 2004 – A blood test is often given during a medical checkup to reveal indicators of general health conditions. In a recent study reported in the December Journal of Periodontology (JOP), Japanese researchers found that a blood test may also reveal indicators of periodontal diseases. Study Abstract *

Researchers examined and measured the oral health of 7,452 men and women, and tested their blood for 37 items used in general blood tests. Some of the items tested for in the blood include cholesterol and C-reactive protein, commonly linked to heart disease; and diabetes. The results of the blood tests were compared against the oral health scores of the participants.

“In this study we found that generally if the blood was “healthy,” the oral health was also healthy. Conversely, if the blood test detected certain “red flags,” the person also had serious symptoms of periodontal diseases,” said Dr. Yuko Takami, Department of Preventive Dentistry and Dental Public Health, School of Dentistry, AichiGakuin University, Japan. “We also found that males were reported to have more serious symptoms of periodontal diseases than females of the same age group,”

“These findings mean that in the future when patients visit their medical doctors for a routine check-up and annual blood work, they may also be referred to a periodontist for a periodontal screening if the blood indicates systemic abnormalities,” said Michael P. Rethman, D.D.S., M.S., and president of the American Academy of Periodontology.

The only item from the blood test that showed a significant relationship with periodontal diseases in women was CRP. A specific reason could not be pinpointed as to why men were reported to have more serious symptoms of periodontal diseases than women. One reason could be that men and women have different endocrine situations, and periodontal diseases are influenced by endocrine conditions.

“With each study that looks at the association between systemic and periodontal diseases, we learn more about the CRP correlation,” said Rethman. “Another study in this JOP issue reinforces previous studies indicating a relationship between CRP elevation and periodontitis.” (Study Abstract*)

In a study from the August JOP, CRP values were compared before and after treatment. Researchers found that the CRP values significantly decreased after periodontal treatment. (Study Abstract*)

“Since the treatment of periodontitis in this study appears to be effective in reducing levels of CRP, patients at risk for coronary heart disease may want to visit a periodontist to control their periodontitis,” said Rethman.

Blood Test Values and CPI Scores in Medical Checkup Recipient Study Findings

This study investigated correlations between the blood test values of people who had general medical checkups and their community periodontal index score (CPI). CPI represents periodontal disease indicators in order to clarify how periodontal diseases relate to systemic conditions. The study included 7,452 people and divided them by age and gender. CPI scores were listed as 0, 1, 2, 3 and 4 to indicate, respectively, the following conditions: healthy, bleeding after probing, dental calculus detected by probing, 4- to 5-mm deep pockets and >6-mm deep pockets. A total of 37 items were tested in the blood, some of which include C-reactive protein (CRP), triglyceride (TG), total cholesterol (TC), white blood count (WBC) and blood sugar (BS).>

Comparisons were then made between blood test values higher than the standard range and the standard values for CPI scores of 3 and 4.>

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

About the AAP

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

CHICAGO – March 30, 2004 – Many women report an increase in gingival inflammation and discomfort associated with their menstrual cycle, according to findings published in the March Journal of Periodontology. This is the first time this well-known phenomenon has ever been studied. Study Abstract *

“What we found is that several women reported considerable oral symptoms prior to menses,” said Eli E. Machtei, D.M.D., Unit of Periodontology Department of Maxillofacial Surgery, Rambam Medical Center and Technion Faculty of Medicine.

The symptoms included a slight burning sensation, bleeding with minor irritation, redness to the gums, oral ulcers and general pain and discomfort in the gums.

In this study, researchers compared the gingival and periodontal status of 18 premenopausal women between the ages of 20 to 50 years at different time points of their menstrual cycles. The time points were ovulation, premenstruation and menstruation. During the examination, researchers measured plaque index, gingival index, probing depth, gingival recession and clinical attachment level.

“Gingival inflammation was lower during menstruation than during ovulation and premenstruation,” said Machtei. “This may be attributed to the hormone known as serum estradiol, which is a natural form of estrogen that peaks and drops during ovulation and premenstruation.”

“Further studies will be required to explore the mechanism by which this phenomenon occurs, and to examine whether these transitional changes have any lasting negative effects on the periodontium,” said Michael P. Rethman, DDS, MS, and president of the American Academy of Periodontology. “In the meantime, patients should remember the importance of telling their dental professionals about what is going on in their bodies including any prescription or over-the-counter medications they are taking. This way dental professionals can explain any effects it has on periodontal health.”

A referral to a periodontist in your area and free brochure samples including one titled Women and Periodontal 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 – 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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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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