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periodontal disease; gum disease; gingival disease

Diseases of the gums & other structures around the teeth. Etiology: 1) most commonly mixed bacterial infection a) Pseudomonas gingivalis is a common isolate b) Pseudomonas melaninogenica c) anaerobes 2) other periodontal bacteria enriched in periodontal disease - Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella spp, Porphyromonas endodontalis, Fretibacterium fastidiosum 2) risk factors: a) diabetes mellitus b) Down's syndrome c) pregnancy 3) oral fungal infections (esp Candica albicans) in patients with dentures [2] Pathology: - proposed causative factors - diminished neutrophil function - abnormalities in collagen metabolism - formation of advanced glycation end products [2] which adversely affect collagen & blood vessels - xerostomia - association with cardiovascular disease, not causal [3] - proposed association with amyloid deposition in Alzheimer's disease [9] Complications: - aspiration pneumonia* [2] - atherosclerosis (association, no evidence causation) [3] - postmenopausal women with periodontal disease have excess risk for breast cancer, lung cancer, esophageal cancer [8]*, gastric cancer [8], gallbladder cancer & melanoma [7], - increased risk for colon cancer [10] * bacteria originate from plaque on natural teeth & on dental prostheses (dentures) [2] * oral microbiome may be implicated in esophageal cancer & gastric cancer (specifically adenocarcinoma) [8] Management: - treatment of periodontal disease may improve outcomes & reduce costs in patients with diabetes mellitus type 2 &/or cardiovascular disease [4] - treatment of periodontal disease may improve outcomes & reduce costs in pregnant patients [4]

Related

gingiva (gum)

Specific

genetic disease of the gums; hereditary periodontal disease giant cell epulis gingivitis periodontal abscess periodontitis

General

oral cavity infection

References

  1. Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 200
  2. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  3. Friedewald VE, Kornman KS, Beck JD, The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol. 2009 Jul 1;104(1):59-68. PMID: 19576322 - Lockhart PB et al AHA Scientific Statement Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association? A Scientific Statement From the American Heart Association Circulation April 18, 2012 PMID: 22514251 http://circ.ahajournals.org/content/early/2012/04/18/CIR.0b013e31825719f3
  4. Jeffcoat MK, Jeffcoat RL, Gladowski PA et al Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions. Am J Prev Med 2014;47:166-174 PMID: 24953519
  5. Vedin O, Hagstrom E, Gallup D Periodontal disease in patients with chronic coronary heart disease: Prevalence and association with cardiovascular risk factors. Eur J Prev Cardiol. 2015 Jun;22(6):771-8. PMID: 24721691
  6. Yasui M, Ryu M, Sakurai K, Ishihara K. Colonisation of the oral cavity by periodontopathic bacteria in complete denture wearers. Gerodontology. 2012 Jun;29(2):e494-502. PMID: 21929616
  7. Nwizu NN, Marshall JR, Moysich K et al. Periodontal disease and incident cancer risk among postmenopausal women: Results from the Women's Health Initiative observational cohort. Cancer Epidemiol Biomarkers Prev 2017 Aug; 26:1255 PMID: 28765338 http://cebp.aacrjournals.org/content/26/8/1255
  8. Swift D Dysbiotic Oral Microbiome May Raise Cancer Risk - Periodontitis and tooth loss tied to two specific cancers MedPage Today. July 20, 2020 https://www.medpagetoday.com/gastroenterology/generalgastroenterology/87649 - Lo CH, Kwon S, Wang L Periodontal disease, tooth loss, and risk of oesophageal and gastric adenocarcinoma: a prospective study. Gut (BMJ Jourrnal). 2020. July PMID: 32690603 https://gut.bmj.com/content/early/2020/06/30/gutjnl-2020-321949
  9. Kamer AR, Pushalkar S, Gulivindala D et al Periodontal dysbiosis associates with reduced CSF Abeta42 in cognitively normal elderly. Alzheimer's & Dementia: Diagnosis, Assessment, & Disease Monitoring 2021. April 12 PMID: 33869725 PMCID: PMC8040436 https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/dad2.12172
  10. Worcester S Gum Disease Linked to Colorectal Cancer: COLDENT Study. Medscape February 10, 2022 https://www.medscape.com/viewarticle/968247 - Idrissi Janati A, Karp I, Latulippe JF et al Periodontal disease as a risk factor for sporadic colorectal cancer: results from COLDENT study. Cancer Causes Control. 2022. 33(3):463-472. Jan 26. PMID: 35079924 https://link.springer.com/article/10.1007/s10552-021-01541-y
  11. National Institute of Dental and Cransiofacial Research Periodontal (Gum) Disease https://www.nidcr.nih.gov/health-info/gum-disease/more-info