The Oral Systemic Connection
Over the last few decades the relationship between oral health and general health has become increasingly recognised.
What happens in the mouth can affect our body and what happens in our body can affect our mouth.
The importance of oral hygiene is highlighted when you think about the term ’quality of life’. Quality of life is not merely the absence of disease, it encompasses how we grow, the ability to eat, speak, chew, our appearance, how we socialise, and our self acceptance and esteem. It is widely accepted that the mouth is a mirror of general health status, and it reflects signs of disease, stress, drug use, addictions, habits, dehydration and malnutrition. At present, there is a large body of evidence that demonstrates that the reverse is also true: the disease status of the mouth can also be reflected in other areas of the body. Specifically, the presence of oral disease can negatively impact many systemic diseases, thus making their management more difficult.
Poor oral health has been associated with:
- Cardiovascular disease
- Adverse pregnancy outcomes
- Rheumatoid arthritis
- Respiratory Diseases
It is being encouraged in the public health arena, that to reduce the burden of these types of systemic diseases, improvements in oral health need to be made. The best way to see improvements in oral health is to have a nutritious diet, daily brushing and flossing, and to consult with your dental provider to manage any pre existing oral conditions.
Cardiovascular disease CVD
Oxygen and nutrients are carried to the cells of the body via blood. Blood movement occurs through a complex network of vessels, and is under control of the heart muscle. Cardiovascular diseases are a group of diseases that involve the heart or the blood vessels. The most common types are high blood pressure (hypertension) and a hardening of the arteries caused by fatty build up (atherosclerosis). They can affect the heart by causing changes to the heart muscle and damage to the heart muscle, which may alter how the heart beats, how much blood it can pump out to the rest of the body and how much blood the heart itself receives in order to survive. They can affect the blood vessels by narrowing them, and making the passage of blood through difficult. This can have detrimental effects on the heart itself, and other body organs such as the brain and the kidneys.
How is cardiovascular disease and gum and bone disease associated? Direct Link-
Bacteria in the oral cavity grow in plaque and burrow into the bone around a tooth. At this site they can enter the bloodstream and travel through to the blood vessels of the heart. Here they can attach to already damaged blood vessels, or fatty build up. Their presence can lead to further damage of the heart vessels Indirect Link-
Inflammation of the gums and bone of the jaw can lead to an increase in factors in the bloodstream that are created to try and mediate the inflammation.
- High levels of a substance called C - reactive protein (CRP) are released into the bloodstream as part of the bodies inflammatory response to gum and bone disease. They are also significant risk factors for CVD, as they can cause damage to the lining of the blood vessels of the heart. This risk is intensified if the individual has high levels of bad cholesterol present in the bloodstream.
- When the body fights the bacteria in the mouth, the damaged bacteria cells release proteins, and the body creates antibodies against these proteins to fight of the oral infection. In CVD, when the cells lining the blood vessels are damaged, they also release similar proteins to what the bacteria make. Our own body’s antibodies can’t recognise the difference from its own cells, and the bacterial cells. So it just fights off both. This strongly suggests a role for the immune response linking gum and bone infection and heart disease.
Gum and bone treatment, such as cleaning and deep tarter removal, in addition to optimum oral hygiene, aim to prevent the release of bacteria and mediators into the bloodstream. Studies have shown that the effect of preventative treatment can be associated with improvements in the health of the blood vessels, which are present for up to six months. Subsequently, it is important to be part of a dental hygiene active maintenance program to sustain these health improvements.
The cells in our body need energy to function. This energy is carried to the cells throughout the blood stream in the form of glucose ‘blood sugar’. The hormone insulin allows the blood sugar to enter the cell. Most of this blood sugar comes from our diet, and when it is not needed by the body cells, it is removed from the blood stream and stored in the liver, muscle tissue or as excess fat around the body. Diabetes occurs when there is a problem with the movement of the blood sugar into our body cells. Type 1 diabetes occurs because the body cannot make insulin to facilitate the movement of blood sugars into the cells. Type 2 diabetes occurs when the body cells have developed a resistance to insulin, so although the body can make this hormone, it no longer works on the cells. The result in both cases is blood sugar levels which can become very high. Chronically high blood sugar levels can cause damage to blood vessels, particularly in the eye, heart, kidney, feet.
How is diabetes and gum and bone disease associated?
It is generally accepted that the relationship between diabetes and gum and bone disease is bidirectional. This means that the presence of uncontrolled blood sugar levels in individuals with diabetes can give rise to gum and bone disease, and that the presence of gum and bone disease can also result in poor blood sugar control, which can increase the risk for diabetic complications. Effects of diabetes gum and bone disease-
High sugar level in blood may cause and increased risk for gum and jaw bone disease due to;
Effects of gum and bone disease on diabetes-
- More sugars present in the fluids that bathe the teeth. This change in the environment in the mouth may make it more attractive to bacteria (bacteria LOVE sugar)
- Impaired functioning of white blood cells so they can’t work properly in defending the body against the gum and bone infection
- Comprising the structure of the tissues of the body, making them less stable, aged, and poor at healing (therefore the gum tissue and the bone that supports the teeth will be easier to break down)
The substances that are released by the body in response to the gum and jaw bone infection may make the ability to control health blood sugar levels difficult.
In addition to gum and jawbone disease individuals with poorly controlled diabetes may also experience the following:
- Dry mouth (Xerostomia) - which can increase risk of tooth decay.
- Unexplained Tooth Pain
- Infections and altered wound healing
- Tongue changes
- Fungal infections
- Fruity Breath
High sugar level in blood may cause:
- A narrowing of the blood vessels including those in teeth which can lead to unexplained tooth ache
- A decrease in saliva causing a dry mouth. This can lead to an increase in the plaque and tartar build-up that causes gum disease. It can also increase the risk of decay as there is less saliva available to protect the teeth. ( A dry mouth can also be caused by some common medicines)
- Fungal mouth infections such as thrush. Thrush appears as white (sometimes red) patches in the in the mouth and on the tongue. These patches can get sore and turn into ulcers.
Asthma occurs when the airways constrict and produce excess mucous, making it difficult for an individual to breathe. The condition of asthma alone does not affect gum and jaw bone disease, however the medication that is used in asthma treatment can make gum and bone disease worse. The oral effects of asthma medication include decreased antibodies and amount of fluid present in the saliva. The decreases in the protective mechanisms of the saliva result in increased risks in dental decay, tooth wear, oral thrush and gum and jaw bone disease. It is advocated that individuals with asthma seek regular dental checkups to identify if they are affected by any of these problems and to participate in preventative procedures such as:
- dental hygiene active maintenance
- optimal oral hygiene practices
- fluoride supplements
- pit and fissure sealants
- increase in drinking tap water.
Adverse pregnancy outcomes
Recent research has shown that there is a correlation between gum and jaw bone disease in the mother and preterm, low birth weight infants. Some studies have even suggested that the risk of the preterm low birth weight infant is proportional to the severity of the gum and jaw bone disease.
Bones are comprised of collagen fibers and minerals. The fibers outline the architecture of the bone, and the minerals form the bulk of the bone, giving it its durability and strength, much like how a wooden frame provides the structure for a house, and the brickwork builds up around the frame. Osteoporosis is a disease of the bone. In this disease, minerals are lost from the bone, and subsequently the bone density is reduced. The bones become weaker and are more prone to breaking. Some small studies have shown relationships between osteoporosis and the progression of gum and jaw bone disease. It is hypothesised it may be because the jaw bone is less dense in those with osteoporosis, and may be less resistant to the breakdown that occurs in gum and jaw bone disease.
Rheumatoid arthritis is an inflammatory disorder that can affect many body tissues, but it primarily attacks joints that can bend (hands, feet and spine). The affected joints may be swollen, warm and painful and movement may be restricted. Rheumatoid arthritis and gum and jaw bone disease share many features, and both modify the bodies inflammatory responses. Individuals with advanced Rheumatoid arthritis have been shown to be more likely to experience more severe gum and jaw bone infection.
Dental plaque acts as a reservoir for bacteria to live and thrive within the oral cavity. Individuals who have poor oral hygiene and who reside in aged care facilities, are hospitalised, or have already companied lung function, have an increased risk of inhalation of these germs whilst they breathe. The germs can become lodged in the airways of the lungs. This can result in Chronic Obstructive Pulmonary Disease (COPD) or pneumonia, both of which can be life threatening. Interventions aimed at reducing the load of bacteria present in the mouth, such as dental hygiene cleaning and gum and bone treatment, in addition to good oral hygiene practices and the use of antibacterial gels and rinses, have been shown to reduce the risk of these types of respiratory complications. References: Bartold, P. M., Marshall, R. I., Haynes, D. R.
(2005) Periodontitis and rheumatoid Arthritis: A review. Journal of Periodontology,
76: 2066-2074. Cullinan, M. P., Ford, P. J., Seymour, G.J.
(2009) Periodontal Disease and Systemic Health, Australian Dental Journal,
54: 62-69 Kapellas, K., Slade, G.
(2008) The relationship between diabetes and oral health among Australian adults, Australian Dental Journal,
53: 93-96 Krejci, C. B., Bissada, N. F.
(2002) Women’s Health Issues and their relationship to periodontitis, Journal of the American Dental Association,
133: 323- 329 Thomas, M. S., Parolia, A., Kundabala, M., Vikram, M.
(2012) Asthma and Oral Health: A Review. Australian Dental Journal,