The link between systemic disease and oral health

There is an old saying that a good smile “warms hearts and opens doors”. It’s one of the first things people notice about you and is extremely important when trying to make a great first impression during a job interview, making new friends or even meeting a new partner.

Having teeth that are decayed, discoloured, crooked or missing, may affect your self-confidence to a great degree and prevent you from reaching all of your goals.

Good dental health does however go beyond just the way you look as it can also be an indication of your overall health (systemic health).

Our mouths are full of plaque, bacteria and biofilms. Disease causing organisms originating from the oral cavity can disseminate to distant sites in the body through the circulatory system resulting in a bacteremia (bacteria in the blood). This is especially common in people who are immunocompromised such as people suffering from diabetes, rheumatoid arthritis, cancer and HIV. Furthermore, large amounts of plaque and bacteria in the oral cavity results in inflammation which in turn causes a host response to deal with the infection. Inflammation can contribute to a number of systemic diseases.

Diabetes

Diabetic patients generally have an increased susceptibility to many types of infections as the high blood sugar levels can weaken the patients’ immune system defences. High blood sugar levels also provide an ideal environment for bacterial growth resulting in periodontal disease. Many studies have shown a positive relationship between poor control of blood sugar levels and an increased incidence of periodontal disease. Periodontal disease has been listed as the sixth most common complication of diabetes. Diabetic patients may also present with a dry, burning mouth, abnormal wound healing, multiple dental cavities, increased viscosity of the saliva, gingivitis and periodontitis.

Cardiovascular disease

The body contains 40 billion blood vessels, which makes it simple for harmful inflammatory by-products to remain anywhere inside arteries feeding the heart and brain. An under-lying inflammatory response, such as that caused by large amounts of plaque in the oral cavity, may place an individual at high risk for both periodontal disease and atherosclerosis. Cardiovascular disease is characterised by the build-up of inflammatory plaques that may cause thromboses and myocardial infarction (heart attack). Atherosclerosis is the term used for the thickening and hardening of the arteries that is caused by this plaque build-up. Furthermore, bacteria and viruses from the oral cavity may directly infect these atherosclerotic lesions contributing to a greater inflammatory process. C-Reactive protein increases clotting and is a marker for heart disease. It is thought that C-Reactive protein production is increased in response to oral inflammation.

Respiratory infections

The oral cavity is a reservoir of bacteria for lower airway infections. Bacteria from the mouth can cause a biofilm on various respiratory pathways causing a build-up of oral bacteria in the respiratory tract. Oral bacteria can also be ingested or inhaled by a patient and links have been found between the presence of tooth-decay causing bacteria and aspiration pneumonia. People who have a great risk for this type of respiratory infection are usually those who are unable to perform self-oral care.

Preterm low-birth weight babies

Evidence exists to show there is an association between the presence of periodontitis and preterm labour as well as low birth weight infants. However, the exact nature of the association is still unclear. It is thought that inflammatory molecules from the mouth can get into the circulatory system. These molecules can reach the foetal membranes and cause preterm delivery. This theory is supported as oral bacteria has been found in foetal membranes.

Since periodontal disease is a significant risk factor for the above-mentioned systemic conditions then failure to address poor oral health will increase the risk of patients developing such conditions.

Oral disease may be prevented by following some simple steps:

•  Brush your teeth regularly.
•  Floss daily.
•  Regular dental visits.
•  Maintain a healthy diet. It is important to eat plenty of dairy and other calcium rich foods such as sardines and dark leafy greens. Calcium is important for the development and maintenance of strong bones and teeth. Eat foods that are rich in vitamin C which is needed for healthy gums. Be sure to stay away from foods that are rich in sugars as these foods will result in the formation of dental cavities.
•  Avoid smoking.
•  Information courtesy of Dr Thanusha Pillay, Aspen Dental Centre.