Oral Health and General Health are Inseparable

Oral Health and General Health are Inseparable

Oral health and general well-being are inextricably bound. Many conditions that plague the body are manifested in the mouth, thus enabling to view the onset, progression and management of numerous systemic diseases. The wide array of habitat renders the mouth a microbial paradise, offering preferred accommodations on the cheek, back of the tongue and in the moist, oxygen deprived area between the tooth surface and the adjacent periodontal tissues.

Oral infection can have an adverse effect on other organs of the body. Oral cavity can tell of direct assaults by a broad range of systemic disorders such as Diabetes, AIDS, Sjogren’s syndrome, as well as complications of treatments like Cancer Chemotherapy and Radiation. Several recent studies have demonstrated a relationship between periodontal disease and Infective Endocarditis, Coronary Artery Disease, Stroke, Diabetes and Respiratory Tract diseases. Recent studies investigating the association between periodontal disease and other health problems and advanced medical and dental technology have greatly expanded our understanding of various disease processes. The pregnant women suffering from periodontitis are at a higher risk of pre-term delivery or a low-birth-weight baby or may experience pre-eclampsia. Periodontitis appears to share genetically determined risk factors with several other chronic degenerative diseases such as Ulcerative Colitis, Juvenile Arthritis and Systemic Lupus Erythematosus. Obviously, these health problems are of concern to all health care professionals, including dentists. From the insight provided by these studies and technologies, we now recognize that periodontal, or gum, disease may be a potential risk factor for many health problems

As an investigational diagnostic aid and potential monitor of disease progression, saliva has been used increasingly in systemic disorders that affect salivary composition and gland function, including Alzheimer’s disease, Sjogren’s syndrome, Diabetes, AIDS, Herpes, Ulcerative Colitis, Hepatitis, Wegener Granulomatosis and Psoriasis etc.

4.1 Effect of Oral Conditions on Systemic Health

1. Periodontal Disease Vs Cardiovascular Disease

Several recent studies have demonstrated a relationship between periodontal disease and infective endocarditis, coronary artery disease and stroke. According to one hypothesis, periodontal pathogens could enter the bloodstream, invade the blood vessel walls and ultimately cause atherosclerosis. Another hypothesis is based on several studies that have shown that periodontal infections can be correlated with increased plasma levels of inflammation such as fibrinogen (this creates blood clots), C-reactive protein, or several cytokines (hormone proteins). Researchers have found that the risk of fatal heart disease doubles with severe periodontal disease.

2. Periodontal Disease Vs Diabetes

For years, physicians and dental professionals have known of the two-way relationship between diabetes and periodontal health. People with diabetes are at increased risk of getting periodontal disease. And periodontal disease, in turn, may make diabetes worse. It leads to problems with the control of blood sugar levels, which can increase the risk of complications such as vision problems, nerve damage, kidney disease and cardiovascular disease. Researches show that patients with Type II (adult onset) diabetes are about three times more likely to get periodontal disease than non-diabetics. The disease also is more likely to progress rapidly and to more severe stages in people with diabetes. Conversely, it was found that people with more severe periodontal disease were six times more likely to have poor glycemic control at follow-up than those who had less severe periodontal disease. A recent study found that smoking increases the risk of periodontal disease by nearly ten times in diabetic patients.

3. Periodontal Disease Vs Respiratory Disease

A growing body of research is beginning to show a new risk factor for respiratory tract infection-periodontal disease. Studies have shown that poor oral hygiene and periodontal disease may foster colonization of the oropharyngeal region by respiratory pathogens, particularly in hospital or nursing home patients. If aspirated, these pathogens can cause Pneumonia and Chronic Obstructive Pulmonary Disease (COPD). Recent research suggests that bacteria found in the throat and bacteria found in the mouth can be drawn into the lower respiratory tract, causing infections or worsening existing lung conditions. More research is being conducted to further elucidate the association between periodontal disease and respiratory tract infections.

4. Periodontal Disease Vs Adverse Pregnancy Outcomes

Severe periodontal disease in pregnant women causes a seven-fold increase in the risk of delivering Preterm Low Birth Weight (LBW) babies. Scientists theorize that oral pathogens release toxins that reach the human placenta via the mother’s blood circulation and interfere with fetal growth and development. The oral infection also prompts accelerated production of inflammatory mediators PG E2(Prostaglandin E 2) and TNF α (Tumor Necrosis Factor) that normally build to a threshold level throughout pregnancy, then cue the onset of labor. Instead, the elevated levels of these inflammatory mediators trigger premature delivery.

Another recent study revealed that higher salivary levels of Actinomyces naeslundii Genospecies 2 is associated with low birth weight and Preterm delivery while higher levels of Lactobacillus casei during pregnancy positively affected the birth weight. Periodontitis also increases the risk of pre-eclampsia or pregnancy induced hypertension (PIH) which occurs sometime after 20^th week of gestation. Severe PIH reduces the flow of oxygen and nutrients from the placenta to the fetus and can lead to life threatening organ damage and seizures in pregnant women. Mild PIH can be kept under control until birth, but severe cases may require preterm delivery.

5. Periodontal Disease Vs Obesity

The prevalence of periodontal disease among obese young adults (18-34 yrs) was found to be 76% higher than normal weight individuals in this age group. This association of obesity and periodontal disease in young adults can be explained by their different dietary patterns than older people. Their dietary trend reveals a significant decrease in raw fruit and non-potato vegetables, which are rich source of Vit.C. Also, increased intake of soft drinks and non-citrus juices and reduced calcium intake contributes to the development of periodontal disease in the young adults.

4.2 Effect of Systemic Conditions on Oral Health

1. Osteoporosis Vs Periodontal Disease

Another interesting correlation has been found between Osteoporosis & Rheumatoid Arthritis and Periodontitis. Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue and increased vulnerability to fractures. Thus, there is progression of oral bone loss following menopause, which could lead to tooth loss. A current study suggests that estrogen supplementation in women within five years of menopause may slow the progression of periodontal disease.

2. Rheumatoid Arthritis Vs Periodontal Disease

Periodontal disease and Rheumatoid Arthritis are known to have very similar pathologies. Damage caused by the immune system and chronic inflammation is central to both diseases. According to a study, people who had rheumatoid arthritis were more than twice as likely to have periodontal disease with moderate to severe jaw bone loss than the control subjects.

3. Radiation Therapy Vs Oral Diseases

While head and neck radiation treatment kills cancerous cells, it often destroys vital acinar cells that lie within the radiation field. Patients are unable to produce adequate saliva, leading to problems like xerostomia, mucositis, rampant dental caries, infections of the mouth and pharynx, and difficulty with swallowing, speech and taste. These conditions dramatically reduce quality of life and can also be the source of systemic infections that may threaten patient survival or interfere with their cancer treatment.

It will therefore be important to control the oral microflora for systemic reasons, since increasingly strong links are being established between focal infection of oral origin, much of it periodontal, and a range of systemic diseases. All these developments derive from a greatly improved understanding of the fundamentally ecological nature of the natural microbial biofilm that is dental plaque, and of its interactions with its human host. Thus, we can conclude that oral health science is not only expanding our understanding of craniofacial-oral-dental diseases and disorders, but also is broadening the critical knowledge base of fundamental disease processes.