THE ROLE OF ORAL CARE IN OVERALL HEALTH A SUMMARY OF RECENT RESEARCH

Antiseptic 1 ORAL CARE AND SYSTEMIC HEALTH: A SUMMARY OF RESEARCH During the last 20 years, extensive research has been published on the relationship between oral health and systemic health.1 This research suggests that gum disease, if left untreated and allowed to progress to advanced gum disease, may contribute to broader health problems, including diabetes, cardiovascular disease and stroke, adverse pregnancy outcomes, respiratory disease, and rheumatoid arthritis. While further research is needed to understand the connection between oral and systemic health a cause-and-effect relationship has yet to be established one theory is that plaque and gingivitis germs traveling from the mouth to the bloodstream (bacteremia) contribute to these broader health problems. The makers of LISTERINE Antiseptic are committed to gaining a better understanding of the connection between oral health and systemic health in people with advanced gum disease. This connection has been brought to life in an educational video, available at . In addition, a recent study shows that, when used as directed, the plaque and gingivitis germ-killing action of LISTERINE Antiseptic reduces the amount of germs that travel from the mouth to the bloodstream in people with mild to moderate gingivitis.7 THE MOUTH-BODY CONNECTION In many ways, the mouth is the gatekeeper between the outside world and the rest of the body. But even a healthy mouth is teeming with bacteria.2 Over time, these bacteria can stick together and multiply, forming a film over surfaces of the mouth.3 In response, the bodys immune system activates inflammatory cells to kill these bacteria.3 This inflammation can take the form of gingivitis, a mild form of gum disease, which can advance to a more serious condition called periodontitis.3,4 When a persons gums are inflamed, everyday activities like chewing can allow bacteria from the mouth to enter the bloodstream and giving bacteria full access to the rest of the body.5,6 For people with severe gum disease, new science suggests that these bacteria may link to other disorders. 2 Diabetes: The affect diabetes has on oral health has been recognized for more than 100 years, however there have been several recent scientific developments about how advanced gum disease can actually impact diabetes risk and control.1 In the First National Health and Nutrition Examination Survey (NHANES 1) and its Epidemiologic Follow-Up Study (NHEFS), people with intermediate levels of gum disease had a twofold increased risk of type 2 diabetes.8 Research published in the journal Oral Diseases suggests that advanced gum disease can have a negative effect on diabetes control.1 In patients who have both diabetes and periodontitis, treatment of the gum disease can improve control of blood sugar.1 Heart Disease and Stroke: A number of studies have shown a potential connection between advanced gum disease and cardiovascular disease and stroke.1,9 A 2002 review of such studies published in the Journal of the American Dental Association suggests a causal link.10 A recent study from the University of Buffalo showed that heart attack victims had higher numbers of bacteria in their mouths compared with healthy volunteers. These findings were presented at the 2009 International Association of Dental Research meeting.11 Another study published in the Journal of Periodontology found 1.5-fold increased odds of experiencing atherosclerosis (the build-up of plaque in the arteries) and coronary heart disease in older adults who had both periodontitis and tooth loss.9 A consensus paper on the relationship between heart disease and gum disease was recently published concurrently in American Journal of Cardiology (AJC), and the Journal of Periodontology (JOP), providing clinical recommendations for cardiologists to examine a patients mouth, for periodontists to ask questions about heart health and family history of heart disease. 18,19 A case-control study published in the journal Stroke found that men younger than 60 who had severe periodontitis had a 4.3 times higher risk of experiencing stroke than did patients in the same age group who had mild or no periodontitis.9 Pregnancy: An association between periodontitis and adverse pregnancy outcomes has been reported in both clinical trials and observational studies.1 3 New guidelines were recently set forth by the American Academy of Pediatric Dentistry that call for pregnant women to receive counseling on oral healthcare, as evidence associates periodontal disease and increased risk of preterm birth and low birth weight.17 According to the American Academy of Periodontology, pregnant women who have gum disease may be seven times more likely to have a preterm, low-birth-weight baby.12 According to a review article published in the Journal of the American Dental Association, some studies suggest that periodontal therapy decreases the rate of preterm, low-birth-weight babies in women with gum disease.1 Respiratory Disease: Recent research suggests that bacteria growing in the mouth can be breathed into the lungs, causing or worsening respiratory diseases, especially in people with advanced gum disease.13 According to a meta-analysis published in the Journal of the American Dental Association, considerable evidence supports the relationship between poor oral hygiene and bacterial pneumonia in special-care populations, including hospitals and nursing homes.14 Studies are now in progress to learn to what extent oral hygiene and gum disease may be associated with more frequents bouts of respiratory disease in people with chronic obstructive pulmonary disease (COPD).13 Rheumatoid Arthritis (RA): Results from a growing number of clinical studies point toward a potential association between chronic periodontitis and RA.15 According to studies published in Arthritis and Rheumatism and the Journal of Clinical Periodontology, patients with longstanding, active RA may have an increased incidence of advanced gum disease, including loss of alveolar bone and teeth.16 In another study published in Arthritis and Rheumatism, the presence of RA was associated with an increased prevalence of periodontitis. Participants with four out of six criteria for RA had a fourfold increased risk of having periodontitis, after adjusting for age, sex, ethnicity and smoking.15 Emerging science suggests an association between periodontitis (advanced gum disease) and broader health problems, but a cause and effect relationship has not been established. LISTERINE Antiseptic is indicated to help prevent or reduce plaque and gingivitis. It is not indicated for periodontitis or other diseases. -END-4 References: 1. Lamster IB, DePaola DP, Oppermann RV, et al. The relationship of periodontal disease to diseases and disorders at distant sites. JADA. 2008;139(10):1389-1397. 2. Oral Health and Oral Hygiene. American Diabetes Association Web site. /type-1-diabetes/mouth-care.jsp 3. From Anatomical Travelogue no primary reference given. 4. Oral Health Topics A-Z. American Dental Association Web site. Available at: /public/topics/periodontal_diseases.asp. Accessed April 2, 2009. 5. Mealey, Brian L. Diabetes Mellitus and Inflammatory periodontal diseases. Current Opinion in Endocrinology, Diabetes & Obesity. 2002;72( 2):135-140. 6. Elkaim R. Prevalence of periodontal pathogens in subgingival lesions, atherosclerotic plaques and healthy blood vessels: a preliminary study. J Periodont Res. 2008;43:224-231. 7. Araujo MWB, Ricci-Nittel D, Zhang P. An investigation of the effect of an essentials-containing mouthrinse on induced bacteremia. 8. Demmer RT, Jacobs DR, Desvarieux M. Periodontal disease and incident type 2 diabetes. Diabetes Care. 2008;31:1373-1379. 9. Boehm TK, Scannapieco FA. The Epidemiology, Consequences and Management of Periodontal Disease in Older Adults. J Am Dent Assoc. 2007;138;26S-33S. 10. Genco R, Offenbacher S, Beck J. Periodontal disease and cardiovascular disease: Epidemiology and possible mechanisms. JADA. 2002;133:14S-22S. 11. University at Buffalo (2009, April 1). Repeated Treatment Of Gum Disease Reduces Levels Of Inflammatory Factors Known To Increase Heart Disease Risk. MSNBC.com. Available at /id/29990146/ Accessed April 2, 2009. 12. Gum Disease and Pregnancy Problems. American Academy of Periodontology Web site. Available at /consumer/mbc.baby.htm. Accessed April 2, 2009. 13. Gum Disease and Respiratory Diseases. American Academy of Periodontology Web site. Available at: /consumer/mbc.respiratory.htm. Accessed April 2, 2009. 14. Scannapieco FA. Pneumonia in nonambulatory patients: