Periodontal (Gum) diseases
Periodontium refers to the specialized tissues that join the teeth securely to the jawbone. It consists of the gum, the dental socket and its periosteum, the periodontal membrane (which, as a membrane of connective tissue, flexibly secures the tooth to the bone socket) and the cementum covering the root from the outside.
The tooth and the periodontium
The comprehensive name of the diseases of the periodontium is periodontitis. Periodontitis deserves attention as it can cause teeth loss while producing relatively few symptoms. Periodontitis does not affect the teeth, but the tissues supporting the teeth (the jawbone and the periodontal ligaments). If pathogens enter, remain and start multiplying in the narrow gap between the gum and the tooth, the deeper tissues beneath the gum become inflamed. This inflammation damages the connecting tissue fibres, and leads to bone resorption. Bone resorption may cause a so-called dental pocket to form between the root and the gum, which is diagnosed by the dentist with a special probe (a blunt examination tool).
The dental pockets are difficult to reach with a toothbrush, which makes them an ideal habitat for bacteria. Gradually, as a result of the constant inflammation, the gum recedes and even deeper dental pockets form. The bacteria irreversibly destroy the tissues that support the tooth, and the tooth starts to move. The instability of the tooth increases, and sooner or later it falls out. Besides improper dental care, smoking, obesity and diabetes make one prone to periodontitis. Hereditary factors also have a share, as periodontitis is amassed in families.
Arteriosclerosis occurs when the wall of arteries that carry blood rich in oxygen and nutrients to the organs hardens. At birth, the wall of blood vessels is flexible and soft, the innermost layer of the arteries is smooth, and the bloodstream is unobstructed. With ageing, fatty deposits (fatty plaques) form in the wall of blood vessels and get gradually bigger, causing arteriosclerosis and constriction of the vessels, obstructing the bloodstream more and more. The plaque may also crack, and the clot of blood deposited on it will suddenly block circulation in the blood vessel. Constriction or occlusion forming in the arteries of the brain can cause softening of the brain. Arteriosclerosis and constriction of the blood vessels supplying blood to the lower limbs may cause tiredness, pain and gangrene in the legs. Constriction in the coronary arteries results in chest pain when there is physical exertion, and their occlusion causes heart attack.
Inflammation also plays a significant role in the formation and the growth of fatty plaque that causes arteriosclerosis.
The connection between periodontitis and arteriosclerosis
The bacteria responsible for periodontitis, the substances produced by them, and the reaction of the body to the bacterial infection and inflammation have not only local, but also far-reaching consequences. Periodontitis is a significant risk factor for arteriosclerosis. Chronic periodontitis sustains the continuous infection of the oral cavity, and from there bacteria may keep entering the bloodstream. The bacteria affect the body’s immune system, causing a general inflammatory reaction, as a result of which fatty plaque may form on the intima, and if the plaque keeps growing, it can lead to the constriction or occlusion of the blood vessel. Bacteria or their constituent parts entering the bloodstream can show similarities to the components of the wall of blood vessels, and the body’s defence against the bacteria may, as a mistaken reaction, be directed towards the constituents of the wall of blood vessels at the same time, contributing to the damage to the vessels. Bacteria or the substances from the inflammation caused by them bind to the albumin carrying blood fats (like cholesterol) and modify their components. These will be treated by the body as foreign particles, and defending white blood cells will swallow the fat molecules, and then get incorporated into the wall of the blood vessel, causing further constriction. The inflammation caused by the bacteria or their substances may also facilitate blood clot formation, which in turn may aggravate the constriction caused by arteriosclerosis or can cause occlusion of a blood vessel.
Proper dental care, regular dental examination and treatment do not only facilitate the preservation of teeth, but can also contribute to the prevention of diseases of the vascular system.
Dr. Vályi Péter