The association between oral health and systemic disease has been established for some time. Medical research has pointed to a link between health conditions such as diabetes and cardiovascular disease and periodontal disease. What’s still debatable though is how oral bacteria can have such an impact on the oral cavity that it could lead to health conditions in other parts of the body.
David Ojcius is the assistant dean of research and the chair of the Biomedical Sciences department at the University of the Pacific. Based in San Francisco, California, he specializes in medical research in immunology, microbiology, oral health, and cell biology. He has been part of numerous medical research projects and has been published in several medical journals.
Oral Health
The mouth is an important part of the body that interacts with the environment in many ways. It’s not just that we use our mouths to communicate with others, explains David Ojcius, but eating, drinking, and the early stages of food digestion all take place in the oral cavity. It’s no wonder then that oral health and systemic disease are closely intertwined.
With so many different functions that involve food and drink and different surfaces in the mouth each with its own unique set of microbes, oral hygiene is not only important for the individual’s health but the makeup of these microbes. This applies to dental health as well. A combination of saliva and some good bacteria create a biofilm that protects the teeth from dietary acids. Most of these good bacteria attach themselves to the surface of the teeth thus preventing more pathological organisms from damaging the teeth.
Poor oral hygiene can interfere with this balanced ecosystem in favor of bacterial species that could lead to dental demineralization. This opens the door for diseases such as periodontitis and gingivitis. Both are chronic immune-inflammatory diseases that vary in symptoms, with gingivitis being the milder of the two. While gingivitis is mostly painless and easy to treat, periodontitis can lead to tooth loss.
Atherosclerotic Disease and Oral Cavity
Atherosclerosis occurs when cholesterol and cholesterol products are deposited on the walls of arteries, causing these blood vessels to become narrow. This leads to cerebrovascular and cardiovascular diseases. A common factor among many of the people suffering from these diseases is that they have poor oral hygiene, notes David Ojcius. But that’s not all. Some studies have shown a link between chronic inflammation and vascular injury and periodontal diseases. That association hasn’t been fully established, however. Other studies have failed to find conclusive evidence supporting this hypothesis.
That said, gingival inflammation is known to stimulate a persistent inflammatory response felt systemically if left untreated. This in turn, with all the implications it entails, not only contributes to the initiation of atherogenesis but also makes the patient susceptible to vascular injuries.
Oral Pathogens and Pulmonary Disease
Pneumonia, emphysema, and chronic bronchitis are all pulmonary diseases that involve the movement of pathogens to the lower respiratory tract. This movement is called aspiration and it happens even among healthy people who have no swallowing disorders whatsoever, notes David Ojcius. But where do those pathogens come from?
They exist in varying degrees in the oral cavity, living on the biofilm on the teeth, over the tongue, and other oral surfaces. In the presence of periodontal disease, the mouth becomes a fertile ground for some of these pathogens to multiply. It’s easy to see how patients who use ventilators would benefit greatly from good oral hygiene. It limits the number of pathogens in their oral cavity. This in effect can dramatically improve their overall health and prevent pulmonary infections or complications.
David Ojcius on Diabetes and Periodontitis
The relationship between diabetes and periodontitis is complicated at best. David Ojcius acknowledges that patients with type 2 diabetes have a higher risk of oral health issues. At the same time, periodontitis impacts the body’s control of glucose levels in the blood which could contribute to hyperglycemia. It’s like a vicious circle where one disease increases the likelihood of the other.
Recent research found that people with diabetes have a higher risk of developing severe gingivitis compared to those without diabetes. It’s not uncommon for gingival pockets 4 mm deep to appear among diabetics. Meanwhile, people who develop 2 mm pockets are at a higher risk of having diabetes. The connection between the two diseases has been traced back to the prolonged impact of hyperglycemia on the body. Loss of connective tissue, a common symptom of periodontitis, as well as local inflammation is a direct result of that impact.
Impact on Pregnancy
During pregnancy, the woman’s body undergoes many changes. Some of these changes are closely related to and take place in the oral cavity itself. Gastric acid production not only increases during pregnancy but this corrosive substance finds its way into the pregnant woman’s mouth at higher levels than normal. This is called acid reflux and it has a devastating effect on the enamel and could increase the likelihood of tooth loss in severe cases.
This, in turn, could have a negative impact on pregnancy. There’s increasing evidence that poor oral health of an expectant mother could lead to low birth weight or stillbirth. While more research is needed, recent studies have found a correlation between the changes in estrogen and gum health between the second and eighth months of pregnancy.
More Conditions
The jaw is another part of the mouth that is sensitive to other changes in the body’s overall health. People who suffer from osteoporosis would have more gingival pockets on average due to the lower bone density of their jawbones, says David Ojcius.
Oral health has been linked to systemic diseases in patients who suffer from diabetes, pulmonary disease, as well as pregnant women. Improving oral health could have a direct impact on the general health of the individual and prevent other diseases as well.
