With diabetes and chronic lung disease.

University at Buffalo School of Dental Medicine

Diabetes and chronic lung disease can be added to the growing list of systemic diseases and conditions associated with bacteria from infected gums, new studies from the University at Buffalo School of Dental Medicine have shown. The findings from both studies were presented at the combined meeting of the American Association of Dental Research and International Association of Dental Research.

To investigate the association of periodontal disease with diabetes, a research team headed by Sara G. Grossi, D.D.S., UB senior research scientist, concentrated on insulin resistance, a known precursor of active diabetes, in which cells do not absorb insulin from the blood stream. As their study group, the researchers used 11,198 non-diabetic participants between the ages of 20 and 90 who had at least six natural teeth. They assessed information on periodontal status, defined as degree of gum detachment from bone, along with fasting-insulin and fasting-glucose levels, which were combined to establish an index of insulin resistance.

Analysis showed that the index of insulin resistance increased as severity of periodontal disease increased. The relationship was not affected by age, gender, body-mass index (a measure of obesity) or smoking. Results showed that those with severe periodontal disease (gum detachment), have a higher index of insulin resistance than those with little or no disease. "Gram-negative periodontal infections are significantly associated with insulin resistance in non-diabetics," Grossi said. "We know that when diabetics have an acute infection, their diabetes goes out of control. Gram-negative bacteria produce a very potent toxin called LPS, which probably interferes with the action of insulin and is responsible for maintaining a chronic state of insulin resistance in people with gum infections," she said.

The study on the relationship between periodontal infection and chronic lung disease was designed to follow up earlier reports of a link between poor oral hygiene, gum disease and chronic lung disease. Frank Scannapieco, D.M.D, Ph.D., assistant professor of oral biology, analyzed data from 13,792 adults concerning the incidence of pneumonia, asthma, bronchitis and/or emphysema and the condition of their oral health, using degree of gum detachment from bone as an indicator.

Results showed that persons with chronic lung conditions had more gum detachment than those with no lung disease. There also was a direct correlation between the amount of detachment and lung-disease risk. Subjects with gum detachment that exceeded 2 mm had a 40 percent greater risk of developing lung disease than those with attachment loss of less than 2 mm, results showed.

Text II. Bad teeth and gums may exacerbate

Existing lung problems.

University at Buffalo, N.Y.

Chronic lung-disease sufferers should be especially fastidious about brushing and flossing their teeth. That is the message delivered in a study just published in the Journal of Periodontology conducted by oral biologists from the University at Buffalo, N.Y. The researchers found an association between chronic respiratory disease and periodontal disease in an analysis of data from a large national database, the Third National Health and Nutrition Examination Survey, known as NHANES III. The results add to a growing body of evidence that poor oral health is linked to a number of chronic diseases.

Frank Scannapieco, D.M.D., Ph.D., associate professor of oral biology in UB's School of Dental Medicine and a group of researchers found that the mechanism linking oral health and lung disease isn't clear, but that bacteria in the mouth likely are to blame. "Accumulation of disease-causing organisms associated with gum disease may increase the risk for serious lower-respiratory-tract infection in susceptible subjects," said Scannapieco. "It is possible that bacteria that normally stick to the teeth are sloughed into the saliva and may be breathed into the upper airways, changing that environment and paving the way for other germs to infect the lower airways. Oral conditions work together with other factors, such as smoking, environmental pollutants, allergies and genetics to make existing lung problems worse."

Questionnaires completed by participants included items about their history of respiratory disease. The physical examination measured each person's forced expiratory volume (FEV1), or how much air a person can blow out in one second, a measure of lung health and function. A dental examination assessed the loss of gum attachment supporting the teeth, amount of gum bleeding, number of cavities and number of teeth.

Analyzing these two sets of data for a relationship, the researchers found that lung function appeared to diminish as the amount of gum-attachment loss increased. Results also showed a decline in respiratory function as oral health worsened. "We aren't saying that if you don't brush, you'll develop lung disease," said Scannapieco. "We're saying that if you already have lung disease, taking care of your teeth and gums is especially important. It's possible that improved oral health is one factor that may help prevent progression of this disease, which is responsible for 2.2 million deaths a year worldwide."