Periodontal Disease - Complications

Highlights	Complications	Other Treatments
Introduction	Prevention	Resources
Symptoms	Diagnosis	References
Causes	Treatment
Risk Factors	Medications

Complications

The ultimate outcome of uncontrolled periodontal disease is tooth loss. As the destructive factors cause the breakdown of bone and connective tissue, there remains no anchor for the teeth.

Bad Breath

A much less severe but nevertheless distressing problem caused by periodontal disease is bad breath, although coatings on the tongue may contribute more to bad breath than even periodontal disease.

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Heart Disease and Stroke

Some studies have reported a 1.5- to 4-fold increased risk for heart disease in people with periodontal disease. (The highest risk was in men with extensive gum disease, bleeding from every tooth.) In one study, 85% of heart attack patients had periodontal disease compared to 29% of people with no heart problems. In another study of patients with hypertension, severe periodontal disease was associated with damage on the left side of the heart. In addition, high cholesterol blood levels have been associated with chronic periodontal disease.

Periodontal disease has also been linked to stroke and to coronary artery disease (CAD). A 2005 study observed periodontitis in 91% of patients with CAD versus 66% of healthy patients. The researchers concluded that periodontitis is a significant risk factor for CAD, and that the more severe the periodontitis, the greater the risk for developing CAD.

A stroke is caused by a loss of blood circulation to areas of the brain. The blockage usually occurs when a clot or piece of atherosclerotic plaque breaks away from another area of the body and lodges within theblood vesselsof the brain.

Recent evidence is pointing to the inflammatory response as the common element. This is an over-reaction of the immune system that causes injury to tissues in the body. A common link between patients with both heart conditions and periodontal disease may be elevated levels of C-reactive protein (CRP), a marker for the inflammatory response. Some experts believe, then, that immune factors causing this response are released into the blood stream during periodontal disease and cause injury in the arteries supplying blood to the heart.

Other evidence suggests that the bacteria itself, particularly P. gingivalis, may play a direct role in arterial injury. In 2005, results from the NIH-sponsored Oral Infections and Vascular Disease Epidemiology Study (INVEST) determined an association between cardiovascular disease and the bacteria that cause periodontal disease. In this study, higher levels of periodontal bacteria were associated with thicker carotid arteries (a predictor of heart attack and stroke), regardless of C-reactive protein levels. While this study's findings are an important advance in understanding the relationship between periodontal and heart disease, it is still not clear if periodontal disease actually causes cardiovascular disease. Researchers hope that future results from INVEST will clarify this issue.