Tuesday, October 30, 2018

Alzheimer's and Periodontial Disease

Chronic Periodontitis (gum disease) may have connection to Alzheimer’s disease


There is an unsettling trend to view dentistry as a simple cosmetic procedure with little to no focus on the well-established link of dental health to overall systemic health of the body and mind.  Social media, commercialization of dentistry, overstressing new technologies and a general erosion of ethics may all be somewhat to blame.  I don’t recall seeing anything on my Facebook come up on the dangers of Chronic Periodontitis or its relationship to life altering diseases but I certainly see many ads about Invisalign and tooth whitening.  However now and then there is a study that really is worthy of informing the public, even if it is very preliminary.


So how can dental health affect your body?


Already researchers have linked Chronic Periodontitis (Gum disease) to Cardiovascular Disease (CVD), Chronic Obstructive Pulmonary Disease (COPD) and recently to Rheumatoid Arthritis (RA), the later by promoting the onset and even the severity of RA.  In particular, bacteria that causes gum disease actually increases the severity of RA with increased bone and cartilage destruction.
P. gingivalis attacking bone in Rheumatoid Arthritis

But a new study recently published in the peer-reviewed journal of the Pubic Library of Science (PLOS One*, Oct. 3, 2018) was designed to investigate if there is a correlation between bacteria normally seen in periodontal disease (Porphyromonas gingivalis or P. gingivalis for short) and that same bacteria seen sometimes in the brain tissue of Alzheimer’s patients. 

P. gingivalis

This bacteria, P. gingivalis, is a known pathogen in the oral cavity associated with Chronic Periodontitis (the very same bacteria linked to CVD, COPD and RA), the chronic infection of gum tissue that causes people to lose alveolar bone and eventually teeth. The article was presented by Keiko Watanabe, DDS, PhD, a Periodontology professor at the University of Illinois at Chicago who focuses her research on systemic effects of specific oral bacteria known to cause Chronic Periodontal Disease in humans.



Dr. Watanabe’s prospective study took 20 mice and injected half with regular doses of the bacteria P. gingivalis while the other half received a saline injection.  After 22 weeks, the mice were sacrificed and the brain tissues compared.  As expected, the mice that received the saline injections had normal brain tissue however the mice receiving the bacterial suspension revealed brains with signs of degeneration, inflammation and senile plaque typically characteristic of Alzheimer’s disease in humans.  Dr. Watanabe points out that it is the chronic nature of the infection that related to the changes in the brain tissue, the same chronic exposure any patient would be receiving from years of chronic periodontitis.      

Brain tissue showing degeneration with plaques

It is possible there is a direct effect from the bacteria on increasing beta amyloid production (a major constituent of senile plaque and widely believed to cause Alzheimer’s) or, as Dr. Watanabe postulates, it may be an effect of neuroinflammation caused by the chronic presence of the bacteria. 

No matter the direct causation/mechanism, the study definitely suggests there is a link and there needs to be more research on chronic bacterial infections as they relate to Alzheimer’s.  Periodontal disease is a common ailment for humans even in the developed world making this potentially a landmark study.  And any advancement in the understanding and/or treatment of Alzheimer’s disease is certainly of unmeasurable value to society as a whole.  I am always quick to point out to patients the multi-faceted nature of diseases; that there can be many factors and/or triggers for what we perceive as a single disease or ailment.  Sometimes just reducing these factors is enough to keep the disease at bay or prevent expression of certain symptoms.  This is why I feel strongly that anytime you can reduce the risks, you should make that effort (and of course good oral health is in itself its own reward).
Most people reading this will have been touched one way or another with the terrible effects of Alzheimer’s disease; and Periodontitis will affect many more of us if left untreated.  This study demonstrates how even preliminary research can be employed to possibly reduce risks of potentially severe diseases simply by strengthening our individual resolves to maintain something we should already be maintaining.


Health as a game of Chess?

I believe we should view our individual health like a chess game (as opposed to a single faceted approach like checkers) visualizing cause and effect many moves ahead.  The sooner we realize we are in the game, the better we will fare many moves later.  Therefore I would be amiss not to point out that dental crowding is a factor in chronic Adult Periodontitis due to difficulty cleaning, approximation of roots and plaque accumulation.  Which is another reason for this article in my Blog as a Board Certified Orthodontist; just as we chase down every known factor correlating to Alzheimer’s, it is wise to also look at the predisposing factors for known antagonists.  By straightening teeth, we reduce the risk of Periodontitis which then reduces the risk (or possibly severity) of such diseases as CVD (the leading cause of death in men AND women in the US making up some 25% of all deaths each year; not including the many diseases CVD may also lead to such as stroke and heart disease.), COPD (irreversible chronic disease that ultimately leads to death), and RA (can lead to lung disease, nerve damage and osteoporosis).  And now, another piece of the puzzle, Alzheimer’s disease for which there is currently little treatment and no cure. 


“I think we should view our individual health like a chess game ... so I would be amiss not to point out that dental crowding is a factor in chronic Adult Periodontitis due to difficulty cleaning, approximation of roots and plaque accumulation.”


*PLOS One is a peer-reviewed open access scientific journal published by the Public Library of Science since 2006. The journal covers primary research from any discipline within science and medicine. The Public Library of Science began in 2000 with an online petition initiative by Nobel Prize winner Harold Varmus, formerly director of the National Institutes of Health and at that time director of Memorial Sloan–Kettering Cancer Center; Patrick O. Brown, a biochemist at Stanford University...

If you have questions or comments concerning this or any orthodontic question, please feel free to make a complimentary new-patient appointment at either my Steiner Ranch location or my North-central Austin location on West 35th street and MoPac.


Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 22 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at BracesAustin.com. 



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