Is oral health even more important than we thought? Well, new research from Finland has pointed to a surprising link between gum disease and the development of some cancers. And even worse, it has been linked to the risk of cancer-related death.

Periodontitis, or gum disease, is characterized 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 CDC, 47.2% 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% of US 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 study in the British Journal of Cancer showing that Treponema denticola, 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 proteinase (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 and the rates of cancer-related mortality.

The new research—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.

"These studies have demonstrated for the first time that the virulence factors of the central pathogenic bacteria underlying gum disease are able to spread from the mouth to other parts of the body, most likely in conjunction with the bacteria, and take part in central mechanisms of tissue destruction related to cancer."

Timo Sorsa

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.