Over the last few years I have become increasingly passionate about the links between oral health and general health. The evidence seems to grow daily that having a healthy mouth can have a significant contribution to improving overall health. For years, as many of my patients will testify (and my nurses are tired of hearing, I’m sure), I have been saying that the teeth don’t walk in on their own, there is a person coming into my surgery and that is what we should focus on. I believe that it is time to stop treating people as a collection of separate compartments and look at the impact we can have on their health as a whole. It’s also time to stop being just tooth technicians and gum gardeners and become true physicians again.
I’m going to use this series of blogs to talk about where the links come from, what disease processes are connected and just how having a healthy mouth contributes to general health and where this may take us in the future.
Let’s start with the basics. The connections to general health start with good oral hygiene and excellent gum health. It’s not just as simple as throwing you a toothbrush or floss and telling you to get on with it. We should be looking at your own personal needs: where you need help and what tools are best for the job in your mouth. Why? Well for years there has been a misconception that a little bleeding from the gums when you brush is somehow normal. But it isn’t. Can you think of anywhere else you would brush or clean and if you saw blood you would just think, I’ll just not do it as hard tomorrow? No? Neither can I. The bleeding is a sign of inflammation and this is the key to the oral-systemic connection as we call it.
Healthy gum tissue is your good barrier. It is an important defence against bacteria and performs other protective and regulatory functions in the mouth. Inflamed gum tissue, however, is an inefficient barrier and very easily damaged, that is why you can make it bleed with your toothbrush. The surface area of the periodontium, the gums and other structures that support your teeth, adds up to about the size of the palm of your hand. In reality that is a large area to become inflamed and therefore it’s no wonder it can affect your whole body. Imagine an area of inflammation like that anywhere else on your body, then you can start to understand the significance.
So how does this then impact the rest of the body? Well, firstly, that inflamed, inefficient barrier can allow bacteria from your mouth to pass into the gum tissue and eventually into your bloodstream. We call this a bacteraemia. When your gums are very inflamed this can be happening when you eat and chew, when you brush and floss and in the worst cases just randomly as the inflamed tissue bleeds. The bacteria in your mouth are part of an ecosystem that we call the microbiome and generally it is kept in check and balanced so problems don’t arise. Transport those bacteria to other parts of the body and that can cause problems. We call these ‘travelling oral microbes’ and they can be found in the neck, in plaques inside arteries, on heart valve prostheses, in thrombii that cause heart attacks and strokes, in the lungs, liver, gut, pancreas, joints and vertebrae, in umbilical cords and placentas, in breast milk and the list goes on and on!
At the same time the very presence of inflammation in the gums has an impact too. Gum disease is now the 6th most prevalent human disease. Uncontrolled inflammation, such as that found in gum disease, is a common feature of many other diseases. The chemicals that your body uses to regulate inflammation are released from inflamed gums in high numbers and this can trigger similar reactions across the whole body and encourage your body to produce high levels of markers of inflammation that again are common across many diseases and conditions. One of these that you may have heard of is C Reactive Protein (CRP). It is produced by your liver as part of the inflammation process and is now used as a marker for risk in many conditions and it can easily be demonstrated that gum disease leads to an elevation of CRP. By controlling the gum disease you reduce CRP levels and therefore the risk that elevated CRP brings in other disease processes.
Watch my blogs here over the coming weeks and months as I expand on this topic and explore the ways in which a healthy mouth contributes to overall health. I’ll start next time by discussing something very relevant to patients here in the UAE, the “two way street” link between oral health and diabetes.
Look out for information on the seminar I’ll be holding here at Dr Roze and Associates on Wednesday October 23rd at 7.15 UAE time “Putting the Mouth Back in the Body” which we will be running as a Facebook Live event with the availability of DHA approved CME points for healthcare professionals. You can also contact me directly on firstname.lastname@example.org and follow me on twitter @geordiedentist and instagram @geordiedentist2018 (views and opinions are mine personally and you will be bombarded with football, horology and casual footwear – you have been warned).