Trending Clinical Topic: Periodontal Disease

Ryan Syrek


May 20, 2022

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The association between gum disease and significant comorbidities has been highlighted in several recent studies. From inflammatory disorders to neurologic disorders, the link between oral health and overall health put periodontal disease in the spotlight. In the early stage of periodontal disease (gingivitis), the gums can be swollen and red and may bleed. In the most serious form, periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out. According to the US Centers for Disease Control and Prevention, periodontitis is more common in men than women (56.4% vs 38.4%), those living below the federal poverty level (65.4%), those with less than a high school education (66.9%), and current smokers (64.2%). Periodontitis has been connected to various serious systemic conditions (see Infographic).

The kind of tooth loss caused by periodontitis is commonly seen in individuals with type 2 diabetes (T2D), according to a recent study. In a meta-analysis of 22 recent studies from around the world, T2D was associated with a 20% increased risk for tooth loss after adjusting for multiple other risk factors. The risk for tooth loss ranged from 15% higher in cross-sectional studies to 29% higher in cohort studies to five times higher in case-control studies. Diabetes increases the risk for oral disease directly by a gingival inflammatory response and indirectly by decreased saliva production due to antidiabetic medications. Oral complications include dry mouth, tooth decay, and periodontal disease. The latter ranges from gingivitis to periodontitis that can lead to tooth loss. About one third of people with diabetes have severe periodontal disease, and 1 in 5 cases of tooth loss in adults is related to diabetes.

Periodontal disease also appears to raise the odds of developing other serious conditions, as a recent study found that it may increase the risk for sporadic colorectal cancer (CRC). The population-based case-control COLDENT study found that the rate of new CRC diagnoses among individuals who had a history of periodontal disease was nearly 50% higher than in those with no such history, after adjustment for a host of medical and demographic factors. Janati and colleagues analyzed 348 histologically confirmed cases of colon or rectal cancer diagnosed from January 2013 to December 2019 and compared them with 310 matched controls. The rate of new CRC diagnoses among individuals with a history of periodontal disease was 1.4 times higher after adjustment for age and gender. That increased to 1.45 times higher after additional adjustment for body mass index, education, income, diabetes, family history of CRC, regular use of aspirin and nonaspirin nonsteroidal anti-inflammatory drugs, lifetime cumulative smoking, consumption of red and processed meats, alcohol consumption, and total physical activity score.

Gum disease may also be a potential target by which to help mitigate certain conditions, such as Alzheimer's disease (AD). New research suggests that an oral, experimental medication targeting the bacteria that causes gum disease may offer a "new treatment paradigm" for mild to moderate AD. Results from the phase 2/3 GAIN trial of atuzaginstat, which targets the gum bacteria Porphyromonas gingivalis, suggest that this pathogen is a "potential driver of AD." The trial included 643 generally healthy patients aged 55-80 years (mean age, 69 years) with mild to moderate AD. Some patients who received the drug saw a significant slowing of decline on the AD Assessment Scale-Cognitive subscale of 26%-57%, with another statistical analysis showing that decline slowed by 40%-56%.

From dental concerns in patients with T2D to concerning associations between gum disease and CRC and AD, research into links between periodontal disease and various serious conditions resulted in this week's top trending clinical topic.

Learn more about gum diseases.


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