Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Time for a New Mouthwash

Waiting with bated breath for the latest on fetid breath, failed immune systems.

Adults with gingivitis (swollen, bleeding gums) performed worse on tests of memory and other cognitive skills than did those with healthier gums and mouths, according to a report in the Journal of Neurology, Neurosurgery & Psychiatry published a couple of years ago.

Those with gingivitis were more likely to perform poorly on two tests: delayed verbal recall and subtraction -- both skills used in everyday life.

An analysis published a little over a year ago in the British Journal of Psychiatry found that people with severe mental illness had 3.4 times the odds of having lost all their teeth than the general community. The care-giving community appears satisfied if the (often non-compliant) patient accepts the proffered mental illness-fighting regimen. But we should be thinking of oral care and not just oral fixations, as the cognitive difficulties associated with the fallout from poor oral hygiene can only worsen functionality.

Interestingly, research has found an association between gum disease and rheumatoid arthritis (RA), an autoimmune disease that causes inflammation of the joints: a chronic disease, with unimaginable potential for chronic pain and disability.

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At this year’s American College of Rheumatology annual scientific meeting, the risk factors for RA were discussed---and how much we do not know about them. But we do know that there is something about the citrullination of certain proteins that is associated with RA. Smoking is a major risk factor for the development of RA. Researchers have found that if this environmental insult, smoking, occurs in the context of the presence of certain genes in an individual, these genes may trigger RA-specific immune reactions to citrullinated proteins, which in turn leads to inflammation.

Alas, there are a variety of ways by which proteins can be citrullinated.

The bacteria, Porphyromonas gingivalis—or P. gingivalis, to make it a little easier—is found in the mouth, and associated with periodontal disease. It also has the ability (apparently fairly unique among the many oral bacteria tested) to citrullinate proteins. P gingivalis-mediated citrullination of bacterial and host proteins provides a molecular mechanism for generating antigens that drive the autoimmune response in RA.

More and more traditional psychiatric diseases, like schizophrenia, major depression, and Alzheimer's disease, are increasingly viewed as involving autoimmune and inflammatory processes.

The emerging data on the importance of inflammatory processes in mental illness provide a more complete, albeit much more complex, understanding of potential pathophysiologic processes involved. A whole area of therapeutics not directly involving neurotransmitters is becoming possible. Given that almost all of these data are less than 10 years old, it seems certain that discussions of inflammation and autoimmunity will become more commonplace in psychiatric literature and, hopefully, offer novel therapeutic options.

One cannot help but wonder how many of these inflammatory processes are triggered by poor dentition and infected gums.

We marvel at pre-Columbian trephination, recoil in horror at frontal lobotomies, and grudgingly accept an occasional electroconvulsive therapy session. When will we sublimate our primordial fear of the dental profession into, say, an appreciation for the role dentition has in the illnesses we treat, and trade that trephine in for a dental drill?

Perhaps we will see less disease, and have better teeth.

 

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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