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.

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.

Could Diabetes be Caused by Periodontal Pathogens

We know that diabetes is multi-factorial. We have known since at least the 1970’s that diabetes and gum disease are related. We see more gum disease in diabetics and more diabetes in people with gum disease. A diabetic has a poorer healing response, so it would seem to follow that people with diabetes would defend themselves against gum disease wounds with less success than a non-diabetic. And dentists have been comfortable enough in that belief to treat diabetics more aggressively when the signs of gum disease appear.

But isn’t it possible that the insulin insufficiency diabetes, (the pancreas does not produce enough insulin), is being CAUSED by the same pathogens that might be causing pancreatic cancer, perhaps a less virulent strain? Remember the spirochetes that Dr. Nordquist implicated in coronary artery disease? Isn't it possible that another species of spirochetes could be attacking the pancreas? Shouldn't we be treating periodontal disease as if we could prevent chronic diseases of the rest of the body? It would seem to me that we should.

Gregory L Sawyer DDS