Treating the Aging Baby Boomer: Looking through the Crystal Ball
Overall Health Issues and the Oral-Systemic Link

Chronic diseases are on the rise worldwide.² Declines in health status and higher health care use are more likely to be driven by these chronic diseases than by age itself. More than a quarter of all Americans and two out of every three older Americans have been reported to have multiple chronic conditions. In addition, treatment for this older population accounts for 66% of the total US health care budget.¹¹

The most frequently reported chronic diseases in the US in order of occurrence are:

• Hypertension
• Heart disease
• Diabetes
• Cancer
• Stroke
• Chronic bronchitis
• Emphysema
• Asthma
• Kidney disease

Inflammation is closely linked with several of these chronic diseases. Diabetes for example has been shown through numerous studies to have a negative impact on oral health (i.e., if glucose levels are not under control, then periodontal disease manifests). As a result, the American Diabetes Association has listed periodontal disease as the sixth complication of diabetes.¹² However, research has also shown a two-way relationship exists with diabetes and periodontal disease in that if oral inflammation is kept under control, glucose levels as well tend to normalize.¹³

With any chronic disease that is inflammatory in nature such as cardiovascular disease, kidney disease, some cancers and several respiratory diseases, C-reactive protein (CRP) levels are elevated in the body. CRP is a non-specific marker of systemic inflammation produced in the liver. There is strong evidence from cross-sectional studies that plasma CRP in those with periodontitis, is also elevated compared with controls.^14,15 Periodontal disease is a chronic inflammatory disease during the course of which, microorganisms present in the periodontal pockets, trigger the inflammatory process resulting in elevated levels of cytokines such as IL-6, and PGE2. These cytokines in turn, particularly IL-6, trigger the liver to produce CRP.¹⁵

This perpetuation of inflammatory biomarkers is now believed to play a contributory role in the pathogenesis of diseases such as: aspiration pneumonia, atherosclerosis, stroke, diabetes, rheumatoid arthritis, Alzheimer’s disease, and end-stage renal disease. It is therefore imperative that oral inflammation be kept under control in order to reduce CRP levels even if to a lesser degree. Although no cause and effect relationship has been shown to date between these oral-systemic linkages, what has been shown is keeping one’s periodontal disease under control can reduce the overall burden of systemic inflammation.

Numerous studies have been conducted to examine the effects of periodontal therapy in lowering CRP levels. A systematic review of these studies was conducted by Paraskevas et al., which revealed a modest effect of periodontal therapy in reducing CRP levels.¹⁴

The following table highlights the results of several studies testing various periodontal interventions on not only reductions in CRP values but also on improvements in cardiac endothelial function as well as improved lumen size of the carotid intima media.