Miriam Amil Rodríguez, DMD
MCS Provider
The oral cavity is a window into a patient’s overall health. Because many illnesses and drugs
impact the oral cavity, pathological conditions in it affect overall health more than many
healthcare professionals might appreciate. Although a causal relationship between
periodontal disease and conditions such as vascular atherosclerosis, lung disease, diabetes,
pregnancy complications, osteoporosis and kidney disease has not been established, it has
been proven that they share risk factors – a poor diet, smoking, and alcohol abuse.
There are two mechanisms that scientifically explain this association. On one hand, chronic
inflammation generated in the oral cavity can increase the values of inflammation markers
in the blood, affecting the immune response and exacerbating the patient’s disease.
Secondly, the oral cavity can act as a reservoir of pathogenic bacteria that can enter the
bloodstream and affect distant organs, exacerbating systemic pathologies (bacteremia).
The level of oral hygiene significantly impacts the composition of the microbiome in the
oral cavity as well. Patients with good hygiene usually have a microbiome dominated by
gram-positive cocci and bacilli, with some gram-negative cocci. However, in patients with
poor oral hygiene, it’s dominated by gram-negative anaerobic organisms. Saliva also plays an
important role in the development of dental biofilm which, together with the oral
microbiome, protects teeth from demineralization produced by an acidic diet. When this
balance is interfered with (dysbiosis), the process of oral pathology (cavities and
periodontal disease) begins.
Routine dental care prevents these pathologies and helps stratify those patients at high risk
for systemic conditions. Several studies have found that patients with a history of
myocardial infarction or stroke had poorer oral health that those in the control group.
Patients with periodontal disease and poor oral hygiene suffered from chronic gingival
inflammation and frequent bacteremia, which trigger multiple proinflammatory cytokines
such as C-reactive protein, tumor necrosis factor-a, interleukin 1b, and interleukin 6. These
appear to stimulate the process of atherogenesis and increase the susceptibility of damage
to the vascular endothelium. In episodes of bacteremia, streptococci of the viridian group
can induce platelet aggregation and possible thrombus formation.
Some researchers believe that periodontal disease should be considered a major
complication of diabetes, but the relationship is bidirectional: hyperglycemia affects oral
health and periodontitis can negatively impact glycemic index control. Patients with
diabetes have a three (3) times higher risk of acquiring periodontitis than those without
diabetes. However, studies show that a patient with controlled diabetes does not have a
high risk of acquiring periodontitis compared with those who do not suffer from the
condition. Aggressive prevention, periodontal treatment and the use of antibiotics improve
glycemic index control and periodontal disease in these patients, effectively mitigating their
complications.
As emphasized by the U.S. Surgeon General’s review report, oral health is intrinsic to the
overall health and well-being of the individual. Primary prevention is the best approach, and
to achieve this, interdisciplinary collaboration between the medical and dental care team,
as well as the exchange of information that can impact the patient’s health, is indispensable.
Most patients with these chronic conditions don’t believe a problem in their mouth can
affect their heart and other parts of their body. Modifying any coexisting conditions may be
enough to prevent life-threatening medical complications.
References
Alpert PT. Oral health: the oral-systemic health connection. Home Care Manag
Pract.2017;29(1):56-59.
Kane SF. The effects of oral health on systemic health. AGD 2017.
Oral health in America: a report of the Surgeon General. ADA2006; 137 Suppl:26S-31S.
Centers for Disease Control and Prevention. Heart Disease Facts 2017..
Oral-Systemic Health. Department of Scientific Information, Evidence Synthesis &
Translation Research, ADA Science & Research Institute, LLC..
Periodontal Health and Disease in the Context of Systemic Diseases. Gaetano Isola,
Simona Santonocito, Saturnino Marco Lupi, Alessandro Polizzi, Rossana Scalafani,
Romeo Patini and Enrico Marchetti..
Scannapieco FA. The oral microbiome: Its role in health and in systemic infections.
Clinical Microbiology Newsl.2013;35(20):163-169.
Choi H, Day Ak, Priyamvara A, et al. Role of periodontal Infection, Inflammation, and
Immunity in Atherosclerosis. Current Problems in Cardiology 2021;46(3):100638.
Kou LC, Polson AM Kang T. Associations between periodontal diseases and systemic
diseases: a review of the inter-relationships and interactions with diabetes, respiratory
diseases, cardiovascular diseases, and osteoporosis..
Sanz M, Marco del Castillo A, Jepsen S, et al. Periodontitis and cardiovascular diseases:
Consensus report. Journal of Clinical Periodontology.2020;55(5):581-93..
