Periodontal Disease and Pregnancy, a New Risk

A researcher from Department of Periodontics at Case Western Reserve University School of Dental Medicine, reported the first documented link between a mother with pregnancy-associated gum disease to the death of her fetus.
The link was discovered when a friend of the mother of the stillborn baby introduced her to the researcher, Yiping Han. Han was studying the bacteria, Fusobacterium nucleatum, and it’s relationship to pre-term labor and stillbirths.

This study caught my eye because F Nucleatum is one of the known periodontal pathogens that we test for using DNA-PCR, when we find menacing bacteria from the gums when we look under the microscope.

The mother gave a history of bleeding gums during the pregnancy. Bleeding gums during pregnancy are not uncommon, indeed around 75% of pregnant women experience bleeding gums.

Postmortem microbial studies of the baby found the presence of F. nucleatum in the lungs and stomach. The baby had died from a septic infection and inflammation caused by bacteria. The bacteria was also found in the mother’s mouth.
It is now well understood that oral bacteria can make their way into the bloodstream through the bleeding gums. We are just now beginning to realize the extent of the potential for problems in other organs systems. And too many people still accept bleeding gums as normal. Bleeding gums are dangerous.

WIth the numbers of people with gum disease, 50% over age 30, and the delaying of childbirth by so many women, we need to be more diligent in our explanations of the need for good oral health to pregnant or potentially pregnant women.

And as I continue to remind all involved, the old paradigm of mechanical debridement, is just not enough to cure an existing bacterial infection. Brushing and flossing helps, but once you are infected, it is just not enough.

There is a happy ending to the story. The mother has had periodontal therapy and has now given birth to a healthy baby

The findings are discussed in the February issue of Obstetrics & Gynecology.

I have had an epiphany. While I admit to recognizing that diet is important to health any many ways, I have been influenced by Dr. Dean Edell to resist dietary supplementation by pills. Dr. Edell is in a position to read more of the medical literature than any doctor who actually sees patients, so I credit him with being able to keep up with all the latest research. And he seems to be honest in his advice, so I tend to trust his advice to his listeners.

But now I think he is wrong about nutritional supplements, like vitamins. His reasoning is that he is healthy and personally doesn’t take supplements. It is likely that he is correct in assessing his own needs.

This week I attended a conference on the oral-systemic connection in Reno, where I shared the podium with Dr Lisa Marie Samaha, Dr, Lee Ostler, and Dr. Bill Domb, and Robert Maccario. Dr. Samaha presented case after case of people whose periodontal disease was helped greatly by nutritional supplementation. They still needed treatment to reach optimum periodontal health, but the improvement was unmistakable from the nutritional supplements.

I saw her present briefly last November, and we have started offering nutritional supplements to our periodontal patients. But I admit it was half hearted. I didn’t understand the mechanism of how supplements helped, and I wanted to be able to repeat Dr. Samaha’s success in our own office.

It was Dr. Ostler’s presentation that brought the epiphany. He explained the nature of a few genetic defects which make the body work harder to repair damage on a molecular level. I won’t try to explain, and I am not sure that I can. But suffice it to say that there may be about 20% of the population whose genetics interfere with the body’s defenses or repair mechanisms enough to affect there ability to defend themselves against the pathogens of periodontal disease. And if we can provide molecules to help them in the diet, their defenses or repair mechanisms can be more normal. I would speculate that Dr. Edell does not have any of these genetic anomalies, so he would be correct in saying that he does not need them.

The day of genetic medicine and dentistry is coming, and soon. Doctors will be able to look at the entire genome for known genetic polymorphisms and either repair them or provide the work-around to help people avoid getting sick. Right now the reams of data from the entire genome is overwhelming and expensive to acquire. But the days of computer interpretation of the data are here and soon the practice of medicine and dentistry will be vastly changed by the information from the genetic testing.

So my take on this new understanding, is that we must infer from unusual presentations of periodontal disease that nutritional supplementation is necessary or the person will not ever get healthy. And there is another bit of evidence that it is just not always the fault of the person that they are not healthy. We have placed too much blame on people for their dental diseases. Good oral hygiene certainly helps people prevent dental diseases. But for somebody who has been infected with aggressive pathogens, or is genetically missing the ability to effectively fight the pathogens, good oral hygiene is just not enough.

I have never felt so needed. Now be well.

Leading Cardilologist Comments on Gum Disease

If you are a cardiologist, a dentist, or even just any American over the age of 40, I recommend that you spend the fourteen minutes to hear the message above. Dr. Ridker, the director of the Center for Cardiolovascular Disease Prevention, Brigham and Women’s Hospital, was the keynote speaker at the American Academy of Periodontology this year.

Dr. Ridker is proposing double blind studies to prove that inflammation from periodontal disease is related to death by cardiovascular disease. In a previous blog, I proposed that we stop discussing the possible relationship between gum disease and heart attacks and admit that the bacteria from the gum disease are causing heart attacks. Dr. Ridker is recognizing that inflammation is a more important indicator of cardiovascular risk than high cholesterol, and proposing studies to prove just that.

I don’t know about you, but I don’t want to be part of the control group. The scientist in me wants the definitive proof, but the clinician in me already knows the likely outcome. We test the C reactive protein of our periodontal patients before we commence treatment. We see dramatic declines in the C reactive protein levels of the patients who get their periodontal disease under control. And as Dr. Ridker admits, your C reactive protein levels are a better indicator of heart attack risk than your cholesterol levels. Yet while most American adults know their blood cholesterol levels, almost none know their C reactive protein level.

Oral/Systemic Connection

There are two books that have made significant impact in my thinking process about the connection between gum disease and other systemic diseases. In Plague Time, the author, Paul Ewald postulates that the majority of chronic diseases that plague mankind are really chronic transmissible infections. We all know acute transmissible infections, the cold and flu being the most common. They attack us shortly after we have been exposed, and generally run their courses in a matter of a week or so. But chronic transmissible infections are different. These infections can wait for years or even decades to attack us, and all the while we can be spreading them without knowing we are infected. Dr. Ewald gives multiple examples in his book, but the one that jumped out at me was a cancer pathogen in Japan that is spread from mother to daughter in breast milk that does not manifest until the fifth or sixth decade of life, by which time the daughter has already passed the pathogen to the grand-daughter.

What is difficult for us to imagine, is that there are chronic diseases such as cancers that have a pathogen as the cause because we don’t know or can’t find what the actual pathogen is. The invention of the microscope allowed mankind to look at one celled animals first the first time, but their existence had already been postulated if not yet well understood by the infectious disease specialists at the time.

Wouldn’t a transmissible pathogen explain the breast cancer cluster in Marin County of California? Researchers have looked at the air, the water, the high power lines and who knows what else in Marin without an explanation of the breast cancer cluster there.

Wouldn’t a sexually transmitted pathogen explain the fact that a man’s risk for prostate cancer is exactly in line with the number of sex partners? The fact that we don’t know what that pathogen is does not diminish the likelihood of its existence.

What does all of this discussion have to do with our oral health? Well, I asked Dr. Ewald if he thought that the route of entry to the body of some of these pathogens might be through the bleeding gums. He told me that he thought it was not only possible but likely.

Which brings me to the other book that has had a major effect on my thinking. Stealth Killer, by WIlliam Nordquist. Dr. Nordquist is also a dentist, who had noticed the presence of spirochetal bacteria in the biofilms of the plaques of gum disease. These spirochetes worry me, because they are related to the bacteria that cause Syphilis and Lyme disease, which are truly dread diseases with no known cure if they aren’t defeated soon after infection. They worried Dr. Nordquist even more (and sooner), so he began studying them.

When a mature spirochete is attacked by antibiotics, it rolls its body up into a little ball that resembles a spore. The spores are impervious to any known attack that we can mount against them, and they can live for decades in the tissue of the body waiting for a signal to attack the host. Dr. Nordquist identified that presence of these spores in the bacterial plaques that had occluded the coronary arteries of recent heart attack victims. How did those spores get there? Since the exact same spores can be found in the plaques around the teeth under the gums, it would certainly follow that these are getting access to the bloodstream via the bleeding gums. The bacteria can be as small as 1 micron, and the red blood cells that we are seeing are between 70-100 microns in size. Isn’t it likely that these bacteria are getting access back through the damaged blood vessel wall in the gums and attacking the blood vessel walls around the heart? And when we use an antibiotic, these spores defend themselves from the attack by rolling up into the defensive spores that we see in the coronary arteries of recent heart attack victims and the gums of periodontal patients.

I am tired of the hedging of all the doctors that are saying that gum disease MAY be related to other diseases such as coronary artery disease. Isn’t it time that we stop the hedging and say that the bacteria from bleeding gums create the bacterial plaques that CAUSE heart attacks? The evidence here is nearly as strong as the evidence that HIV causes AIDS, and we can’t prove that either. Why can’t we prove HIV causes AIDS? Do you want to volunteer for the study to be inoculated with HIV and wait to see if you develop AIDS? Me neither.

And what about pancreatic cancer? What is the cause? We will admit that it MAY be related to gum disease again. What about Alzheimer’s disease? Renal (kidney) Insufficiency? Preterm births? Ischemic stroke? What else?

Gregory L Sawyer DDS