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Periodontal Disease and Atherosclerosis in Senescence
Theodore Hersh, MD, MACG
Professor of Medicine, Emeritus, Emory University
Chairman, Thione International, Inc
Epidemiologic studies have revealed the association and prevalence
of gingival (gum) disease and coronary artery disease in the elderly.
There is nearly a three fold increase of heart disease in patients
with gingivitis and periodontitis, independent of risk factors such
as tobacco abuse. Blood and tissue levels of glutathione, the body’s
pivotal antioxidant, and its synergistic partners tend to be decreased
in the elderly and have been related to early senescence and geriatric
conditions. The free radicals generated in the inflammation of periodontal
disease promote the oxidation of low density lipo-proteins and thereby
enhance the development of atherosclerosis. Local and systemic repletion
of glutathione and its synergistic partners help repair gingival
disease and thus may decrease the risks of atherosclerosis in the
elderly, another anti-aging function of glutathione.
In the oral cavity, glutathione has been shown to promote the normal
process of attachment, spreading and growth of gingival fibroblasts,
vital in periodontal tissue repair. Tobacco, whether smoked or chewed,
and betel quid chewing, worldwide health problems, inhibit these
mechanisms and locally deplete intracellular glutathione levels.
Through these injurious free radicals, the noxious factors interfere
with collagen synthesis and cause DNA mutations which increase the
risks of oro-pharyngeal malignancies. Repletion with glutathione
and its endogenous antioxidant partners abolishes the damaging effects
of the free radicals on the periodontal tissues, thereby promoting
normal functioning gingival fibroblasts, decreasing the inflammation
and enhancing collagen synthesis for gum repair.
Periodontal disease results from invasion of pathogenic micro-organisms
and bacterial toxins in the gingiva causing both inflammation and
destruction of the connective tissue. These generate toxic free
radicals which aggravate gingival problems while both bacteria and
free radicals may contribute to inflammation of arterial walls and
oxidation of low density lipo-proteins, linking gum disease to atherosclerosis.
The elderly are greatly afflicted by periodontal disease and loss
of teeth, a condition which complicates coronary heart diseases.
Oxidative stress also accelerates gingival disease in elderly diabetic
patients and promotes the vascular complications of diabetes.
Local antibacterial therapy and odontologic procedures are mandatory
to help heal gingivitis and periodontitis.The administration of
antioxidants, low in senescent subjects, are adjuncts in the management
of gingival disease. Healthy gums thus may equate to a healthy heart;
and glutathione therapy with its synergistic antioxidants may then
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