Beware of chronic inflammation to improve systemic health
• Increasing evidence has shown chronic inflammation as the common thread for many health issues such as cardiovascular diseases, diabetes and periodontitis.
• This compelling correlation means that we should not overlook seemingly minor ailments such as periodontitis, or gum disease.
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Inflammation is the immune system getting overly excited due to viral or bacterial infection. Acute inflammation can manifest in pains in the kidneys, lungs, liver and stomach as the body attacks the invasion of the pathogen.
Dr. Cheong Yan Yue, Adrian, Specialist in Cardiology, Honorary consultant at the Matilda International Hospital, said: “But chronic inflammation is a low-level, simmering type of inflammation with subtle symptoms that do continuous damage to one’s health but may not be noticeable. Symptoms, if any at all, can be as varied as fatigue or bleeding gums when you brush your teeth, if you have periodontitis.”
Attacks to the heart arteries
Dr. Cheong explained that teeth and gums are intimately connected to the heart because of the short physical distance in between. Bacteria could find their way into the bloodstream and damage the valves, or more commonly, the arteries, which is supported by histological reports of heart arterial plaques containing bacterial fragments.”
“Alternatively, inflammatory mediators can also travel to the heart and activate white blood cells. When the immune system is activated in the heart arteries, it promotes the growth of plaques because white blood cells swallow the cholesterol molecules and embed themselves in the arterial wall, sometimes triggering blood clots,” he continued.
Clinical trials have demonstrated that treating low-level inflammation can reduce the chance of heart attacks and strokes. “Therefore people should not ignore periodontitis which can be treated very effectively by a specialist. Don’t be afraid to seek help. If you have periodontitis, be aware that cardiovascular diseases and even diabetes can come together with this,” said Dr. Cheong.
Diabetes and chronic inflammation
From an endocrinologist’s point of view, anything that increases insulin resistance can be a cause for chronic inflammation.
Dr. Wu, Enoch, Specialist in Endocrinology, Diabetes and Metabolism, said: “Periodontitis is regarded as a conspirator for diabetes, because it increases insulin resistance and the secretion of stress hormones like cortisol, which leads to high blood sugar levels and ultimately diabetes. Therefore endocrinologists would also look at the heart, blood vessels and the gums to avoid a downward spiral of these inter-connected issues.”
“Another catch is that some young people have undiagnosed blood sugar problems. They are mostly asymptomatic so if they have periodontitis, it could be an important telltale sign for underlying diabetes,” Dr. Wu continued.
According to the PAROKRANK study conducted in 2019 in Sweden, undetected dysglycaemia, or blood sugar abnormality, is an important risk factor for heart attacks and periodontitis. The takeaway is that those with severe periodontitis, especially if they are young, should seek medical ad-vice about their heart and blood sugar levels.
A case for holistic treatment
The medical profession has become increasingly aware of the interplay of these seemingly separate issues, whereby blood sugar abnormalities can exacerbate periodontitis and heart disease. Specialists are working in tandem to offer a holistic treatment that yields marked improvements for patients’ health.
According to Dr. Cheong, a 45 year-old patient who had periodontitis and had even lost some teeth to it was presented to hospital with chest pain. He was found to suffer from severe coronary artery disease, diabetes that he was unaware of, as well as antibiotic-resistant Helicobacter gastritis that caused vomiting and chronic inflammation.
He had been reluctant to go to the dentist due to Covid-19. The specialists took a team approach to treat him with surgery for the arteries, medication for the gastric infection and periodontitis, and he eventually recovered.
Periodontitis and dental treatments in the new normal
Sign of early stage periodontitis can be slightly swollen gums, progressing to bleeding, pain, and loosened teeth with a gum pocket that hides dirt, and eventually periodontal abscess and damage to the bones underneath.
According to Dr. Tsang Hin Kei, Century, Immediate Past President of Hong Kong Dental Association, some patients with diabetes have no teeth left by age 40. Uncontrolled diabetes can cause periodontitis to worsen quickly. Conversely, your blood sugar levels would generally improve when you have treated your periodontitis.
Like other chronic diseases, early treatment and prevention are key. Apart from medical treatments, patients should maintain good oral hygiene by going for annual dental cleaning regularly, as well as daily flossing and thorough brushing.
The public should be aware that the health risk of neglecting your gums is greater than a visit to the dental office.
Dr. Tsang said: “Dental clinics go to great lengths to ensure patients’ safety during Covid-19 and the lack of clusters arising from dental treatments is not a fluke but the result of a conscious ef-fort. Extra measures include full on PPEs and a mouthwash before treatment that kills viruses in the saliva. Most supplies are used once and equipment for repeated use goes through high pressure sterilisation. There is also additional equipment like air purifiers and extra oral suction through UV filters that minimises aerosols. This is how dental clinics face the new normal of Covid-19.”