Dental Health is Part of Your Overall Health
There is a strong association between dental disease and overall systemic health. After all, the mouth is part of the body made up of nerves, skin, blood vessels, and cells—the same as the rest of our bodies. There is an old adage, “Healthy mouth means a healthy body.” That’s not far from the truth because it is not uncommon for dentists to catch systemic diseases before medical doctors do.
Medical and dental journals are replete with articles correlating gum disease (periodontitis) and heart disease, stroke, premature births, low birth weights of infants, diabetes, some kinds of cancer, and depression. Many systemic problems like candidiasis, lichen planus, and some allergic reactions often present in the mouth before anywhere else. Dental disease itself can make people more prone to other systemic problems.
For example, I once had a patient whose life was on the line because he was rejecting a liver transplant. The patient presented to me with “a little toothache.” A thorough exam revealed not one but multiple dental abscesses. Once those were managed, the patient’s health miraculously recovered. We just celebrated 20 years of that organ transplant together!
Everyone—including denture wearers—should have regular dental exams might, which should involve an evaluation of current dental x-rays that clearly show each tooth from top to bottom, a gum disease assessment, and an oral soft tissue examination. It is also important to seek dental clearance prior to being placed on certain medications. For example, some medications used to treat cancer pain and osteoporosis may pose risks for future dental treatments like extractions or periodontal surgery. Ideally, these procedures should be done prior to beginning these medications.
Dentists are actually doctors of dental surgery or doctors of medical dentistry, this is what the designations DDS or DMD mean. We are trained to evaluate the mouth as part of the body—not just to fix cavities in teeth. In fact, medical doctors and dentists often have to work together to make sure our patients receive the best care possible. This is why we routinely ask our patients about their medical history and the name of their doctors.
More on the Oral-Systemic Connection
What Is the Oral-Systemic Link?
It’s frequently said that the mouth is the gateway to the body. More and more, medical professionals have been discovering just how true this really is. This is referred to as the oral-systemic link or oral-systemic connection.
Dentists are often the first to detect conditions such as Crohn’s disease, diabetes, or cancer because the early symptoms may first show up in the mouth. Going in the other direction, we’re learning more and more how what happens in your mouth affects the health of the rest of your body.
The brain has the blood-brain barrier which protects it from toxins in the blood. In our mouths, there is a barrier between our gums and teeth and the rest of our body as well. In the case of periodontal disease, this barrier can break down and may cause disease or other problems in the rest of the body. Previously, it was thought that bacteria were the main factor in this, but more recent research has been indicating that inflammation may play a bigger role.
While the details of this connection between oral health and the health of the rest of the body is still being explored, it’s becoming increasingly clear that treating the inflammation of periodontal disease can help with the treatment of other inflammatory conditions (and, in some cases, vice versa).
Diseases with oral connections
Some conditions with strong connections to oral health include:
Diabetes – Gum disease can make diabetes harder to control, and diabetes can exacerbate gum disease. We explore the topic in more detail below.
Heart disease and stroke – Conditions causing chronic inflammation, such as periodontal disease, have connections to the likelihood of heart disease and stroke. Below, you can read more about this topic.
Respiratory disease – The bacteria that grow in the mouth can find its way into the lungs as well. Respiratory diseases, such as pneumonia, can be caused by the same bacteria responsible for periodontal disease.
Cancer – According to the American Academy of Periodontology, those with periodontal disease were more likely to develop cancer than those without:
- 54% more likely to develop pancreatic cancer
- 49% more likely to develop kidney cancer
- 30% more likely to develop blood cancers
Other diseases that may be caused or complicated by oral infections include:
- Breast cancer
- Prostate cancer
- Weight gain
- Alzheimer’s and dementia
- Low birth weight and premature birth
- Rheumatoid arthritis
Some diseases can influence your oral health, as well, such as osteoporosis. Osteoporosis can lead to bone loss in the jaw which, in turn, can result in tooth loss, as there is no longer sufficient bone to support the teeth.
It’s critical to understand how important oral health truly is to our wellbeing, and to take it seriously in order to help prevent, or reduce the effects of other conditions.
Below, we’ll look at some of these conditions in a little more detail.
The health of your mouth and the rest of your body are linked, and there’s an especially strong connection when it comes to diabetes and periodontal disease. For those who are suffering from diabetes, gum disease is often more likely and cases can be more severe.
How is diabetes linked to gum disease?
Diabetes is a disease that occurs when the amount of glucose, or blood sugar, in the body is too high. A hormone known as insulin is responsible for helping the cells in your body to use this glucose for energy. For those with diabetes, the body doesn’t produce enough insulin, so too much glucose stays in the bloodstream.
Inflammation in the mouth, such as the type responsible for periodontal disease, have an impact on the body’s ability to regulate blood sugar levels as well. This means that people with diabetes, whose bodies are already struggling with processing sugar, can find themselves having an even harder time if they are suffering from gum disease.
This link can go both ways, too, as high blood sugar levels provide an environment that can make gum infections more likely.
Heart Disease & Stroke
Heart Disease & Stroke
The potential links between periodontal disease and heart disease and stroke have been the subject of medical research in recent years. While a clear cause-and-effect relationship has yet to be established, findings lend a lot of credibility to the connection between oral inflammation and cardiovascular disease.
Researchers have found that chronic inflammation in the body is a major contributor to health problems in the body. This means that long-term inflammation, such as that in gum disease, may lead to narrowing or blockages in blood vessels—a situation that can lead to a heart attack or stroke.
In an article that looked at a number of related studies, it was found that having periodontal disease increases a person’s risk of cardiovascular disease by around 20%. One stroke expert reported that periodontal disease could make a person almost twice as likely to experience a stroke.
While research is still ongoing, what’s already been discovered should only put more emphasis on the need for a healthy mouth and gums.
If you have any concerns about the health of your mouth, or if you haven’t had a dental appointment in a while, make sure to get in touch to schedule your next visit.
Studies performed at Brown University, Harvard, New York University, and others have looked into the link between gum disease and pancreatic cancer. Pancreatic cancer is extremely hard to detect and causes death within six months of diagnosis. It is approximated that pancreatic cancer is responsible for nearly 40,000 deaths per year in the US. So, what is the connection between gum disease and pancreatic cancer?
The connection comes from changes in the microbial mix in your mouth. Those who have porphyromonas gingivalis in their mouth were at a 59% higher risk of developing pancreatic cancer. In addition to prophyromonas gingivalis, those who had aggregatibacter actinomycetemcomitans were one 50% more likely to develop pancreatic cancer.
While the names may not mean much to the average person, the important thing to understand is that both of these types of bacteria have been tied to gum disease.
Unfortunately, the majority of Americans do not take proper care of their gums. It is reported that nearly half of American adults over the age of 30 have some form of periodontal disease. If you look at Americans over the age of 65, the percentage suffering from periodontal disease increases to 65%. Although not nearly as talked about, gum disease is almost 2.5 times more common than diabetes.
However, there is some good news! Gum disease responds extremely well to treatment and can easily be reversed after detected by your dentist.
A study done by the Federal University of Santa Maria Dental School in Brazil found that women with periodontitis are 2-3x more likely to develop breast cancer. In this instance, the researchers believe that breast cancer may be triggered due to systemic inflammation resulting from gum disease.
The study was based on 67 women who have been diagnosed with breast cancer and 134 controls from 2013 to 2015. It is important to remember that this study has not proven that gum disease causes breast cancer, but the findings do provide further support for the idea that oral health is vital to our overall wellbeing.
In the United States, for every 100,000 women, there are 124.9 new cases of breast cancer. Breast cancer continues to be studied, and this possible connection to oral health provides another avenue to be explored when learning to treat this type of cancer.
A 10-year study performed by NYU Langone Health’s Perlmutter Cancer Center has found that two types of bacteria that are present in individuals with gum disease can increase the chances of being affected by esophageal cancer.
The eighth most common type of cancer in the world, esophageal cancer can be highly fatal and is the sixth most common cause of cancer-related deaths. In the US, it affects around 1 in 125 men and 1 in 417 women. The American Cancer Society says that currently, only around 20% of those diagnosed with this form of cancer will live for more than five years following diagnosis.
The study by NYU Langone found that bacteria associated with periodontal (gum) disease can find their way into the upper digestive tract, and in the case of one of the types of bacteria in the study, tannerella forsythia, its presence may increase the chances of this kind of cancer by 21%.
It is important to note that while the bacteria involved demonstrates a link between gum disease and esophageal cancer, it has not yet been proven that periodontal disease directly causes the cancer. However, the connection should be reason enough to reinforce the importance of proper oral hygiene and treatment of gum disease.
Gum disease provides a way for oral bacteria to find their way to other parts of the body. According to research done by Virginia tech, this bacteria may facilitate the spread of colon cancer and other types of cancer to other parts of the body.
The bacteria of interest in the study was Fusobacterium nucleatum, which is common in the mouth and has been found to invade tumors in the colon. Daniel Slade, Ph.D., an assistant professor in the Virginia Tech Department of Biochemistry explains the importance of the discovery that this type of bacteria may responsible for the spread of cancer in the body: “This is vital information because 90% of cancer-related deaths result from nonprimary tumors or sites that have metastasized to somewhere else in the body.”
In a 2017 study performed on mice, researchers found their first evidence that F nucleatum could be directly responsible for causing cancer in the colon to spread to the liver.
The research team has made examining the role this bacteria plays in the spread of cancer a focus on their treatment. Understanding the process by which this works can help medical experts find a way to inhibit the spread of cancer from one organ to another.
The team’s latest study, “Fusobacterium Nucleatum Host-Cell Binding and Invasion Induces IL-8 and CXCL1 Secretion That Drives Colorectal Cancer Cell Migration” was published in Science Signaling.
While promising for future research into the treatment of cancer, these findings also further highlight the importance of treating gum disease, in order to minimize the presence of oral bacteria in the rest of the body.
A November 2020 study found more evidence of connections between rheumatoid arthritis and periodontal (gum) disease.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis is a chronic inflammatory and autoimmune disease, which causes the immune system to mistakenly attack healthy cells of the body. It results in painful swelling of the affected tissues. While RA primarily affects the joints of the body, it can also damage the skin, lungs, heart, blood vessels, and eyes.
How Is Rheumatoid Arthritis Connected to Gum Disease?
Although there’s still more to learn about whether or not one condition could be a cause of the other, past studies have found that people with RA are 8 times more likely to develop gum disease than those without RA. It’s also been found that the type of bacteria that causes periodontal disease, porphyromonas gingivalis, can lead to an earlier onset of RA and make it more severe.
Connections With Cardiovascular Disease
People with rheumatoid arthritis also face elevated risks for cardiovascular disease, which itself has links to periodontal disease.
The November 2020 study in Arthritis & Rheumatology found that a pathogen related to periodontal disease, called aggregatibacter actinomycetemcomitans, “had the strongest associations with atherosclerosis in the patients with rheumatoid arthritis that we studied,” according to Jon T. Giles, MD, MPH, of Columbia University.
While research into the connections between periodontal disease and other diseases continues, this should further reinforce the importance of a healthy mouth. Preventing or treating gum disease may very well prevent or lessen the impact of ailments such as rheumatoid arthritis.
It can’t be overstated how much the health of the body is connected to oral health. Research has found that gum health is even linked to sexual and reproductive health.
The plaque that develops as a biofilm in our mouths is made up of bacteria, including these:
- Porphyromonas gingivalis
- Tannerela forsynthia
- Prevotella intermedia
- Aggregatibacter actinimucentemcomitans
- Treponema denticola
Periodontal disease allows these pathogens, which originate in the mouth, to be introduced into the bloodstream. The presence of some of these types of bacteria in the bloodstream is where many of the links between oral health of various other ailments have been discovered. And it isn’t just the bacteria itself, but the resulting inflammatory response and waste products of the bacteria that can cause problems.
Pregnancy and Oral Health
In the case of pregnancy, it’s believed that these pathogens can cause negative outcomes such as low birth weight or premature birth. A few studies have suggested that women suffering from chronic periodontitis may be 4 to 7 times more likely to give birth prematurely.
Women who become pregnant should be aware that hormonal changes make them more susceptible to getting gum disease as well. Gum disease has been linked with preeclampsia, a condition that can damage internal organs such as the kidneys and liver of both the baby and the mother.
Fertility and Periodontal Disease
Along with the impacts on pregnancy, studies have found that gum disease can play a role in fertility, with both male and female fertility being impacted.
One study in Australia found that women with periodontal disease may require two more months to conceive than those without. In men, the bacteria related to gum disease lead to low sperm count, and poor sperm mobility. There appears to be a connection with erectile dysfunction as well, with men who have gum disease being more likely to suffer from ED.
According to the National Institutes of Aging, the bacteria responsible for periodontal disease are also associated with the development of dementia (particularly vascular dementia) and Alzheimer’s disease.
We frequently emphasize the importance of oral health and treatment of periodontal/gum disease, as this infection of the tissues surrounding the gums allows bacteria from the mouth to enter the bloodstream and affect other parts of the body.
Using data from the National Health and Nutrition Examination Survey along with blood tests, the National Institutes of Aging researchers looked at a group of more than 6,000 people to find if the oral bacteria in gum disease could be linked with diagnoses of dementia.
They looked for nineteen different types of oral bacteria, including Porphyromonas gingivalis, which is the most typical type of bacteria found in gum disease. In those who are afflicted by Alzheimer’s, it’s been found that beta-amyloid proteins can clump together to form plaques. A previous study has suggested that these plaques may actually be produced in the body as a response to Porphyromonas gingivalis.
One of the findings was that older adults with gum disease at the start of the study were more likely to develop Alzheimer’s during the course of the study than those who did not have signs of gum infections.
While it appears to be clear that there are connections between dementia and the bacteria found in periodontal disease, researchers are looking into more long-term studies to learn more about this association. The current findings suggest that gum disease may precede cases of dementia, but it’s also known that dementia makes it harder for patients to properly care for their teeth and gums. Further research needs to be done into whether or not treatment of infections of gingivalis can have an impact on Alzheimer’s disease.
Respiratory disease can also be referred to as pulmonary disease or lung disorder. These are conditions that affect the lungs and have an impact on breathing. Some forms of respiratory disease may be caused by air pollution or tobacco smoking, while others are the result of infection.
How is respiratory disease connected with gum disease?
We normally think of periodontal disease as a localized infection of the gums and connective tissues in the mouth, but researchers are finding more evidence to link it to respiratory diseases, either playing a possible role in the contraction of the illness or in increasing its severity.
Respiratory diseases with links to periodontal disease include:
- Chronic obstructive pulmonary disease (COPD)
Gum disease and pneumonia
Pneumonia is a type of inflammation of the lungs caused by infection by bacteria, viruses, or fungus, though bacterial infections are the most common. The disease results from these infections making it to the lower part of the airway.
In healthy people, the body has defense mechanisms that prevent bacteria from the mouth from being able to reach places far into the lungs, but there are instances where this can be impaired, such as malnutrition, diabetes, or smoking.
In an examination of patients with pneumonia undergoing care in an ICU, it was found that patients who had dental plaque upon their admission to the ICU, or within the first five days of their stay, were 10 times as likely to develop pneumonia as those who were plaque-free.
In a two-year study of nursing home patients, one group was given routine toothbrushing by a caregiver as well as weekly professional care for plaque and tartar. At the end of the study, it was found that the group receiving oral care had fewer cases of pneumonia (11% vs 19%) and lower instances of pneumonia-related mortality (8% vs 16%).
What is Osteoporosis?
Osteoporosis is a disease of the bones involving the reduction of bone mineral density and mass. These changes in bones can cause them to become more fragile and put them at greater risk of breaks or fractures.
Considered a “silent” illness because of the subtlety of, or lack of, any noticeable symptoms, many people who suffer from osteoporosis are not even aware that they have it until they break a bone. However, osteoporosis is the leading cause of bone fractures in older men and women.
How Is Osteoporosis Related to Oral Health?
When considering osteoporosis in the context of oral health, the potential connection to periodontal disease is that one that interests researchers. Periodontal disease, or gum disease, if left unchecked, can lead to the loss of the bone and connective tissues that hold teeth in place. Since both diseases can have an impact on bone, the interaction between the two is something that needs to be better understood.
Research is currently inconclusive when it comes to whether or not having osteoporosis can lead to an increase in the chances of developing gum disease, however, for those who are suffering from gum disease and osteoporosis, data indicates that there is a higher chance of seeing deterioration in the alveolar bone which hold teeth in place.
For this reason, it is a good idea to let your dentist know if you have osteoporosis, especially if you are currently being treated for, or at risk of developing gum disease, as the condition may cause periodontal disease to progress more quickly.
What Are the Symptoms of Osteoporosis?
In the US, it’s estimated that about 54 million people have osteoporosis. Bone mineral density tests ordered by your healthcare provider are the typical way that the disease is diagnosed. There aren’t any overt symptoms to look for, which is why, for many, bone fractures are the most obvious indicator, however, some things to watch out for include:
- Reduction in height
- Change in posture
- Reduction in lung capacity
- Pain in the lower back
How Can Osteoporosis Be Avoided?
Recommended steps to take to lower your chances of developing osteoporosis include:
- Getting regular exercise
- Eating a healthy diet rich in vitamin D and calcium
- Avoiding smoking
- Avoiding excessive alcohol use