Newsletters for MDs

Your Mouth as Contributor to Systemic Disease

Oral infections such as dental caries and periodontal disease are the most common chronic diseases in the world. The health of the oral tissues is a good indicator of the health of the individual. Often systemic or hormonal disorders first show themselves in the oral cavity. but recently epidemiological studies are showing evidence that there is probably an effect on several systemic diseases by these chronic oral infections.

As early as the seventh century B.C. the effect of oral health on the rest of the body, was proposed by the Assyrians. Again in the 18th Century Dr. Rush suggested that arthritis could be relieved in certain people by the removal of infected teeth. This led to the concept of ‘focal infection’, a belief that a small local infection could be the causative agent in systemic disease, and elimination of the infection would cure the disease. This theory resulted in many people having their teeth removed, with little to no systemic effect noted.

In 1989 an investigation, in Finland, associated dental infections with acute cerebral and myocardial infarctions. In these times of heightened cardiac awareness there are well known risk factors (smoking, weight, exercise, cholesterol levels etc.) which relate to increased incidences of stroke and heart attack. If dental disease, particularly periodontal disease, as suggested by this study can significantly increase the chances of heart attack or stroke, then it is one of the easiest risk factors to control.

There are two general areas in which dental disease affects one systemically. First, tooth loss, through loss of chewing efficiency, is related to dietary changes which lead to increased risk of systemic disease. In addition the bacteria and bacterial byproducts may have a direct action in raising risk factors for several diseases.

Coronary Artery Disease occurs when the walls of the heart blood vessels thicken due to a build up of fatty proteins. Often blood clots form in these narrowed vessels resulting in angina or myocardial infarction. The byproducts of the bacteria found in oral disease, as well as the bacteria themselves, are associated with both the formation of the plaque on the vessel walls and blood clot formation.

It may be that the inflammatory response characteristic of periodontal disease, marked by high levels of inflammatory mediators, exacerbates the process of atherogenesis (arterial plaque formation). Another mechanism involves oral bacteria (S. sanguis and P. gingivalis) which induce the aggregation of platelets and thereby may be involved in the clot formation often related to infarction. Combined with other risk factors such as age, smoking, diabetes, hypertension, and elevated blood cholesterol, it seems quite likely that oral disease is a significant factor in coronary artery disease.

In a new study tooth loss has been associated with an increased risk of systemic disease, including cardiovascular disease, cancer, and diabetes. This is due to changes in diet with less fiber and carotene, fewer vegetables, and increased saturated fat and cholesterol being consumed. People with less than 25 teeth were shown to have a 13% change in the proportions of these foods eaten.

The risk factors for stroke are similar to those for coronary artery disease. Therefore reduction of dental disease and maintenance of one’s chewing potential would seem to be an important part of risk reduction for stroke as well as cardiac disease. Research is ongoing to see if antibiotic therapy will have an effect on the risk of either of these diseases.

Bacterial endocarditis is characterized by inflammation of the interior lining of the heart and the heart valves, generally caused by bacterial infection. Injury to the gum tissues can allow bacteria to enter the blood stream. Accumulation of these bacteria on the heart valves can lead to this serious life threatening disease. Prosthetic devices (joints etc.) may also be colonized in this manner. Antibiotic therapy is indicated preventatively for these disorders.

Other diseases that may be affected by dental bacteria: Diabetes, Respiratory Disease, Low Birth Weight Preterm Infants, as well as behavioral and psychological changes due to perception of self. For now, watch your diet, exercise, practice good oral hygiene, and get regular checkups.

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