Oral Hygiene and Overall Health

​This month I would like to address a topic we may not always discuss: oral health and its relationship to systemic health. It has been 40 years since a relationship was observed between atherosclerosis and alveolar bone loss (in the tooth sockets). At the time, little was known about the nature of the relationship, but now this is an area of increasing interest among researchers and clinicians. Let’s take a closer look.
 
Systemic conditions associated with poor oral health include diabetes, cardiovascular disease, bacteremia/endocarditis, pneumonia, gastritis, rheumatic arthritis, cancer, liver and kidney disease and dementia. A person with poor oral health may exhibit tooth loss, gingivitis (swollen bleeding gums), halitosis (bad breath) and periodontitis (bone loss in the tooth socket). Beyond a lack of oral hygiene, culprits contributing to poor oral health include genetic factors, xerostomia (dry mouth), bruxism (jaw clenching), diet (excessive sugar consumption), gut dysbiosis and smoking.
 
What is the mechanism by which the relationship between oral hygiene and systemic health exists?
 
In general, inflammation that is allowed to fester (advances from acute to chronic) doesn’t remain contained, regardless of where it occurs. Meaning the oral inflammatory mediators and pathogenic bacteria can spread beyond the damaged periodontium to damage other organs and systems.
 
In addition, the same inflammatory burden and bacteria may be absorbed extra-orally via inhalation or ingestion. This is the case when bacteria associated with gingivitis or periodontitis is aspirated leading to pneumonia, a common nosocomial infection (hospital acquired). If ingested, it may lead to endocarditis or gastritis. In some cases, specific oral bacteria have been linked to specific diseases, such as atherosclerosis. With diabetes, a bi-directional relationship exists. Periodontal disease is a complication of poorly managed blood sugar and acute inflammation (such as that in gingivitis and periodontitis) reduces the uptake of glucose and reduces the efficiency of insulin. Thus, diabetes can cause periodontal disease and periodontal disease can exacerbate diabetes.
 
A final consideration is the relationship between the gut microbiome (GMB) and overall health. Dysbiosis (an imbalance in the gut flora) in the GMB is a culprit in numerous conditions and disease states, because the digestive system initiates with the oral cavity.
 
There is much we are still learning about the relationship between oral health and systemic conditions/diseases. We do know that maintaining oral health includes:
 

• Daily brushing and flossing. A soft brush is your go-to on this one. A hard toothbrush is not a friend to your gums and enamel. Add a water pick if you have the counterspace for it.
• Tongue scraping
• Replacing your toothbrush every three months or if you have been sick
• Visiting your dental hygienist at least twice a year, more often if indicated or recommended
• Replacing missing teeth or broken filings
• Addressing bruxism either with a mouthguard created by your dentist or by injecting Botox into the masseter muscles
• Identifying xerostomia, which is a common side effect of many medications
• Quitting smoking if you are a smoker

 
It has been said that the oral cavity is the mirror reflection to one’s overall health. If you have concerns, please schedule a visit with me for a discussion. I am happy to collaborate with you and your dental team to shine that mirror.