Gum disease and mental health: Is there a link?

• A study from the University of Birmingham, in the United Kingdom, finds that periodontal disease is associated with the development of a range of serious health issues.
• These include mental health conditions, autoimmune diseases, cardiovascular disease, and cardiometabolic disease.
• With gum health problems affecting many adults, links to these other conditions are especially concerning.

According to the Centers for Disease Control and Prevention (CDC), gum, or periodontal, disease and tooth decay are the two most serious conditions affecting dental health.

Now, a study from researchers in the U.K. reports that the impact of periodontal disease may extend well beyond the mouth, increasing the risk of a range of serious health conditions.

The study finds that poor gum health is associated with a rise in mental health conditions, as well as autoimmune, cardiovascular, and cardiometabolic diseases.

The CDC notes that nearly half, 47.2%, of people older than 30 have some form of periodontal disease. For people 65 and older, that figure increases to 70.1%.

As the study’s co-first author, Dr. Joht Singh Chandan, explains in a press release:

“When oral ill-health progresses, it can lead to a substantially reduced quality of life. However, until now, not much has been known about the association of poor oral health and many chronic diseases, particularly mental ill-health. Therefore, we conducted one of the largest epidemiological studies of its kind to date, using U.K. primary care data to explore the association between periodontal disease and several chronic conditions.”

To gauge the non-dental health effects of periodontal disease and its initial phase, gingivitis, the researchers identified a cohort of 64,379 adults in the country with gum health problems, as noted in the records of a general practitioner (GP).

The average age of the cohort was 45 years, 43% of the group were male, and 30% were smokers. Each individual’s health was tracked for an average of 3.4 years.

The researchers assessed the risk of developing additional health problems by comparing the cohort’s medical histories with those of a demographically matched control group of 251,161 people without periodontal disease.

The results appear in BMJ Open.

The widespread influence of gum disease

The most pronounced association in the study’s analysis was between periodontal disease and mental health conditions, such as anxiety and depression, which developed in 37% of those with gum disease.

Co-study author and periodontal specialist Dr. Devan Raindi suggested to Medical News Today that “It could be postulated that the consequences of periodontitis, which included halitosis (bad breath), drifting of teeth, mobility of teeth, and ultimately tooth loss, would have a psychosocial impact on an individual.”

He added:

“This can lead to loss of confidence, ability to socialize, as well as functional issues [relating to eating and pain]. However, it is important to remember that there is a multifactorial element to the development of mental health issues, and we are, of course, focusing on just one, albeit potentially modifiable, aspect.”

Autoimmune diseases, such as rheumatoid arthritis, type 1 diabetes, arthritis, and psoriasis, developed in 33% of the cohort.

To explain the link between gum disease and autoimmune conditions, Dr. Raindi gave an example. “One mechanism that links rheumatoid arthritis and periodontitis looks at the post-translation changes in proteins caused by enzymes produced by P. gingivalis, a periodontal pathogen. This change is known as citrullination, which can, in turn, lead to production of antibodies against these proteins (known as anti-citrullinated protein antibodies). It is postulated that these autoantibodies may sustain synovial inflammation.”

In addition, the study identified an 18% increased risk of developing cardiovascular disease, a 26% greater risk of developing type 2 diabetes, and a 7% higher risk of developing other cardiometabolic disorders in the cohort with gum disease.

Assessing associations

But could common factors cause both periodontal disease and the other conditions in the study? Dr. Raindi said:

“The first thing I would say here is that we are not suggesting causal relationship for any of the outcomes, rather an association which, I think, is important to separate.”

He continued, “My understanding in relation to common factors here is that the study accounted for potential confounders, such as age, sex, smoking status, deprivation index, and ethnicity.”

Considering that the study grouped together people with gingivitis and more advanced periodontal disease, MNT asked Dr. Chandan whether the results indicate that the development of any level of gum disease could lead to increased health risks. He replied:

“It is difficult to know this for sure, as in some cases periodontal disease can be chronic, but you are right: In numerous cases, gingivitis may improve. However, in this study, we could not be sure of the length of timeframe of the initial periodontal disease.”

“So yes,” said Dr. Chandan, “it does appear that even simply developing a periodontal disease which then gets recorded by the GP is a risk factor.”

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