Dental Hygiene Practice Also Important for Possible Risk of Pancreatic Cancer from Periodontal or Gum Disease
Gum disease progresses in stages. Believe it or not, more than half of teens have some form of gum disease.
Do your gums bleed when you floss or brush your teeth? Chances are you already have the mildest form of gum disease. Bleeding gums are usually a sign of gingivitis (pronounced: jin-juh-vy-tus), the mildest form of gum disease. Other warning signs of gingivitis include gum tenderness, redness, or puffiness.
If plaque from teeth and gums isn't removed by good daily dental care, over time it will harden into a crust called calculus or tartar. Once tartar forms, it starts to destroy gum tissue, causing gums to bleed and pull away from the teeth. This is known as periodontitis (pronounced: per-ee-oh-don-ty-tus), a more advanced form of gum disease.
Periodontitis, or Pyorrhea, is a disease involving inflammation of the gums (gingiva), often persisting unnoticed for years or decades in a patient, that results in loss of bone around teeth. This differs from gingivitis, where there is inflammation of the gingiva but no bone loss; it is the loss of bone around the teeth that differentiates between these two oral inflammatory diseases.
According to the Centers for Disease Control and Prevention (CDC), approximately 500 million dental visits occur annually in the United States, with an estimated 50 billion dollars currently being spent on dental services.
Yet, many children and adults needlessly suffer from oral diseases that could be prevented. In fact, 30,000 Americans will be diagnosed with oral and pharyngeal cancers this year, resulting in more than 8,000 deaths -- many of which could have been prevented.In addition, close to 20 percent of preschoolers (children ages 4 and 5) have tooth decay -- with 50 percent developing tooth decay by the third grade, and 86 percent by age 17.
Having periodontal or gum disease may boost the risk of getting pancreatic cancer, according to new research from Harvard Medical School involving more than 51,000 men.
"Men who had reported periodontal disease had a 64 percent higher risk of pancreatic cancer [or were 1.6 times more likely to get it] compared to those who didn't have periodontal disease," said the study's lead author, Dominique S. Michaud.
The study provides the first strong evidence that gum disease may increase pancreatic cancer risk, added Michaud, an assistant professor of epidemiology at the Harvard School of Public Health in Boston.
Her team published the findings in the Jan. 17 issue of the Journal of the National Cancer Institute.
Two previous studies have uncovered a link between tooth loss or gum inflammation and pancreatic cancer, Michaud said. But one included all smokers and the other did not control for smoking, known to boost the risk of pancreatic cancer, in the analysis.
The pancreas, a gland behind the stomach, makes pancreatic juice, which helps break down fats and proteins in foods. The gland also produces the hormone insulin, which helps regulate blood sugar.
In their 16-year study, Michaud and her colleagues followed 51,529 men who participated in the Health Professional Follow-Up Study, which began in 1986. The researchers controlled for the effects of smoking.
"Our study was a prospective study of health professionals," Michaud said. "Not MDs, but dentists, podiatrists, veterinarians."
They also calculated the risk of pancreatic cancer among smokers and nonsmokers.
"Among men who never smoked, having periodontal disease led to them being twice as likely to get pancreatic cancer," Michaud said. That helped convince the researchers that periodontal disease and pancreatic cancer were linked.
The mechanism behind the link isn't known, Michaud said. And while her team found an association, it is not a proven cause-and-effect relationship.
One possible explanation is that inflammation from gum disease may somehow promote pancreatic cancer.
"People with periodontal disease have higher levels of blood levels of C-reactive protein, an inflammatory marker that has been associated with heart disease," Michaud said. "Periodontal disease is also linked to heart disease in some studies." The inflammation may somehow contribute to the promotion of cancer cells, she added.
The men in the study had severe gum disease, the type that can lead to tooth loss, she noted.
Dr. Eva Schernhammer, an assistant professor of medicine at Harvard Medical School who was not involved in the study, said the results were intriguing.
Pancreatic cancer is one of the most serious of cancers. It develops when cancerous cells form in the tissues of your pancreas — a large organ that lies horizontally behind the lower part of your stomach. Your pancreas secretes enzymes that aid digestion and hormones that help regulate the metabolism of carbohydrates.
By the time that pancreatic cancer is diagnosed, most people already have disease that has spread to distant sites in the body. Pancreatic cancer is also relatively resistant to medical treatment, and the only potentially curative treatment is surgery. In 2004, approximately 31,800 people in the United States were diagnosed with pancreatic cancer, and approximately 31,200 people died of this disease. These numbers reflect the challenge in treating pancreatic cancer and the relative lack of curative options.
"Pancreatic cancer is one of those diseases we don't know much about," she said. "Once you get it, the survival is very low."
This research "confirms that inflammation may play an important role in pancreatic cancer," she said.
According to Michaud, the findings should also "give consumers one more reason to really take care of their teeth and their oral health. I think that's really the message, even though we aren't sure this is a causal association."
Even so, she added, "people with severe periodontal disease shouldn't be worrying they are going to get pancreatic cancer. It is a horrible disease, but it is rare."
According to the American Cancer Society, 33,730 Americans got pancreatic cancer in 2006 and more than 32,000 died from it.
The earlier that gum disease is caught, the better. Adopting better brushing and flossing habits can usually reverse gingivitis. Sometimes your dentist will also prescribe antibiotics or a special antibacterial mouth rinse to tackle the problem.
Once someone develops periodontitis, it isn't as easy to control. Usually there is widespread infection of the gums that needs to be treated. This may require several special treatments either by a dentist or a periodontist, an expert who specializes in the care of gum disease.
Daily oral hygiene measures to prevent periodontal disease include:
- brushing properly on a regular basis (2 times a day), with the patient attempting to direct the toothbrush bristles underneath the gum-line, so as to help disrupt the bacterial and plaque growth that may occur there.
- flossing daily and using interdental brushes if there is sufficient space between teeth and behind the last tooth in each quarter.
- using an antiseptic mouthwash. Chlorhexidine gluconate based mouthwash or hydrogen peroxide in combination with careful oral hygiene may cure gingivitis, although they cannot reverse any bone loss due to periodontitis. (Alcohol based mouthwashes may aggravate the condition).
- regular dental check-ups and professional teeth cleaning as required. Dental check-ups serve to monitor the person's oral hygiene methods and levels of bone around teeth, identify any early signs of periodontitis, and monitor if it has responded to treatment.