Does Periodontal Disease Increase the Risk of Cancer?

Having gum disease increases your risk for many health problems other than tooth loss, such as heart disease. To add to the list, a study from Harvard summarized in a letter published online July 20, 2020, by the journal Gut suggests that the microbes camping out between your teeth and gums may affect your risk for cancers of the stomach and esophagus. Harvard scientists analyzed health data from two large studies that included almost 150,000 men and women. In up to 28 years of follow-up, people with a history of periodontal (gum) disease were 43% more likely to develop esophageal cancer and 52% more likely to develop gastric (stomach) cancer compared with people whose gums were healthier. The risk was even higher in those with gum disease severe enough to cause tooth loss. The study is observational and doesn’t prove that gum disease causes cancer, but it could mean that someday doctors will include a look at your gum health when assessing your overall risk. Fortunately, it’s easy to prevent gum disease. The American Dental Association recommends that you brush your teeth twice per day, floss at least once per day, and get a dental exam and cleaning regularly.

More Evidence of Link Between Severe Gum Disease and Cancer Risk

Data collected during a long-term health study provides additional evidence for a link between increased risk of cancer in individuals with advanced gum disease, according to a new collaborative study led by researchers at the Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Kimmel Cancer Center and Tufts University School of Medicine and Cancer Center. Advanced gum disease, also called periodontitis, is caused by bacterial infection that damages the soft tissue and bone that support the teeth. Previous research has shown a link between periodontitis and increased cancer risk, although the exact mechanism connecting the two diseases is still uncertain. We all know brushing and flossing are necessary for maintaining optimum oral health. But not everyone understands that failing to maintain proper oral hygiene can have serious consequences for our overall health, including the increased risk of certain cancers associated with gum disease. According to the Center for Disease Control, 47.2% of adults age 30 and over have some form of gum disease. For adults 65 and over, that number increases dramatically to 70.1%. These numbers are of particular concern because of links between gum disease and more serious health problems including diabetes, heart disease and stroke, and esophageal and gastric cancer.

What are the warning signs of gum disease?

Gum disease is the result of infection and inflammation caused by bacteria in the mouth. When left untreated, the inflammation causes the gums and bone structure to deteriorate, which can lead to oral health complications. The signs and symptoms of gum disease include:
  • Swollen gums
  • Tender gums
  • Bleeding gums
  • Receding gums
  • Loose teeth
  • Sensitive teeth
  • Bad breath
Smoking, poor diet, genetics, and poor oral hygiene can all increase the risk of developing periodontal disease.
How is gum disease linked to serious health problems?
Periodontal disease is a persistent infection of the gums. The bacteria present in gum disease can travel to different parts of the body, triggering inflammation and infection, and significantly increasing the risk of serious health problems, including heart attack, stroke, and diabetes. Researchers are still working to understand the exact connections between gum disease and specific health problems, but generally systemic inflammation and infection play a role.
  • Diabetes – Research shows a distinct relationship between gum disease and diabetes: the elevated blood sugar levels in those with diabetes increase the risk of developing gum disease because it diminishes the body’s ability to fight off the bacteria. Conversely, gum disease can also contribute to higher levels of blood glucose.
  • Heart disease and stroke – Scientists suspect that the bacteria associated with gum disease triggers inflammation in the arteries, which causes the blood vessels to narrow, restricting blood flow and increasing the risk of blood clots, heart attack, and stroke. Periodontal disease can also exacerbate existing heart conditions.

The links between gum disease and esophageal and gastric cancers

In a long-term study involving nearly 150,000 men and women, researchers examined possible links between periodontal disease with tooth loss and gastric and esophageal cancers. In a 22-28-year follow up, they discovered 199 cases of esophageal cancer and 238 cases of gastric cancer. The results of this preliminary research suggests that a history of gum disease with tooth loss increases in the risk of developing esophageal cancer by 43% and gastric cancer by 52%. Further research is still needed to confirm and understand the connections, but early theories involve periodontal pathogens and poor oral hygiene. This does not mean that every person with gum disease will develop cancer, but it does serve as an important reminder that gum disease is a serious condition that can have a significant impact on a person’s overall health in the long-term.


Gum disease has long been linked to heart disease. Now it is being reported that the condition can increase the risk of certain cancers – like cancers of the esophagus and the stomach. But while there may be a link between gum disease and an increased cancer risk there is no concrete evidence of a cause and effect relationship. “We can’t say if you don’t treat your gum disease you are going to die from cancer,” said James Winkler, DDS, PhD, with University of Utah’s School of Dentistry. “In fact, we cannot say if the increased risk is because of gum disease at all.” That’s right. While people who suffer from gum disease have an increased risk of cancer, it may not be the fault of the gum disease. It may be that both conditions develop due to issues in the immune system. Genetics could also play a role. “As we learn more about genetics we find a lot of your risk is based on your genetic make-up,” said Winkler. “You may have a makeup that makes you more prone for gum disease, or cancer, or both.” Even if a cause and effect link between gum disease and cancer is proven we may not know what bacteria are to blame—yet. Currently all eyes are on Tannerella forsythia and Porphyromonas gingivalis as potential culprits. However, that could change as more is learned about what lives in our mouths. “The bacteria that they are implicating are pretty nasty organisms,” said Winkler. “But we have hundreds if not thousands of different types of organisms that live in our mouths. It could be one that has not been identified yet.” The term gum disease covers a wide range of conditions from gingivitis, which is a mild form, to necrotizing periodontal disease, which can lead to bone loss and other serious complications. Symptoms of gum disease include red or swollen gums that bleed easily. Bad breath or pain when chewing are also symptoms. As the condition worsens the bacteria can move below the gum line forming pockets and breaking down the structure of the teeth and the tissues that support them. You can reduce your risk of gum disease by practicing good oral hygiene. Brush your teeth after meals, and floss after brushing. Be sure to see a dentist once a year as well to detect any problems that may arise. “Even if there is no proven cause and effect link between gum disease and cancer it is important to avoid gum disease, to decrease the overall inflammatory burden on the body,” said Winkler. A new study led by researchers from Tufts University School of Medicine and Johns Hopkins Bloomberg School of Public Health has found that advanced gum disease is associated with an increased risk of cancer. Oral diseases such as cavities and gum disease are common in the United States. According to the Centers for Disease Control and Prevention (CDC), more than 80% of adults have at least 1 cavity by the age of 34, and 46% of adults aged 30 and older show signs of gum disease. Bacteria in dental plaque produce acids that break down tooth enamel, which can lead to tooth decay and cavities. When left untreated, tooth decay can lead to severe infection under the gums which can spread to other parts of the body. Gingivitis, or a gum infection, can lead to a more serious condition known as periodontal disease, in which the gums pull away from the teeth and the bones supporting the teeth can be lost, leading to tooth loss. More than 70% of adults age 65 and older have some form of periodontal disease. Factors that can contribute to periodontitis include diabetes, a weakened immune system, poor oral hygiene, and heredity. Now, in a new study published in the Journal of the National Cancer Institute, researchers examined the link between periodontal disease and risk of cancer. While previous studies have found that advanced gum disease may increase cancer risk by 14% to 20% due to immune response changes or the spread of harmful bacteria, the authors of the new study say previous research has had limitations. Noting the prevalence of periodontal disease, the authors emphasized the potential public health impact of oral health. The research team looked at dental data collected from 7,466 participants enrolled in the Atherosclerosis Risk in Communities study in the late 1990s who were followed until 2012. At follow-up, there were 1,648 cancer cases among study participants and 547 cancer deaths. Those who had severe periodontitis experienced a 24% increased risk of developing cancer compared to participants with mild or no periodontitis. Participants without any teeth had a 28% increased risk of total cancer and an 80% increased risk of colorectal cancer. The risk of lung disease doubled in those with severe periodontal disease. “This is the largest study addressing the association of gum disease and cancer risk using dental examinations to measure gum disease prior to cancer diagnosis,” said first author Dominique Michaud, ScD, in a recent press releasefrom Tufts University School of Medicine. Dr. Michaud also pointed out that previous research has found bacteria associated with periodontal disease in colorectal cancer tissues. “Additional research is needed to evaluate if periodontal disease prevention and treatment could help alleviate the incidence of cancer and reduce the number of deaths due to certain types of cancer.” The CDC notes that the United States spends more than $113 billion a year on cost related to dental care, and loses more than $6 billion of productivity each year when individuals miss work to receive dental care. To maintain good oral hygiene, dentists recommend brushing with a fluoride toothpaste at least twice daily, flossing, drinking fluoridated water, and avoiding tobacco products. Share on PinterestOral health may be more important in preventing the development of cancer than we thought. Periodontitis, or gum disease, is characterizedTrusted Source by the inflammation of the tissue surrounding the base of the teeth, or the gums. In its more advanced stages, periodontitis might lead to the destruction of the gums and even begin to attack the bone that holds teeth in place. According to the Center for Disease Control and Prevention (CDC), 47.2Trusted Source percent of adults who are over 30 years of age in the United States have some type of periodontitis. With age, this rate increases, so that 70.1 percent of U.S. adults over 65 years old have this disease. As if living with the symptoms of periodontitis wasn’t hard enough, researchers from the University of Helsinki and Helsinki University Hospital, both in Finland, in collaboration with colleagues from the Karolinska Institutet in Sweden, have shown that the bacteria to blame for this disease might also be able to cause certain types of cancer — specifically pancreatic cancer. In November 2017, Timo Sorsa — at the University of Helsinki — and team published a studyTrusted Sourcein the British Journal of Cancer showing that Treponema denticolaTrusted Source, which is the bacterium that causes periodontitis, may also be responsible for the development of some types of cancer.

Gum disease bacteria and cancer tumors

They noted that Treponema denticola and some gastrointestinal cancers, such as pancreatic cancer, share an enzyme: Treponema denticola chymotrypsin-like proteinaseTrusted Source (Td-CTLP). This enzyme, which was observed in certain cancerous tumors, is typically found in the mouth and acts as the main “boosting” agent in the development of gum disease. Next, the researchers investigated the molecular mechanisms at play that might explain the link between the bacterium responsible for periodontitis and the development of cancer tumors elsewhere in the body. They found that Td-CTLP can activate other enzymes — pro-MMP-8 and pro-MMP-9 — that cancer cells use as a vehicle that allows them to encroach on previously healthy cells. “In addition,” the authors write, “our in vitro experiments provide evidence that Td-CTLP shows immunomodulatory activity that can have a crucial role in promoting and regulating carcinogenesis.” This means that the Td-CTLP enzyme is also able to impair the response of the immune system through its action on enzyme inhibitors, which are molecules that normally slow down enzyme activity when required. Thus, Td-CTLP enables cancer-friendly enzymes to do their worst.

‘Virulence factors spread from the mouth’

Additionally, Sorsa and another team of researchers conducted a supplementary study, this time investigating the link between the incidence of periodontitis the rates of cancer-related mortality. The new researchTrusted Source — published last week in the International Journal of Cancer — discovered a positive association between the two. For the purpose of this study, Sorsa and colleagues analyzed data sourced from 68,273 adults over a period of 10 years. What they found was a strong association between a gum disease diagnosis and death caused by pancreatic cancer. Looking at the two studies, the team concludes that the inflammation characteristic of periodontitis may make it easier for harmful bacteria to travel to other parts of the body, allowing their virulence factors — such as CTLP — to act as a “booster” for cancer cells. For these reasons, Sorsa and colleagues encourage people to pay more attention to their oral health, since prevention of oral diseases may also mean prevention of more serious health outcomes such as cancer. “In the long run, this is extremely cost-effective for society,” Sorsa concludes.

At DC Perio & Implants, we can help you maintain optimum oral health

With proper oral hygiene and regular professional cleanings, you can prevent, stop, or even reverse the symptoms of gum disease. Brushing and flossing regularly helps remove plaque and food particles, which in turn keeps the oral bacteria down. Regular visits to DC Perio & Implants will help identify and treat early symptoms before they cause more serious health complications. If you have bleeding gums, red tender gums, bad breath, or loose teeth, you may have periodontal disease. We can help. Give us a call today at (202) 659-3500 to schedule an appointment or a consultation.

Armin Abron, DDS, MS


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