Alan R. Weinstein DDS, FACD, FICD

ALAN R. WEINSTEIN, DDS, FACD, FICD
7835 Remington Road Cincinnati, OH 45242
(513) 793-1977 FAX (513) 793-1943

PERIODONTAL DISEASE AND SYSTEMIC DISEASE
Risk Factors

Periodontal disease (periodontitis - leading to bone loss, and gingivitis - limited to gingiva) is extremely common, often chronic, frequently insidious, inflammatory and infectious in nature. These diseases result from exposure of the periodontium to dental plaques - complex bacterial “biofilm” masses that accumulate on the teeth from which over 400 species of bacteria have been isolated. Although specific bacterial types cause periodontitis, these biofilms shed virulent components and metabolites especially lipopolysaccharide resulting in a chronic inflammatory response. Periodontitis progresses in episodes of attachment loss with much diversity regarding susceptibility. As many as 30% of the adult population has some degree of periodontal disease.1-3

Systemic disease and conditions as risk factors for causing periodontal disease include diabetes mellitus, neutrophil disorders, osteopenia, Down syndrome, the host’s immunoinflammatory response, and stress. Other acquired and environmental factors include smoking, nutritional deficiencies, and poor oral hygiene. 1,2,6

Untreated periodontal infections can potentially spread bacteria and inflammation by-products through openings in the gum tissue throughout the bloodstream and trigger or influence other chronic diseases, including stroke, heart disease, diabetes, respiratory infections, infections in and around prosthetic devices/artificial heart valves and cause premature spontaneous births by pregnant women. Proper pre-operative antibiotic coverage is indicated for any patient at risk prior to treatment. 1-4

A common factor of both periodontal disease and these illnesses is stress. Stress depresses our immune system's ability to produce and maintain lymphocytes (white blood cells necessary for stopping infection) and natural killer cells (specialized cells that seek out and destroy foreign invaders). Both are necessary to fight infection and disease. Research shows an increase in circulating WBC's but a decrease in circulating B-cells, T-cells, helper T-cells and large granular lymphocytes. 5

STROKE:
Recent studies have shown 3 times the rate of stroke in people with periodontal disease. Fatty deposits in carotid arteries of stroke sufferers show 70% contain bacteria 40% of those bacteria are oral in nature.

HEART DISEASE:
Atherosclerosis and resulting coronary thrombosis, ischemic heart disease and stroke are together the major causes of death in the United States. Hypertension, high cholesterol, and cigarette smoking account for only 1/2 to 2/3 of the incidences of cardiovascular disease. Patients with periodontal disease have demonstrated almost 2 times the rate of heart disease. Bacteria mix with blood clotting cell platelets to form clumps that travel through blood vessels irritating vessel walls and promoting the formation of heart-stopping blood clots. Inflammation produces proteins (prostaglandins, interleukins) that can irritate the interior of blood vessels, causing sites where fatty deposits can form.

DIABETES MELLITUS (PANCREAS):
The most common endocrine disease. Diabetes is characterized by metabolic abnormalities and long-term complications involving the kidneys, eyes, nerves, vasculature, and periodontium. The National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) study of Pima Indians in Arizona showed that diabetics with periodontal disease were 3 times more likely to have heart attacks than those without periodontal disease. They were non-smokers. NIDDK research conducted on the Pima Indians for the past 30 years has helped scientists prove that obesity is a major risk factor in the development of diabetes. One-half of adult Pima Indians have diabetes and 95% of those with diabetes are overweight.
* *Obesity and Diabetes. www.niddk.nih.gov/health/diabetes/pima/obesity/obesity.htm

SPONTANEOUS PRE-TERM BIRTHS:
Women with periodontal disease were 7-8 times more likely to have premature, low birth-weight babies. Possible low-grade infection causes damaged cells to release inflammation-causing substances that could affect the term of the pregnancies.

Behavioral Psychosocial Status: Oral diseases can lead to pain and malaise, which can lead to a decrease in immune function and can impact a patient's sense of well-being. Poor oral function, esthetics and hygiene can lead to loss of pleasure from eating and drinking and loss of life satisfaction through concerns of "self-presentation" - a fear of embarrassment. These concerns can affect socialization and self-esteem - vital factors in "Emotional Intelligence" and "Wellness". 5 The Biopsychosocial Model of Illness of noted University of Rochester psychiatrist Dr. George Engel states that: 1. A person’s immune system affects their disease. 2. Thoughts, emotions, and life experiences may affect the outcome of the illness. 3. Treatment acts on the pathogen but is influenced by the person’s environment and psychosocial functioning. Mental health issues may contribute to the cause of the illness, and illnesses may worsen our mental health, which may affect the outcome. 6,7 Positive problem-focused coping strategies rather than emotion based coping is most effective for stress management. 2,6

Xerostomia (Dry Mouth): The causes of dry mouth include side effects of many medications, diseases (Sjogren’s Syndrome, HIV/AIDS, diabetes, Parkinson’s disease), radiation therapy, chemotherapy, nerve damage, and aging. Sequelae of chronic xerostomia are related to progressive caries, acceleration of periodontal disease, candidiasis and generalized dental breakdown at a time when patients can least afford it physically, financially, or emotionally. Treatment can include scrupulous oral hygiene, dietary factors, hydration, therapeutic topical fluoride gels/toothpastes, and saliva enhancing/tissue protective products. 8

OBESITY
Ninety-seven million American adults, or 55% of people over 20 are overweight or obese. Over 300,000 people die each year due to obesity related causes.1 Of children ages 6 to 11, 13% are overweight, up from 11% in1990 and 4% in the 1960’s.2 Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. The Body Mass Index is useful to provide a healthy weight to height ratio. The BMI categories of underweight, healthy weight, overweight, obese, and extremely obese are based on the government's 1998 Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Research suggests excess fat in the abdomen is a greater health risk than excess fat in the hips and thighs.3

Your Body Mass Index = weight/height and is calculated with this formula:
U.S.: Multiply your weight (in pounds) by 704.5. Multiply your height (in inches) by your height (in inches). Divide the first result by the second.

Example: If you're 5'5" and weigh 140:

140 x 704.5 = 98,63065 x 65 = 4,22598,630 divided by 4,225 = 23 BMI

The higher your BMI, the greater your risk. A BMI over 25 = overweight (5’4 and over145lbs) and a BMI over 30 is considered obese (5’6 and over 186lbs). Weight loss of 10% of body weight/ 6months is considered safe.

FATS
Elevated blood cholesterol can clog arteries and potentiate heart attacks. High-density lipoproteins (HDL good cholesterol) + low-density lipoproteins (LDL) + very low-density lipoproteins (VLDL triglycerides) = total serum cholesterol. The higher the LDL levels in the blood, the greater the risk of heart disease.

COMMON DENOMINATORS of FAD DIETS
* Low calorie diets tend to be deficient in nutrients. * Out of balance. * High water loss.
* Fasting state ketosis… possibly dangerous! * “Quick fix” vs. lifestyle change.5
1. http://health.aol.thriveonline.oxygen.com/weight/tools/bmi.source.htm
2. http://www.cdc.gov/nccdphp/dnpa/dnpalink.htm (Centers for Disease Control)
3. http://www.nhlbi.nih.gov/guidelines/obesity/obhome.htm
4. http://www.aicr.org (American Institute for Cancer Research)
5. AICR, American Heart Association, American Dietetic Association, Surgeon General

ALAN R. WEINSTEIN, DDS, FACD, FICD
7835 Remington Road, Cincinnati, OH 45242
(513) 793-1977 FAX: (513) 793-1943

NUTRITION AND VITAMINS
Factors That Can Affect Our Immune System

DRUGS OF ABUSE:
1. Alcohol: As long as your liver is ok, your immune system seems to be ok.
2. Tobacco: Alters immune ability - both mechanical (emphysema/chronic bronchitis) and PMN systems, causing 30% of all cancer deaths. Smoking increases risk of cancer 50 fold.

MORE MAY NOT BE BETTER - TAKING MORE THAN THE RECOMMENDED DAILY REQUIREMENT MAY BE HARMFUL. * Vitamins A, D, E, and K are fat-soluble - stored in body. You do not need a supply every day.
1. Keller, Dr. Steven E.: "The Immune System." Cortext, Fall 1998.
2. Meinz, David: www.eatingbythebook.com
3. Burns, Dr. Steven: www.teachhealth.com