o With the aging process often comes lowered resistance and decreased ability to fight infection. As a result many elderly individuals will be at greater risk for various infections. One of these infections is periodontal (gum) disease.

o Not only are many elderly persons more vulnerable to developing periodontal disease, but if they already have periodontal disease, the aging process could trigger increased disease activity resulting in more severe disease.

o About 90% of the elderly population has periodontal disease (gum disease) and the majority may be undiagnosed. As a result of untreated periodontal infection over many years, inflammation and destruction usually goes beyond just the gum tissue and into the bone.

o Typically, periodontal disease is not painful until the most advanced stages when abscesses and tooth loss, through natural means or extraction, are very common.

o Damage from periodontal disease is not limited to the oral cavity. Recent research suggests that there may be a relationship between periodontal disease and other serious chronic conditions, including coronary heart disease, stroke, and increased risk for complications of diabetes.

o Of particular importance to you, research also suggests that elderly people with periodontal disease may be at greater risk for pneumonia.

o Research indicates that dental plaque can serve as a reservoir for certain bacteria which are known to cause pneumonia. Secretions from the oral cavity often contain these types of bacteria which can by aspirated into the lungs.

o As is often the case in the aging process, the immune system is impaired and as a result, the body’s defenses may fail to clear the bacteria.

o Cytokines are a type of chemical which are normally produced by the body to defend itself against inflammation. Cytokines which are produced in gum tissue as a result of periodontal infection may promote inflammation of the lower respiratory airway following aspiration of bacteria known to pneumonia. This causes the lining of the airways to become more vulnerable to these invading bacteria.

o Therefore, it is important to identify elderly individuals who may be at greater risk for respiratory problems because of undiagnosed and untreated gum infection.

o It has become increasingly clear that prevention, diagnosis, and treatment of periodontal disease are very important in maintaining overall health during the aging process.

o Make sure that you come to each dental appointment with an up-to-date list of the prescribed and over-the-counter medications you are taking so your dentist or dental hygienist will be aware of any medication that may affect the oral cavity or be a contraindication for certain types of dental treatment.

o Make sure you provide updated information regarding the status of your overall physical health to your dental care provider.

o Make sure you provided the status of your oral health, especially when periodontal disease has been diagnosed, to your medical care provider.

Copyright Casey Hein 2008

o We know that diabetes increases the risk of infection from any source. Periodontal (gum) disease is an infection and complication of diabetes which is often unrecognized.

o People with poorly controlled diabetes are much more susceptible to periodontal disease; with a 2 to 4 time’s greater risk of developing periodontal infection than people without diabetes.

o Once periodontal disease is established in a patient with diabetes, metabolic control (glycemic control or blood sugar levels) of diabetes is complicated from the constant reservoir of gram-negative anaerobic bacteria that sit at the bottom of the gum pockets producing infection and low grade inflammation throughout the body.

o That is why it is important for diabetic patients to achieve and sustain the same level of glycemic control as a healthy, non-diabetic individual.

o Good glycemic control, and HbA1c value of less than 6% for most patients, significantly reduces the risk for the serious complications of diabetes, including periodontal disease.

o The presence of periodontitis increases the risk of worsening glycemic control; (perhaps 6-fold increased risk of worsening glycemic control over time).

o Research also suggests chronic periodontal infection causes systemic inflammation that enhances insulin resistance and hyperglycemia. Insulin resistance makes it difficult for patients and their physicians to achieve and sustain optimal glycemic control, and increases the risk for coronary heart disease.

o Some studies show that diabetic patients with periodontitis require less insulin following treatment of periodontal disease.

o Although more research needs to be conducted, studies that have measured the difference in HbA1c after treatment of periodontal disease reported improvements in HbA1c ranging from 0-2 percentage points in HbA1c levels.

o Patients with poorer glycemic control may have more rapid recurrence of deep pockets and less favorable long-term response to treatment.

o When a periodontal infection goes untreated in diabetic patients, this puts them at greater risk for developing the long-term complications associated with diabetes and cardiovascular disease.

o Comply with your health care provider’s recommendations of HbA1c testing at least every 3 months, and request copies of the results are forwarded to your dentist. This allows your dental care provider to monitor your glycemic control against your periodontal status.

Copyright Casey Hein 2008