- Although gum disease occurs in the mouth, previous research shows it can affect health in other parts of the body, such as the heart and bones.
- Researchers from King’s College London recently found that metformin —a common type 2 diabetes drug—may help improve clinical outcomes for non-diabetic people with gum disease.
- The same study also found that metformin may help prevent bone loss caused by either periodontal disease or aging via both mouse and clinical trials.
About 19% of the world’s adult population has severe periodontal disease.
Also known as gum disease, this condition occurs when the tissues holding teeth in place become infected. If left untreated, periodontal disease can damage bones in the mouth and ultimately lead to tooth loss.
Periodontal disease can also impact other areas of the body. Previous studies link gum disease to an increased risk for cardiovascular disease, Alzheimer’s disease, diabetes, and respiratory disease.
Now, researchers from King’s College London have found a common type 2 diabetes drug may help improve clinical outcomes for non-diabetic people with gum disease, as well as help prevent bone loss caused by either periodontal disease or aging, via both mouse and clinical trials.
This study was recently published in the Journal of Translational Medicine.
Using metformin to treat gum disease
For this study, Dr. Vitor Neves, academic clinical lecturer, periodontology registrar in the Faculty of Dentistry, Oral & Craniofacial Sciences at King’s College London, and lead author of this study, and his team focused on using a common type 2 diabetes drug called metformin.
Previous studies have looked at the anti-inflammatory properties of metformin to provide protection against conditions like cardiovascular disease, liver disease, and certain types of cancer.
This is also not the first study to look at metformin as an ‘anti-aging’ therapy. Research published in August 2019 found there is mounting evidence suggesting the drug offers beneficial effects in reducing the risk of aging-related diseases.
A study published in April 2021 says metformin reduces the levels of AGEs — a marker of aging — by lowering insulin and blood glucose levels and increasing insulin sensitivity.
Metformin helps control inflammation
First, the researchers tested metformin in a mouse model of periodontal disease. After the mouse study, scientists found metformin led to significant prevention of bone loss during induced periodontal disease and age-related bone loss in living mice.
“What surprised me about metformin was being able to make my aging animals healthier and (prevent) 50% of bone loss,” Dr. Neves told Medical News Today. “When I analyzed that data, it was the (first) time I felt, ‘Wow, there is really something here’.”
Next, Dr. Neves and his colleagues performed a clinical trial with 20 study participants who all had gum disease but did not have diabetes.
At the end of the trial, researchers discovered participants given metformin had improved clinical outcomes in their gum disease treatment. Additionally, metformin helped control sugar levels and inflammation in the mouth and body, even when bacteria levels were high.
Improving aging with metformin
“Prevention starts before disease takes place, with both my animal data and patient data showing good metformin outcomes even with high levels of bacteria in the mouth. This raises the question about whether ‘solely brushing your teeth’ truly is the only way we can actually prevent gum disease development throughout our lives,” Dr. Neves said.
“In addition to those surprising findings, my clinical data also points to the potential use of metformin to improve the overall health of gum disease patients, due to seeing the stabilization of glucose levels, improvement of insulin sensitivity, and control of inflammation,” he added.
“All these markers [stabilized glucose, improved insulin, controlled inflammation] are directly correlated with improvement of aging according to aging research. Therefore, it seems that preventing systemic diseases from the mouth is a good pathway to prevent overall systemic diseases.”
— Dr. Vitor Neves
How does gum disease happen?
Periodontal disease happens when bacteria is allowed to collect onto teeth, forming a sticky substance called plaque.
Most plaque can be removed with good dental hygiene — brushing teeth twice a day and flossing once a day. If plaque stays on the teeth too long, it can harden into a material called tartar, which can only be removed through professional dental cleaning.
Plaque and tartar buildup on teeth can also inflame and infect the gums, leading to gingivitis.
Suppose plaque and tartar are not removed from teeth and gingivitis is not treated. In that case, the infection can travel deeper into the soft tissues around teeth, potentially causing bone and tooth loss, known as periodontitis.
How is periodontal disease treated?
The best treatment for periodontal disease is prevention by following healthy oral hygiene practices. This includes visiting a dentist for a professional teeth cleaning every six months.
If periodontal disease has set in and become serious, a dentist may recommend a deep cleaning where plaque is removed from areas of the teeth below the gumline.
Severe periodontitis cases might require medications and surgical treatments.
“If you go to the dentist today, the only possible treatment for gum disease is based on oral hygiene, cleaning the teeth, and antibiotic therapy, which are solely based on controlling plaque — bacteria and food — that accumulates around the teeth,” Dr. Neves told MNT.
“The issue is that [current treatments for gum disease] only tackle the disease from the bacterial angle of the problem, ignoring inflammation. Additionally, the treatments available do not help toward the prevention of other non-communicable diseases.”
— Dr. Vitor Neves
“So, the development of novel therapies and pathways within health systems that sees gum disease patients as a potential patient for other non-communicable diseases can help decrease the overall burden of disease around the world and potentially create a new healthy geriatric generation,” he said.
How does gum disease affect aging?
Past studies show periodontal disease can impact a person’s systemic — or overall body — health, affecting how well they age.
Periodontal disease is also linked to inflammaging, which is chronic inflammation that can occur with aging.
According to Dr. Neves, systemic diseases that affect overall health, such as diabetes, obesity, and cognitive decline, often start affecting people from late adulthood into the geriatric stage. Gum disease, however, starts much earlier, around 30 years old for everyone.
“The diseases I have mentioned and gum disease are all classified as non-communicable diseases, which means that they develop throughout one’s lifespan. These diseases have also been shown to be associated with people with gum disease. In other words, people with severe gum disease are more likely to have these conditions,” he noted.
“What our research suggests is that if we start fighting gum disease from a systemic point of view, over time, we may be able to fight and prevent the development of other non-communicable diseases that gum disease patients may develop in their lifespan,” Dr. Neves added.
The mouth: A window into the body’s health
After reviewing this study, Dr. Purnima Kumar, American Dental Association spokesperson and professor at the University of Michigan School of Dentistry, told Medical News Today that as a clinician who specializes in treating patients with periodontal disease, she initially found this research very intriguing.
“But it’s also important to keep in mind that these findings are very preliminary and have several caveats — including the fact that the majority of the results are reported from animal studies,” she said.
“These findings require additional studies in larger and broader populations. Moreover, because the researchers are proposing an off-label use of a drug that is only FDA-approved to help improve glycemic control in people with type 2 diabetes, there will have to be more data gathered on any adverse reactions to the use of this drug in normoglycemic people,” she added.
When it comes to overall health, Dr. Kumar said the mouth is a window into the health of your body. She said many people fail to realize that several systemic conditions and diseases, like heart disease and diabetes, can affect oral health systemically or due to physical inability to maintain appropriate oral hygiene.
“Periodontal and systemic diseases share many common risk factors, including smoking and poor diet. An important part of healthier aging is to take care of your oral health, which includes brushing your teeth twice a day, cleaning in-between your teeth once a day, and regularly visiting the dentist. You can find helpful dental health information from the ADA at MouthHealthy.org.”
— Dr. Purnima Kumar
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