Alzheimer’s, diabetes, cancer and oral healthUncategorised
Posted by: The Probe 16th September 2020
One of the many roles fulfilled by modern dental professionals is patient education. In addition to national campaigns and initiatives involving the wider healthcare profession, the dental team is integral to getting the right messages to the right people. In particular, this includes making people more aware of the links between different dental and systemic health conditions in order to help them lower their risk of an array of serious illnesses.
The bacterium responsible
Various diseases have been linked to Porphyromonas gingivalis (P. gingivalis), which is a bacterium often found in interdental spaces. In fact, the bacterium has been detected at this location in 19% of healthy adults aged 18 to 35-years-old.[i]
- gingivalis has been described as a “keystone pathogen” for the inception and development of periodontal disease, as well as for a host of other non-communicable health conditions.[ii] It is a gram-negative anaerobic bacterium that requires the fermentation of amino acids to produce energy. It has been shown to cause a range of virulence factors that can lead to tissue destruction either directly or indirectly.[iii]
There is some evidence to suggest that P. gingivalis can spread between cells without moving through the extracellular space, possibly allowing it to colonise oral tissues without triggering a humoral immune response. It can invade, then multiply and survive in the lining of cells within the gingival crevice. The rate of transmission also seems to increase incrementally over time.[iv]
The exact mechanisms surrounding initiation and development of Alzheimer’s disease are not yet fully understood. However, there is a strong body of research linking Alzheimer’s disease and chronic periodontal disease.[v] One in vivo study found that P. gingivalis in the brain may significantly influence the pathogenesis of Alzheimer’s disease.[vi] As such, good oral hygiene that protects against periodontal disease remains crucial for reducing the risk of Alzheimer’s disease.
A bi-directional relationship has been established between periodontitis and diabetes mellitus. Diabetic patients are more susceptible to infection,[vii] in turn increasing their risk of periodontitis. Effective treatment of periodontal disease has also been shown to improve the diabetic condition.[viii] A study identified P. gingivalis in 35% of subgingival plaque sites in diabetic patients, which was the most prevalent of five pathogens being tested.[ix] This supports the importance of oral hygiene and the reduction of oral pathogens for those with diabetes.
- gingivalis has been linked to various cancers in the digestive system, including oral squamous cell carcinoma in the mouth, oesophageal squamous cell carcinoma in the digestive tract and pancreatic cancer.[x] P. gingivalis has been found to colonise the periodontium and spread to the oral and lingual mucosa. Alcohol also seems to play a role in that ethanol is dehydrogenated in the presence of P gingivalis to become acetaldehyde, which can lead to the damage and mutation of cells in the epithelium.[xi]
Several other systemic diseases and health conditions have been associated with P. gingivalis. These include chronic obstructive pulmonary disease, cardiovascular diseases and rheumatoid arthritis, although more research is required to confirm casual relationships and better understand the exact mechanisms at work.[xii]
It is important to communicate the risk factors of any health conditions to patients in a way they will comprehend. It’s not about scaring them into submission, but rather giving them accurate information that impresses the importance of good oral health and helps them make informed decisions about their general wellbeing.
The easiest way for patients to reduce their risks is to simply maintain effective oral hygiene. Homecare routines are particularly important right now and will be for the foreseeable future as the dental profession recovers from the disruption caused to services by recent practice closures. Providing patients with access to clear and concise instructions on what to do, how and when is key.
Just as important is the recommendation of clinically proven products you can trust to aid your patients’ daily oral hygiene regimes. An array of solutions is available by Swiss oral healthcare expert, Curaprox, catering to the needs of all your patients. The Home Oral Care Kit is the ideal starter pack, including a CS 5460 toothbrush, a CPS Interdental Starter Kit and a tube of Enzycal Toothpaste, as well as a bottle of hand sanitiser. For even greater value, patients can enjoy a further 10% off and your practice will receive 10% commission when they submit your practice code at the online checkout – to get your code just email email@example.com.
These might be strange times for us all, but the importance of maintaining oral and general health has remained constant. By working alongside other healthcare colleagues and helping to educate patients on what they can do to mitigate risk factors, the dental team will continue to be integral to the health and wellbeing of the nation.
Author Dawn Woodward National Sales manager Curaprox UK
[i] Carrouel F, Viennot S, Santamaria J, Veber P, Bourgeois D. Quantitative Molecular Detection of 19 Major Pathogens in the Interdental Biofilm of Periodontally Healthy Young Adults. Front Microbiol. 2016;7:840. Published 2016 Jun 2. doi:10.3389/fmicb.2016.00840
[ii] Prof. Denis Bourgeois, University Lyon 1, Laboratory “Health Systemic Process”, EA4129, 69008 Lyon, France
[iii] How KY, Song KP, Chan KG. Porphyromonas gingivalis: An Overview of Periodontopathic Pathogen below the Gum Line. Front Microbiol. 2016;7:53. Published 2016 Feb 9. doi:10.3389/fmicb.2016.00053
[iv] Yilmaz Ö, Verbeke P, Lamont RJ, Ojcius DM. Intercellular Spreading of Porphyromonas gingivalis Infection in Primary Gingival Epithelial Cells. Infection and Immunity. December 2005; 74(1);703-710; DOI: 10.1128/IAI.74.1.703-710.2006
[v] Singhrao SK, Olsen I. Assessing the role of Porphyromonas gingivalis in periodontitis to determine a causative relationship with Alzheimer’s disease. J Oral Microbiol. 2019;11(1):1563405. Published 2019 Jan 29. doi:10.1080/20002297.2018.1563405
[vi] Dominy SS et al. Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors. Science Advances. January 2019: 5(1), eaau3333. DOI: 10.1126/sciadv.aau3333
[vii] Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab. 2012;16 Suppl 1(Suppl1):S27‐S36. doi:10.4103/2230-8210.94253
[viii] Preshaw PM, Alba AL, Herrera D, Jepsen S, Konstantinidis A, Makrilakis K, Taylor R. Periodontitis and diabetes: a two-way relationship. Diabetologia (2012) 55: 21. https://doi.org/10.1007/s00125-011-2342-y
[ix] Tervonen, T., Oliver, R.C., Wolff, L.F., Bereuter, J., Anderson, L. and Aeppli, D.M. (1994), Prevalence of periodontal pathogens with varying metabolic control of diabetes mellitus. Journal of Clinical Periodontology, 21: 375-379. doi:10.1111/j.1600-051X.1994.tb00732.x
[x] Zhou Y, Luo GH. Porphyromonas gingivalis and digestive system cancers. World J Clin Cases. 2019;7(7):819‐829. doi:10.12998/wjcc.v7.i7.819
[xi] Zhou Y, Luo GH. Porphyromonas gingivalis and digestive system cancers. World J Clin Cases. 2019;7(7):819‐829. doi:10.12998/wjcc.v7.i7.819
[xii] Bourgeois D, Inquimbert C, Ottolenghi L, Carrouel F. Periodontal Pathogens as Risk Factors of Cardiovascular Diseases, Diabetes, Rheumatoid Arthritis, Cancer, and Chronic Obstructive Pulmonary Disease-Is There Cause for Consideration?. Microorganisms. 2019;7(10):424. Published 2019 Oct 9. doi:10.3390/microorganisms7100424
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