Study shows high gum disease rates in rural Appalachia

Research on 445 families centered in two Pennsylvania towns and two West Virginia counties shows that 80 percent of adults suffer from more severe forms of periodontal disease, according to Richard Crout, D.M.D., Ph.D., an expert on gum disease and associate dean for research in the West Virginia University School of Dentistry.

"Leaving periodontal disease untreated is a major public health problem," Crout says. "Not only do we see cases where the inflammatory process has eaten down around the bone, ultimately causing tooth loss in many patients, but also, more important, the inflammation likely has traveled throughout the body. A person with periodontitis may be twice as likely to have a heart attack and almost three times more likely to have a stroke."

He added, "If a woman is pregnant, she is four to seven times more likely to have a preterm, low birth-weight baby compared to someone who does not have gum disease."

Unlike gingivitis, an inflammation of the gums that is reversible, periodontitis can create infections below the gum line leading to bone destruction and tooth loss if not treated. Bleeding of the gums can signal gingivitis. But in periodontitis, no pain or symptoms may accompany the infection spreading into the bone.

Eighty-five percent of adults in the study showed signs of bone loss.

The study focusing on rural areas of Appalachia is a WVU-University of Pittsburgh collaboration, yielding a gold mine of dental data. Crout, who is directing the West Virginia portion of the collaboration, is sharing some of the more significant findings at the 94th Annual Meeting of the American Academy of Periodontology in Seattle Sept. 8. (The academy's annual meeting runs Sept. 6 through 9.)

"This is the largest oral health study ever done in Appalachia," Crout says.

In addition to dramatic rates of periodontal disease, discovery of high bacterial counts and the virulence of the disease-causing organisms in the mouth surprised the researchers, Crout says.

"These findings are significant in a state that leads the nation in all those who have lost all their teeth over the age of 65," Crout says. "The national average is 20 percent, but in West Virginia, it's 43 percent."

The West Virginia families in the study live in Webster and Nicholas Counties. The Pennsylvania families are from the towns of Burgettstown and Bradford.

WVU's portion of the National Institutes of Health grant is approximately $3.12 million. WVU researchers have followed the West Virginia families since 2002, studying genetic as well as environmental factors including attitudes, behaviors and beliefs. They are also examining microbial samples.

The study is part of COHRA -- the Center for Oral Health Research in Appalachia. Originally involving only WVU and the University of Pittsburgh, the study has expanded to include the University of Michigan and the University of Iowa.

The researchers say parents and grandparents who have already lost their teeth are likely to transmit attitudes to the next generation. "Too often the attitude is, 'Don't worry, you're going to lose them anyway,'" Crout says.

When Crout travels throughout West Virginia giving presentations to students on the importance of oral health, he sometimes meets schoolchildren who come up after the talk and say, "Hey, Mister, what's this bump?" The child will crook a finger inside his cheek to offer a look, and Crout will observe a large, untreated abscess of the tooth.

A large abscess sometimes means the mouth can't be numbed. So the child's first visit to the dentist may end up being painful. Fear of pain may lead to a lifelong reluctance to visit the dentist.

"We have found that dental fear is highest in the very young. It may be one of the reasons that, by the age of 8, one-third of children have untreated dental decay in West Virginia," Crout says. "One-third of West Virginians under age 35 have lost at least six permanent teeth. Our research has found that more than 25 percent of people would rather have a tooth out than have treatment done that might preserve the tooth. Fear was one of the main factors."

Crout would like the study to lead to interventions such as introducing children to the dentist and the dentist's chair at age 1 or when the first tooth comes in.

"It's likely that at this age, treatment will be more preventive and provide a more positive first dental visit experience. This would go a long way in reducing fear and be very helpful in getting larger numbers of people to go to the dentist," Crout says.

"It is also critically important to get the word out to our people in the state of the importance of oral health. Not only will it keep their teeth, but it will also be very important for good systemic health. Brushing, flossing and routine dental visits have never been more important," Crout says.

Crout's co-authors on the study are Dan McNeil, Ph.D., of WVU, and Robert Weyant, Dr.P.H., and Mary Marazita, Ph.D., of the University of Pittsburgh.