A recent study by Sharma and Shamsuddin published in the January 2011 issue of the Journal of Periodontology suggests a possible link between upper respiratory diseases—including pneumonia, acute bronchitis, and chronic obstructive pulmonary disease (COPD)—and periodontal disease. Typically occurring when bacteria are inhaled into the lungs, the bacteria that cause periodontal disease also can be inhaled into the respiratory tract and increase the risk of infection.
The study examined 200 people, 100 who had been hospitalized with a respiratory infection and 100 who were healthy. The study results demonstrated that those who were part of the healthy group had better periodontal health, while the periodontal health of those with respiratory illnesses was worse.
Several studies have suggested a link between periodontal disease and other inflammatory diseases, such as cardiovascular disease and diabetes. However, there is not a lot known about how periodontal disease can impact respiratory health. Considering that respiratory infections, including chronic obstructive pulmonary disease (COPD) and pneumonia, can be severely debilitating and are a major cause of death in the United States, research into how periodontal health and respiratory health are potentially connected is imperative.
The significance of this research study is that it provides further evidence of the perio-systemic link by demonstrating that the incidence of pathogens in the periodontium may play a role in the progression of non-oral disease. These findings suggest that the presence of bacteria associated with periodontal disease, such as Porphyromonas gingivalis, may increase a patient’s risk of developing or exacerbating respiratory infections. The occurrence of these oral pathogens, and the resulting supragingival plaque accumulation, periodontal pockets, and—I would argue—the inflammatory response diminishes the host defense, thereby increasing subjects’ risk for developing a respiratory infection.
Poor periodontal health, therefore, may be viewed as a risk factor for respiratory disease. But as the researchers note, other factors may come into play as well. Additional research is needed in this area to better understand how periodontal disease and respiratory disease are related.
This study places a lot of emphasis on the role of bacterial pathogens in the progression of both periodontal disease and respiratory disease. While the presence of bacteria is a determinant of disease, it is often the inflammatory response to bacteria that is essential in the initiation and progression of disease states.
Individuals may be genetically predetermined to respond differently to a challenge, such as bacteria, and therefore their level of disease may be different. It seems that while an in-depth discussion of inflammation was missing in this study, there was speculation that periodontal pathogens not only are responsible for respiratory tract infection, but also that these pathogens may affect the local defense mechanisms of the region to increase these patients’ risk for respiratory disease.
Both periodontal disease and respiratory disease are often classified as inflammatory conditions, so it may be possible that inflammation may be a factor in the link between the two. Obviously, more research is required to illustrate this and better understand if and how the inflammatory response to periodontal bacteria leads to the development or aggravation of respiratory infections.
Periodontal disease is a chronic, inflammatory disease that can impact overall health, and therefore, we must treat our patients accordingly. This means conducting a comprehensive periodontal evaluation on an annual basis to ensure that periodontal disease is caught early and an appropriate treatment plan can be established. The dental team must work together to ensure that each patient receives a yearly comprehensive examination, including intraoral, extraoral, and occlusal evaluations; a thorough assessment of plaque, calculus, and gingival inflammation; probing of at least six sites per tooth; assessment and documentation of recession and attachment loss around teeth; radiographic evaluation of bone loss; and an assessment of patient-associated risk factors such as age, smoking, and the presence of other chronic, systemic conditions associated with systemic inflammatory burden.
Maintaining periodontal health may contribute to a healthy respiratory system, according to research published in the Journal of Periodontology. A new study suggests that periodontal disease may increase the risk for respiratory infections, such as chronic obstructive pulmonary disease (COPD) and pneumonia. These infections, which are caused when bacteria from the upper throat are inhaled into the lower respiratory tract, can be severely debilitating and are one of the leading causes of death in the U.S.
The study included 200 participants between the ages of 20 and 60 with at least 20 natural teeth. Half of the participants were hospitalized patients with a respiratory disease such as pneumonia, COPD, or acute bronchitis, and the other half were healthy control subjects with no history of respiratory disease. Each participant underwent a comprehensive oral evaluation to measure periodontal health status.
The study found that patients with respiratory diseases had worse periodontal health than the control group, suggesting a relationship between respiratory disease and periodontal disease. Researchers suspect that the presence of oral pathogens associated with periodontal disease may increase a patient’s risk of developing or exacerbating respiratory disease. However, the study authors note that additional studies are needed to more conclusively understand this link.
“Pulmonary diseases can be severely disabling and debilitating,” says Donald S. Clem, DDS, President of the American Academy of Periodontology. “By working with your dentist or periodontist, you may actually be able to prevent or diminish the progression of harmful diseases such as pneumonia or COPD. This study provides yet another example of how periodontal health plays a role in keeping other systems of the body healthy.”
Periodontal disease is a chronic inflammatory disease that affects the gum tissue and other structures supporting the teeth. Previous research has associated gum disease with other chronic inflammatory diseases such as diabetes, cardiovascular disease, and rheumatoid arthritis.
Dr. Clem stressed the importance of routine oral care in helping to prevent periodontal disease. “Taking good care of your periodontal health involves daily tooth brushing and flossing. You should also expect to get a comprehensive periodontal evaluation every year,” he advised. A dental professional, such as a periodontist, a specialist in the diagnosis, treatment and prevention of gum disease, can conduct a comprehensive exam to assess your periodontal disease status.
Bacterial respiratory infections are thought to be acquired through aspiration (inhaling) of fine droplets from the mouth and throat into the lungs. These droplets contain germs that can breed and multiply within the lungs to cause damage. Recent research suggests that bacteria found in the throat, as well as bacteria found in the mouth, can be drawn into the lower respiratory tract. This can cause infections or worsen existing lung conditions. People with respiratory diseases, such as chronic obstructive pulmonary disease, typically suffer from reduced protective systems, making it difficult to eliminate bacteria from the lungs.
Scientists have found that bacteria that grow in the oral cavity can be aspirated into the lung to cause respiratory diseases such as pneumonia, especially in people with periodontal disease. This discovery leads researchers to believe that these respiratory bacteria can travel from the oral cavity into the lungs to cause infection.
Chronic obstructive pulmonary diseases (COPD) cause persistent obstruction of the airways. The main cause of this disease is thought to be long-term smoking. Chemicals from smoke or air pollution irritate the airways to cause obstruction. Further damage to the tissue and working function of the lungs can be prevented, but already damaged tissue cannot be restored – untreated or undetected COPD can result in irreversible damage. Scientists believe that through the aspiration process, bacteria cam cause requent bouts of infection in patients with COPD. Studies are now in progress to learn to what extent oral hygiene and periodontal disease may be associated with more frequents bouts of respiratory disease in COPD patients.