What do bleeding gums mean for my health?

You shouldn’t ignore a little pink in the sink after you finish brushing your teeth. It could be a sign of potential dental and overall health issues.

People somehow assume that what’s going on in the mouth has nothing to do with the rest of the body and vice versa, but nothing could be further from the truth. Teeth are intimately connected to the rest of our bodies, and systemic diseases can present themselves in the mouth.

Furthermore, the mouth isn’t a sterile place – there are more than 700 different species of bacteria. Inflamed and bleeding gums that accompany periodontal disease present a portal for those bacteria in the mouth to enter the body.

Heart disease, stroke, diabetes, pneumonia and Alzheimer’s disease are just a few of the health issues associated with the bacteria that cause periodontal diseases.

What are periodontal diseases?

Periodontal diseases are bacterial infections that destroy the gums and supporting tissues anchoring the teeth. Symptoms include:

• Red, swollen and bleeding gums
• Bleeding while brushing and/or flossing
• Receding gums
• Loose or shifting teeth
• Persistent bad breath
• Pus between teeth

What are the types of periodontal disease?

Periodontal diseases are a family of oral infections that can affect people throughout life. In 2018, the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) published a new classification system that replaced the previous categories of “chronic” and “aggressive” periodontitis with a unified staging and grading system. Periodontal diseases now include:

• Gingivitis: affects the soft tissue around teeth in children and adults
• Periodontitis: classified by stages (I through IV) based on severity and complexity, and grades (A through C) based on the rate of disease progression and risk factors such as smoking and diabetes. This staging and grading system helps health care providers develop individualized treatment plans. According to CDC data, about 42% of U.S. adults aged 30 and older have some form of periodontitis, and about 7.8% have a severe form of the disease.

Why are the bacteria that cause periodontal disease associated with so many diseases?

Research continues to give us answers. Although numerous diseases and medications affect the oral cavity, their effects on periodontal tissues may have greater consequences than we previously knew.

Periodontal diseases are associated with a decrease in the number of beneficial bacteria, which leads to an increase in the number of pathogenic bacteria that contributes to the inflammation and destruction of tissues around the teeth. These pathogenic bacteria and the accompanying inflammation of periodontal diseases enter the bloodstream, affecting other organs.

Published research shows us the connections between periodontal diseases and several systemic illnesses:

• Heart disease and stroke - Research has strengthened the association between periodontal diseases and cardiovascular conditions. Periodontal disease is now recognized as a potential risk factor for atherosclerosis, heart attack and stroke, with studies finding periodontal pathogens present in atherosclerotic plaques (the plaque that builds up in arteries). While research hasn’t yet identified a clear cause for this, we’re continuing to see more evidence supporting this connection.
• Diabetes - Scientific evidence has established a clear relationship between diabetes and periodontal disease. Diabetes has a negative effect on periodontal health, and periodontitis can make it harder to regulate blood sugar. Periodontal disease is now considered an independent risk factor for diabetes with the highest level of evidence supporting the connection. Studies continue to show significant reductions in A1C (blood sugar) levels in diabetic patients after periodontal treatment. The 2018 classification system also incorporates A1C levels as a grading modifier, directly linking diabetes management to periodontal disease progression.
• Pneumonia - A 2017 study in a Virginia Veterans Administration hospital found that regularly brushing patients’ teeth reduced the number of patients who contracted pneumonia while in the hospital by 92%. The nursing staff committed to ensuring that patients brushed their teeth at least once every shift. All that brushing cut down the amount of bacteria the patients were breathing in. Subsequent research has continued to support the association between oral pathogens and respiratory infections, reinforcing the importance of oral hygiene in hospital and long-term care settings.
• Alzheimer’s disease and dementia: One of the most significant recent developments in oral-systemic research has been the growing body of evidence linking periodontal disease to Alzheimer’s disease and cognitive decline. Researchers have detected periodontal pathogens, specifically Porphyromonas gingivalis, in the brains of people with Alzheimer’s disease. Studies suggest that periodontitis may accelerate cognitive decline through neuroinflammation and systemic inflammatory pathways. One study found that periodontitis was associated with a six-fold increase in the rate of cognitive decline over a six-month period.
• Adverse pregnancy outcomes: Periodontitis has been linked to preterm birth, low birth weight and preeclampsia. Researchers continue to study these connections, and the evidence underscores the importance of periodontal health for expectant mothers.

How can you prevent periodontal diseases?

To reduce the risk of periodontal diseases, practice the healthy four:

• Brush twice a day with a fluoride toothpaste
• Clean between your teeth once a day with floss or another interdental cleaning device like a water flosser
• Eat a healthy diet that limits sugary beverages and snacks
• See your dentist on a regular basis for prevention and treatment of oral disease