Disease Transmission and Treatment/Prevention

Disease Transmission

B. subtilis visualized with a Gram stain from http://faculty.mc3.edu/jearl/ML/b_subtilis.jpg

From the research of Yamane et al. (2009), bacteria develop communities called biofilms, and this has been linked to the cause of periodontal disease. Specifically, through rRNA sequencing, strains of B. subtilis were responsible for forming biofilms in periodontal lesions, or empty spaces caused by gingivitis and periodontitis development (Yamane et al., 2009). The bacteria isolated from the root canals of teeth with periodontitis were Gram-positive (containing a thick peptidoglycan layer encapsulating the organism) and produced excess amounts of exopolysaccharide (protective secretions that allow the bacteria to spread) to form biofilms that were able to successfully multiply in the host environment of the oral cavity (mouth) (Yamane et al. 2009). According to Mayo Clinic's (2014) extensive description of periodontitis, the beginning of periodontitis is when plaque forms due to the interaction of starchy and sugary food with oral bacteria. Failure to remove plaque with brushing and flossing causes it to harden in about three days forming tartar, which harbors bacteria more easily within the mouth, causing primarily inflammation associated with gingivitis, then pockets form in the gum tissue connecting to the teeth, which gives bacteria the ability to deposit metabolic endotoxins that cause inflammation and deterioration (Mayo Clinic Staff, 2014). The resulting infection causes bone loss and tissue loss (Mayo Clinic Staff, 2014). In addition to the severe bone and tissue loss associated with periodontitis, tooth loss, coronary artery disease, stroke, premature births, diabetes, arthritis, and asthma have been linked to periodontitis, since bacteria that accumulates within the gums can easily slip into the blood stream to affect other parts of the body, and even lead to narrowing of the arteries (Mayo Clinic Staff, 2014). According to the American Academy of Periodontics, periodontitis can be spread through contact with saliva from mouth to mouth, shared oral health tools, and eating/cooking utensils if put in the mouth (2014). The main mode of transmission of periodontitis is saliva. You will not get periodontitis if the saliva of an infected person gets on your skin. That saliva must somehow find its way into your own mouth for you to become infected. Therefore, periodontal disease is contagious in its spread through saliva and mouth contact.

Image of a severe stage of periodontitis with gum recession from the teeth, from colgateprofessional.com

Risk Factors 

Some of the risk factors for periodontitis mirror those for other common diseases. To be put simply, if whatever you are doing is bad for your mouth, chances are it will contribute to gingivitis which can lead to periodontitis if you already have improperly treated gingivitis! For example, smoking can heighten the risk of developing periodontitis since the chemicals in cigarettes wear away your gums. In girls and women, hormonal changes resulting from puberty or the menstrual cycle can cause gums to become ultra sensitive making gingivitis easier to develop. Having diabetes, cancer, autoimmune disorders, or any type of illness that can increase the risk of developing infections can also be a risk factor for periodontitis. In addition, medications that reduce the flow of saliva in the mouth or increase abnormal overgrowth of the gum tissue also pose a risk for developing periodontitis. Crowding of teeth can also contribute to periodontitis. Overgrowth of the gums or crowding of the teeth causes some parts of the tooth to be improperly cleaned, and efficient coats of saliva are needed for teeth to have some form of protection against oral infections. Poor restorations done in a clinical setting to the teeth can also contribute to periodontal disease. There are also some genetic factors that can make people susceptible to periodontitis. (Source for this passage: NIH, 2012)

In addition, a study conducted by Van Dyke and Dave (2005) showed that there has been a correlation between old age and periodontitis, due to the body's weakened process of tissue regeneration especially in the gums, as well as an increased incidence of periodontitis in those with bone loss or weakened bones caused by osteoporosis, and increased incidence in individuals who suffer frequent stress, causing them to have weakened immune systems and a lesser tendency to pay attention to regular oral hygiene.

Smoker's teeth with periodontitis from studiodentaire.com

Prevalence of Disease

According to a study conducted with the Center for Disease Control and Prevention from my previous post, periodontitis is prevalent in about 47.2% of adults aged 30 years and older, while the disease increases with age in the United States alone (Eke et al., 2012). The World Health Organization estimates that 60-90% of school children and 100% of adults have dental cavities and excess plaque that leads to periodontitis (WHO, 2012). Severe periodontal disease, specifically, is found in 15-20% of middle-aged adults across the world, and periodontitis is one of the most common oral diseases known to exist (WHO, 2012). However, the prevalence of periodontitis and periodontal disease decreases in geographic regions with with readily accessible and affordable dental care, and increases with low and middle-income countries, especially developing countries with a high poverty rate (WHO, 2012). For example, in the United States, areas that have higher prevalence of other diseases due to unaffordable health care are more likely to have periodontitis among the most frequently occurring diseases. Periodontitis is a product of lack of access to decent oral healthcare, lack of education, and lack of oral health awareness. 

Treatment and Prevention

According to the World Health Organization (2012), oral health is linked to overall health, so preventing periodontitis also decreases a person's risk for other related diseases. World Health Organization lists some basic prevention practices so that you can avoid periodontitis:

• Increasing nutritional awareness,  increasing healthy food choices, and decreasing sugar intake
• Consuming fruits and vegetables that contain antioxidant properties and prevent against oral cancer
• Daily, proper oral hygiene (adequately brushing and flossing twice a day with a usable tooth brush and clean strand of floss)
• Using protective mouth gear during sports and other activities that could injure the mouth 
• Long-term exposure to fluoride through fluoridated drinking water, tooth paste, salt, and milk
• Access to affordable oral health care (however, this may be impossible for some age groups and people located in certain geographic regions)

Daily toothbrushing is important for prevention of periodontitis! From chambersburgdentalnews.com

Treatment of periodontitis is extensive and available. Both nonsurgical and surgical options are available depending on the severity of disease progression. Non-surgical treatment according to the American Academy of Periodontology (AAP) includes scaling and root planing, in which a certified hygienist cleans the root surfaces to remove deep bacteria and then follows with an antimicrobial agent injected into the gum pockets, such as Arestin (2014). In addition, patients can be fitted with oral trays that can deliver medication applied to the tray at the surface of the gums (American Academy of Periodontology, 2014). Surgican procedures prescribed by the AAP include gum graft surgery, in which gum tissue from the palate can be used to cover roots and promote gum growth and reduce sensitivity of the exposed tooth (2014). According to the AAP, gum grafts have extensive benefits which include reduced bone loss and reduced gum recession, as well as protection from decay (2014). Regenerative procedures to reduce gingival pocket depth prescribed by the AAP (2014) include regenerative procedures, in which gums are folded back to expose and remove bacteria, followed by a bone graft and tissue stimulating proteins, and dental implants can be placed to combat tooth loss caused by periodontitis, as well as plastic surgery methods such as jaw ridge augmentation. Many of the costly surgical procedures require time, patience, and dedication of the patient and doctor.

The Blogger's Thoughts on Prevention/Treatment

I believe that the treatment available is definitely advanced and has many options. However, in terms of geographical area affected by periodontitis, lack of poor education, a rural environment, and lack of access to health care may inhibit people in these regions from fully being able to combat periodontitis (WHO, 2014). In addition, surgical treatment is often costly, and requires time and dedication from the patients and doctors. If one of these parties does not cooperate, the proper treatment cannot be given optimally. From a global standpoint, I believe access to surgical and basic oral healthcare practices in order to treat and prevent periodontitis may be a problem. However, if these treatmes are readily accessible, they would definitely offer a great amount of relief for those who suffer periodontitis. Non-surgical procedures such as regular checkups and hygiene visits can greatly reduce the incidence of periodontitis if the populace has access to the care and does not fall out of care or fail to seek dental care. While surgical treatments are definitely corrective, I believe these treatments can easily be reversed if the patient does not follow-up with improved oral hygiene habits or frequent check-ups. In addition, periodontal antibiotics, such as azithromycin, may be inaffective if the person develops resistance from constant exposure to antibiotics or if the cigarette smoking individual continues smoking, which has been proven in randomized clinical trials to reduce the efficacy of periodontal antibiotics used to treat periodontitis specifically in smokers (Pradeep et al., 2013).

Bibliography of Section

Brush Teeth Close. Digital image. Chambersburg, PA Dentist Talks about Brushing Teeth. Donnell McHenry, Jr., D.D.S., 21 Nov. 2013. Web. 14 June 2014. <http://www.chambersburgdentalnews.com/wp-content/uploads/2013/11/Brush-Teeth-Close.jpg>.

Eke PI, Dye B, Wei L, Thornton-Evans G, Genco R. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. J Dent Res. Published online 30 August 2012:1–7.

Pradeep, AR, P Bajaj, E Agarwal, NS Rao, SB Naik, N Kalra, and N Priyanaka. "Local Drug Delivery of 0.5% Azithromycin in the Treatment of Chronic Periodontitis Among Smokers." Australian Dental Journal. 58.1 (2013): 34-40. Print.

Yamane, K, K Ogawa, M Yoshida, H Hayashi, T Nakamura, T Yamanaka, T Tamaki, H Hojoh, K.P Leung, and H Fukushima. "Identification and Characterization of Clinically Isolated Biofilm-Forming Gram-Positive Rods from Teeth Associated with Persistent Apical Periodontitis." Journal of Endodontics. 35.3 (2009): 347-352. Print.

"Periodontal (Gum) Disease: Causes, Symptoms, and Treatments." National Institute of Dental and Craniofacial Research: Part of the NIH, 1 Aug. 2012. Web. 20 June 2014. <http://www.nidcr.nih.gov/nidcr2.nih.gov/Templates/CommonPage.aspx?NRMODE=Published&NRNODEGUID=%7bCE246689-D899-4CC7-B68A-805AD910F4E7%7d&NRORIGINALURL=%2fOralHealth%2fTopics%2fGumDiseases%2fPeriodontalGumDisease%2ehtm&NRCACHEHINT=Guest#howDoI>.

Periodontal Disease. Digital image. Studio Dentaire. Studio Dentaire, 2012. Web. 13 June 2014. <http://www.studiodentaire.com/articles/en/smoking-and-gum-disease.php>.

Smoker's Periodontitis. Digital image. Zestfulness: Periodontitis: Do You Know If You Have It? Colgate Professional, 22 May 2011. Web. 20 June 2014. <http://www.colgateprofessional.com/LeadershipUS/PatientEducation/Images/Resources/pated_PeriodontitisAdvance.jpg>.

"Treatments | Perio.org." Treatments | Perio.org. American Academy of Periodontology , 1 Feb. 2014. Web. 20 June 2014. <http://www.perio.org/consumer/treatments_procedures>.

Van Dyke, D.D.S., PhD., Thomas E., and Sheilesh Dave. "Risk Factors for Periodontitis." . Journal of the International Academy of Periodontology, 7 Jan. 2005. Web. 14 June 2014. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1351013/>.