Gum Disease: The Silent Killer

Additional Info

• Segment Number: 2
• Audio File: healthy_talk/1515ht2b.mp3
• Featured Speaker: Robert H. Gregg II, DDS
• Organization: LANAP
• Guest Bio: Dr. Robert Gregg is a former faculty member at UCLA School of Dentistry, Section of Hospital Dentistry.
  
  He has been using lasers clinically since August 1990, including CO2, free-running pulsed (FRP) Nd:YAG, both single- and variable-pulsed; FRP Ho:YAG, surgical Argon, CW Diodes, and Er:YAG. He has given lectures nationally and internationally on the subject of clinical laser applications.
  
  Dr. Gregg is a co-developer of the FDA-cleared PerioLase® MVP-7™ pulsed Nd:YAG laser, and is a co-developer and patent holder of the LANAP® laser periodontitis treatment. He maintains a group private practice where he sees patients.
• Transcription: RadioMD Presents: Healthy Talk | Original Air Date: April 7, 2015
  Host: Michael Smith, MD
  
  Healthy Talk with Dr. Michael Smith, MD. And now, here's the country doctor with the city education, Dr. Mike:
  
  DR MIKE: So is there a new silent killer out there? I mean we all know blood pressure is kind of like the classic silent killer. I think most people are familiar with that. But my guest, who is Dr. Robert H. Gregg, he's the President and Chairman of the Board for Millennium Dental Technologies, Incorporated. He thinks there's another silent killer out there. Dr. Gregg is a former faculty member at UCLA School of Dentistry. He's been using lasers clinically since, gosh, August 1990, so he's really one of the pioneers here. He's given lectures nationally and internationally on the subject of clinical laser application. He is co-developer and patent holder on the LANAP® laser treatment.
  
  Dr. Gregg, welcome to Healthy Talk.
  
  DR GREGG: Good morning. Thank you. Good to be with you.
  
  DR MIKE: So, what's this new silent killer that you think we need to know more about?
  
  DR GREGG: Well, an interesting report was just published defining that fatal heart attacks are more associated with advanced gum disease and most people who survive heart attacks have less severe or no gum disease. And that's something new because we have heard about the connection between gum disease inflammatory markers and heart attacks, stroke, pre-term babies, low birth weight babies, Alzheimer's, pancreatic cancer, and the list goes on. But there's not been, there's only been an association between the various different systemic diseases periodontal diseases not a direct causation. They've now found a causation effect with the sudden death in advanced periodontal disease in someone who then has a heart attack.
  
  DR MIKE: Yes. Dr. Gregg, are they linking this? I know we believe that there's this inflammatory component, but I guess in the mid 90's there was some work looking at certain infectious bacteria in the mouth that may be seeding some of the plaques. Where is that research?
  
  DR GREGG: What we're finding out more and more about this very insidious germ called Porphyromonas gingivalis or P. gingivalis. It's anaerobic that is it's a germ that lives in the absence of oxygen and feeds and attacks the living cells and invades the living cells. But we're finding out that it isn't just isolated to the mouth, that it travels throughout the bloodstream and then lands on percolates through the heart vessel wall and other organs in their walls to lay and wait. They are opportunistic pathogens. That is, they wait for some other weakening of the patient's immune system to express themselves before they become active. So they can lay dormant. In fact we all have P. gingivalis in our mouths. It's not a foreign germ. It's a common germ that can be found. But it's whether or not there are other co-factors that can trigger it to become the nasty germ that it can be.
  
  DR MIKE: What are some of those other co-factors then?
  
  DR GREGG: Well, for example, smoking that depresses the immune system, specifically neutrophils, so that we can't fight off P. gingivalis should we decide to test the waters, so the speak. Diabetes and elevated A1C in diabetics also can change the permeability of the cells and, again, allowing a more hospitable environment for P. gingivalis to activate. So then, we also know that there's an inflammatory protein, C-reactive protein, that's also elevated in patients with diabetes and metabolic stress syndromes. It also has an impact and effect on activating P. gingivalis. So, you can just imagine if someone has a confluence or a number of these elevated markers that they're at high risk of activating P. gingivalis and with more advanced gum disease, they're more likely to have a large volume of P. gingivalis circulating in your system and lying in wait and that's where the trouble begins.
  
  DR MIKE: So, Dr. Gregg, the question becomes for me, since we've moved away from just an association, we're now saying there's a cause effect link here so should cardiologists be treating gum disease now? Where do we go? I mean should we be looking at periodontal disease like we do blood pressure?
  
  DR GREGG: Absolutely. So, in fact, I was speaking with a cardiologist not long ago and we were discussing the correlations which predate the causation that I'm now talking about and he was clueless to the information that I was talking about. He kind of got a little animated and said, "Well, this is why we need to talk more amongst our specialties," and, indeed, there has been some collaboration between the American Academy of Periodontology and the cardiologists. They have done some collaborative work and workshops looking at this. I am hearing and experiencing firsthand collaboration with cardiologists and referrals from cardiologists with patients who are about to undergo heart valve replacement or placement and they're calling and saying or referring them over to me to basically clean up the infection in the mouth.
  
  DR MIKE: Right.
  
  DR GREGG: And in the old days we used to just extract everything. Well, people don't want to have their teeth extracted these days. It's not the 1940's. They want keep their teeth not have everything taken out and live with dentures.
  
  DR MIKE: And the good news is that we're able to do that a little bit better than the old what was it called? The cut and sew type techniques of the past. But before we go there, though, because I want to talk more about what you offer in your laser treatments and some of your research, but before we do that, maybe for my listeners, Dr. Gregg, can we just back up for a second and just define, because we've mentioned this already a couple of times, periodontal disease, what exactly is that?
  
  DR GREGG: Well, periodontal is a name for what happens when gingivitis goes bad. Gingivitis is an inflammation of the gum tissue but not yet the destruction of the underlying structures like the bone and the ligaments that support the teeth. But, when the bacteria combine with the calcium in our saliva we get plaque or tarter on our teeth if that's not removed on a consistent basis. It wants to advance down into the pocket and when it does so, it dissolves the bone and supporting structures of the teeth which can then lead to eventually tooth loss. It's a painless, silent disease for the most part like high blood pressure is, like elevated A1C, so you don't necessarily know it's happening. Many patients come in and have no clue that they've got gum disease. It actually that's kind of what it is in a nutshell.
  
  DR MIKE: Is receding gum line a symptom of this as well or is that something different?
  
  DR GREGG: It's something different. It's called attachment loss, but it's not the same thing as an inflammatory breakdown of the supporting structures. It has other factors like orthodontics. The teeth have pushed through the bones and then the gums have to recede because there's no bone. Tissue typically likes to remain at the height of the bone. Periodontal disease is an exception to that in that the tissue can remain high by the neck of the tooth where you would expect to see it but the bone loss can be quite destructive underneath.
  
  DR MIKE: So, speaking of the periodontal disease how many people in the United States do you think are affected by this?
  
  DR GREGG: Well according to the U.S. Surgeon General's Report, 85% of the adult population has some form. Now, that doesn't mean they have full-blown gum disease. They may have one or two areas that are probing beyond normal. But there is an estimate of around 100 million adults that have moderate to severe gum disease, 50% of those, excuse me 97% of those aren't getting treated.
  
  DR MIKE: Okay, Dr. Gregg, let's leave it there and when we come back, let's talk about treatment of periodontal disease.
  
  This is Healthy Talk on RadioMD. I'm Dr. Mike, stay well.
• Length (mins): 10
• Waiver Received: No
• Host: Mike Smith, MD