Patients often view dental visits as being beneficial only for their oral health. However, going to the dentist and maintaining a proper at-home oral hygiene routine can benefit more than just their oral health. Dentists can not only treat patients and help them achieve oral health goals but also improve systemic health outcomes. There is a clear link between the presence of oral bacteria and systemic diseases in different parts of the body. Some of the most well-known of those “systemic” links, of course, are the connections between oral health and serious complications with conditions like diabetes, heart disease, and several different cancers of the body, including oral cancers.
Today’s dental professionals can proactively identify and manage complications with many of these common diseases with practical, effective dental treatment plans that improve patients’ dental health and positively influence overall health outcomes.
The Oral-Systemic Relationship
In 2000, the Surgeon General issued a report on the status of oral health in the US, recognizing an association between periodontal diseases and cardiovascular health, stroke, diabetes, and adverse pregnancy outcomes, calling for more research to determine whether causation may be established. The Surgeon General’s report of 2000 was updated in 2021, echoing the original statement while stressing the social and behavioral inequities that limit access to care. The report provides a call to action, urging policymakers, healthcare professionals, and the community to “work together to provide integrated oral, medical, and behavioral health care” while addressing “social, economic, or other systemic inequities that affect oral health behaviors and access to care.” But what’s at the core of the oral-systemic relationship, and how can dental professionals proactively manage oral concerns?
Inflammation in the Oral Cavity
When it comes to oral health today, several pieces of research have demonstrated that chronic inflammation in the oral cavity can directly and significantly affect immune response. For example, many inflammatory and autoimmune diseases have demonstrated the ability to develop in the oral mucosa, such as periodontitis, Sjögren’s syndrome, and OLP. Periodontitis, in particular, is initiated by the accumulation of bacterial plaque, subsequent tissue damage, and bone loss due to host immune responses and inappropriate inflammation.
Periodontal disease is one of the most prevalent health problems in the United States, with an estimated 47% of adults aged 30 or older and 70% of those 65 and older being affected by some form of the disease. The oral cavity, when poorly maintained, serves as a reservoir of pathogenic bacteria that quickly enter the bloodstream and affect distant-site or systemic pathologies.
Common Oral-Systemic Conditions
One common condition linked to the oral cavity is heart disease. Patients with chronic oral conditions such as gingivitis or advanced periodontal disease have a higher risk for heart disease caused by poor oral health, particularly if it remains undiagnosed and unmanaged. The bacteria that infect the gums and cause gingivitis and periodontitis also travel to blood vessels elsewhere in the body, where they cause blood vessel inflammation and damage; tiny blood clots, heart attack, and stroke may follow. Studies have shown that people with periodontal disease have a 25% increased risk of developing cardiovascular disease, and nearly 85% of individuals with cardiovascular disease also have periodontal disease.
Anxiety, Depression, and Mental Health
Mental health affects the entirety of the human body, including its oral health. Patients with anxiety and depression may engage in behaviors that lead to poor nutrition (consuming sugary foods or beverages), low energy, and tobacco, alcohol, or drug use. Those who face mental health challenges are more prone to oral health conditions, including periodontitis, among other teeth and gum problems. Research has found that individuals diagnosed with depression are more likely to report fair/poor oral condition and oral aches when compared to those with no depression.
Nearly 1 in 10 Americans, or 37.3 million, have diabetes. People with diabetes have a higher chance of having periodontal (gum) disease, an infection of the gum and bone that hold the teeth in place. Periodontal disease can lead to pain, bad breath that doesn’t go away, chewing difficulties, and even tooth loss. 1 in 5 cases of total tooth loss is directly linked to diabetes. Diabetes raises glucose levels in the body, and numerous dental problems can arise as a result, as those added sugars promote bacteria growth, infection, and bad breath (halitosis). The relationship between diabetes and oral disease is bi-directional, meaning that if an individual can gain control of one factor, the other is typically easier to control.
According to the National Institute of Dental and Craniofacial Research, more than one-third of all cancer patients develop complications that affect the mouth. Cancer and some treatments, including chemotherapy, can weaken the body’s immune system. Pain in the soft tissue, resulting from the side effects of treatment, may prohibit the patient from completing basic oral care. Poor oral health before cancer treatments may lead to infection and ultimately delay a patient’s cancer treatment. Even with good oral health, many cancer treatments affect the mouth, teeth, and salivary glands, making it difficult for patients to eat, talk, chew, or swallow.
Pregnancy may put women at an increased risk of periodontal (gum) disease and cavities. Oral health is considered a key part of prenatal care, given that poor oral health during pregnancy can lead to poor health outcomes for the mother and baby. Nearly 60 to 75% of pregnant women have gingivitis or periodontal disease that occurs when the gums become red and swollen from inflammation aggravated by changing hormones during pregnancy. With gingivitis being so prevalent in pregnant women, dental professionals should be prepared to identify and start treating pregnant patients as early as possible. Giving pregnant patients a detailed view of gingivitis using a tool such as an intraoral camera lets them see what their dentist is describing and better understand the need for treatment. When untreated, periodontitis has been associated with poor pregnancy outcomes, including preterm birth and low birth weight.
There is increasing evidence that those suffering from progressive neurodegenerative conditions such as Alzheimer’s disease and dementia have an increased likelihood of oral hygiene issues. One study suggested that the same bacteria responsible for gingivitis may also be linked to diseases like Alzheimer’s. While an estimated 50 million people are expected to experience the effects of the disease by 2050, research continues to suggest that good oral hygiene can play a role in limiting the impact of the condition.
Chronic inflammatory diseases such as rheumatoid arthritis are proving to have a clear and direct connection to oral health. A study from the John Hopkins Arthritis Center, for example, indicated that 70% of RA patients surveyed had at least moderate gum disease, compared to 35% of the general population. Those suffering from rheumatoid arthritis can also develop other serious oral health conditions, including Sjögren’s syndrome, a condition that causes inflammation in the salivary glands, leading to dry eyes and a dry mouth.
As you might already know, today’s dental professionals can impact not only patients’ oral health but also their systemic health. Proactively managing many of these common diseases with practical, effective oral treatment plans is proven to improve health outcomes. Technology like teledentistry and intraoral cameras make it even easier to effectively communicate with patients and other providers throughout the entire patient journey about both oral and systemic concerns.
Connected care is crucial for monitoring the overall health of high-risk patients. With the powerful connection between systemic and oral health, the collaboration between dental providers and their patients’ medical providers should be an expectation, especially with the availability of telehealth platforms in today’s world. With a HIPAA-compliant teledentistry platform like MouthWatch’s TeleDent, dentists can communicate with a patient’s primary care provider about possible oral-systemic links and collaborate to improve patient outcomes.
Intraoral cameras are great tools for monitoring and keeping a detailed record of patient conditions. Highlighting patients’ oral health concerns with anatomically color-accurate HD images help improve case comprehension and patient accountability. Patients might not understand what you mean when you describe “gingivitis” to them or do not fully grasp the significance of the concern when explaining it without visuals. With high-quality images from the MouthWatch Intraoral Camera, they can immediately recognize the need for treatment without needing to understand complex clinical terminology that could confuse them and make them less likely to accept treatment.