Dr-Raed

The Body’s Window

Mouth health is essential to general health and wellbeing at every stage of life. A healthy mouth enables not only nutrition of the physical body, but also enhances social interaction and promotes self-esteem and feelings of well-being.

Like many areas of the body, your mouth is filled with and generally coping with bacteria; most of them harmless. To be more accurate, the mouth hosts approximately six billion microbes representing 300 to 500 species. Normally the body's natural defenses and good oral health care, such as daily brushing and flossing, can keep these bacteria under control. However, without proper oral hygiene, bacteria can reach levels that might lead to oral infections, such as tooth decay and gum disease. In addition, certain systemic conditions, diseases and medications — such as decongestants, antihistamines, painkillers and diuretics — can reduce saliva flow. Saliva washes away food and neutralizes acids produced by bacteria in the mouth, helping to protect you from microbial invasion or bacterial overgrowth that might lead to teeth and gum diseases. The mouth, besides its well known functions, serves as a “window” to the rest of the body, providing signals of general health disorders. For example, aphthous ulcers are occasionally a manifestation of Coeliac disease or Crohn’s disease, pale and bleeding gums can be a marker for blood disorders, bone loss in the lower jaw can be an early indicator of skeletal osteoporosis, mouth lesions may be the first signs of HIV infection, and changes in tooth appearance can indicate bulimia or anorexia. For decades, physicians and dentists have paid close attention to their own respective fields. Years ago, a physician who suspected heart disease would probably not refer the patient to a gum specialist. The same went for diabetes, pregnancy, or just about any other medical condition. However, recent findings have strongly suggested that oral health may be indicative of systemic health. Currently, this gap between medical and dental practices is quickly closing, due to significant findings supporting the association between periodontal disease (advanced gum disease) and systemic conditions such as cardiovascular disease, type 2 diabetes mellitus, adverse pregnancy outcomes, osteoporosis and other systemic conditions.

Periodontitis, one of the most common oral diseases of humans, is an infectious condition that results in the inflammatory destruction of gum ligaments and the bone surrounding the teeth. As a result of the extensive microbial plaques (deposits) associated with periodontal infections, the chronic nature of these diseases, and the exaggerated local and systemic body response to microbial assault, it is reasonable to hypothesize that these infections may influence overall health and the course of some major systemic diseases affecting the general population, our beloved ones and even ourselves.

Does any one of you remember times were we heard about grandparents or relatives taking all their teeth out and later feeling healthy and energetic? It is not the act of pulling teeth per se that provided the cure. In fact, it was the elimination of all that was attached to the teeth that provided the cure. Science now proves that the bacteria attached to the teeth and associated gum tissues and/or their by products were in fact traveling from the mouth and adversely affecting a remote organ. Today, physicians should be taking a more holistic approach to their patients’ overall health management. Specialized gum treatment should be an integral part of the medical treatment of many systemic diseases. Studies show that people with serious gum disease were about 40% more likely to have a chronic medical condition on top of it.

The Gateway to Your Body

To understand how the mouth can affect the body, it helps to understand what can go wrong in the first place. Bacteria that builds up on teeth, make gums susceptible to infection. The immune system moves in to attack the infection and the gums become inflamed. The inflammation continues unless the infection is brought under control by professional dental care usually by a periodontist (gum therapy specialist).

Over time, without professional dental and gum care, inflammation and the chemicals it releases, eat away the gums and bone structure that hold teeth in place. The result is advanced severe gum disease, known as periodontitis. Inflammation can accordingly cause problems in the rest of the body.

The-Gateway-to-Your-Body

Your oral health might affect, be affected by, or contribute to various diseases and conditions, including: Cardiovascular System:

Atherosclerosis
Coronary heart disease
Angina
Myocardial infarction
Endocarditis

Endocrine System:

Diabetes mellitus

Reproductive System:

Preterm low birth-weight babies

Respiratory System:

Acute bacterial pneumonia
Chronic obstructive pulmonary disease

Other Medical Conditions:

Osteoporosis
Erectile Dysfunction

Cardiovascular System

Periodontal (Advanced Gum Disease) and Cardio-vascular Diseases Oral Health, Heart Disease and Brain Strokes Cardiovascular disease (CVD) is a common cause of death, accounting for a worldwide 29% of deaths. Millions of people have been diagnosed with different forms forms of CVD, which include high blood pressure, coronary heart disease (myocardial infarction –i.e. heart attacks and angina pectoris), peripheral arterial disease, and stroke, with atherosclerosis as the principal cause of all CVDs....

Atherosclerosis refers to the buildup of fats, cholesterol and other substances in and on your artery walls (plaques), which can restrict blood flow. These plaques can burst, triggering a blood clot that can travel through the blood stream and cause a heart attack or brain stroke. Atherosclerosis according to studies is thus responsible for 50% of all mortality in the United States, Europe, and Japan.

After adjustment of other risk factors, studies indicate that severe gum disease is associated with a 25% to 90% increase in risk for CVD . Though the evidence is not yet clear-cut in nature and reasons are not fully understood, it’s clear that gum disease and heart disease often go hand in hand.

Periodontal diseases might affect heart disease through the mechanism of oral bacteria, bacterial toxins (poisonous bacterial by products), and induced inflammatory mediators entering the blood stream and contributing to chronic, systemic vascular challenge, directly resulting in platelet aggregation (accumulation and clustering), adhesion, and vasculitis (inflammation of the vessels), with the subsequent cholesterol deposition, thromboembolic events, and atheroma (clot) formation.

Another possibility is that the inflammation caused by periodontal disease induces inflammatory cell infiltration into major vessels, vascular smooth muscle proliferation (increased growth), vascular fatty degeneration, and increasing plaque build-up, which contribute to swelling and thickening of the arteries. These events may lead to atherosclerosis and atheroma (clot) formation, and result in obstruction of normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly, and eventually increase the risk of heart attacks.

Whatever mechanisms are involved, it is evident that periodontitis may affect the host’s susceptibility to systemic disease through subgingival (under the gum) plaque biofilms acting as reservoirs of bacteria and creating transient bacteremia, through release of microbial toxins and through a reservoir of inflammatory mediators. In parallel, all these factors are capable of predisposing the host to vascular changes or disorders.

Collectively speaking, "The theory is that inflammation in the mouth causes inflammation in the blood vessels,". This can increase the risk for heart attack in a number of ways. Inflamed blood vessels allow less blood to travel between the heart and the rest of the body, raising blood pressure. "There’s also a greater risk that fatty plaque will break off the wall of a blood vessel and travel to the heart or the brain, causing a heart attack or stroke".

Endocarditis Endocarditis is an infection of the inner lining of your heart (endocardium). Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to the damaged areas in your heart. Dental procedures can predispose to endocarditis, if proper precautions and pre procedural medications are not well taken care of.

Endocrine System

Diabetes mellitus is a metabolic disorder characterized by hyperglycaemia (elevated blood sugar levels) due to the defective secretion or activity of insulin, the hormone that converts sugar into energy.

The working relationship between diabetes and periodontitis may be the strongest of all the connections between the mouth and body. Inflammation that starts in the mouth seems to weaken the body’s ability to control blood sugar. ...

Studies demonstrate that periodontal disease (advanced form of gum disease), further complicates diabetes because the inflammation impairs the body’s ability to utilize insulin, and so sugar is accumulated in the blood. Moreover, induced production of the body’s own inflammatory mediators to combat periodontal disease also mediates insulin resistance and reduces insulin action.

To further complicate matters, diabetes and periodontitis have a two-way relationship. High blood sugar provides ideal conditions for infection to grow, including gum infections.

A vicious cycle is thus created, where the diseased gum condition negatively affects sugar breakdown, elevating blood sugar levels, increasing susceptibility to infections, impairing tissue repair, increasing gum tissue break down, increasing inflammation, impairing insulin function, increasing blood sugar content and so on.

Accordingly, one should understand that if one has gum disease, then he/she is susceptible to have an increase in his/her blood glucose levels and should try to control it at least partially by managing gum disease by a periodontist (gum therapy specialist).

Fortunately you can use the gum disease-diabetes relationship to your favor: Managing one can help bring the other under control.

Medical treatment using medications is not the only way to control diabetes. Professional dental care to eliminate possible pathways of blood glucose elevation should be an essential part of managing patients with diabetes.

Reproductive System

Oral Health, Pregnancy and your Baby
It is important to understand that during the course of pregnancy the fetus grows in size and its nutrients needs increase. Along with this, the decreasing space becomes a critical parameter that plays an important role in parturition. As the pregnancy progresses, amniotic fluid levels of prostaglandin E2 (PGE2) and inflammatory cytokines, such as TNF-α and IL-1β rise steadily until a critical threshold level is reached to induce structure of the amniotic sac membranes, uterine contraction coma cervical dilatation and delivery ...

. Hence, it is important to understand here that the partition process is controlled by various pro-inflammatory cytokines and abnormal changes in their levels in the amniotic fluid may affect this process.

Babies born too early or with a low birth weight often have significant health problems, including lung conditions, heart conditions, and learning disorders. While many factors can contribute to premature (early) or low birth weight deliveries, researchers are looking at the possible role of gum disease. Infection and inflammation in general seem to interfere with a baby’s development in the mother’s womb. Preterm low-birth weight, as defined by the 29th World Health assembly in 1976, is a birth weight of less than 2500 grams with pregnancy duration of less than 37 weeks.

Preterm and /or low birth weight continues to be a significant cause of infant disease and infant death (morbidity and mortality). This is associated with risk for baby’s death in the first year of life, with developmental problems in childhood, and with risk of several diseases in adulthood. According to various studies, the prevalence of preterm birth varies from 6% to 15% of all deliveries.

The placental complex (which is the temporary organ that joins the mother and fetus, transferring oxygen and nutrients from the mother to the fetus and permitting the release of carbon dioxide and waste products from the fetus) may be affected by infections located far away from it. This may be due to an indirect action of the movement of bacterial products from one place to another (translocation) such as lipopolysaccharides (which are a major component of some bacterial cell walls that trigger immune response and inflammation) and/or the action of maternally induced inflammatory mediators that may adversely affect pregnancy outcomes.

Bacteria associated with advanced gum disease, may cause inflammation of the placental membrane. Bacterial lipopolysaccharide triggers release of a variety of biologically active mediators (eg: interleukin Ibeta , tumor necrosis factor-alpha & prostaglandin E2). These locally (i.e. orally) produced mediators are released by the body to fight and control the advanced gum disease. On the other hand, they may have a systemic effect, which may contribute to premature labour. Studies have also shown that these advanced gum infections may also impair fetal growth and trigger increased levels of biological fluids that induce preterm labour.

Hence, periodontal (advanced gum disease) has the potential to influence preterm low birth weight through an indirect mechanism involving inflammatory mediators or a direct bacterial assault on the amnion, which is the sac that encloses the developing fetus (baby).

It has been also observed that periodontal diseases (i.e. advanced gum diseases) appear to be associated with miscarriage between 12 and 24 weeks of gestation, even after controlling for other risk factors of poor pregnancy outcome. However, it is not yet known whether treating periodontal disease in pregnancy can reduce the risk of miscarriage.

Therefore, gum disease might be a newly considered risk factor of adverse pregnancy. Studies showed that preterm deliveries were 7.5-fold more common in women with severe gum disease than in those with good gum health. Studies have also shown that women whose periodontal condition (meaning the soft and hard tissues surrounding the teeth) worsens during pregnancy have an even higher risk of having a premature baby.

It is therefore highly advised to have a thorough clinical and radiographic full mouth assessment before thinking of becoming a mom. For the best chance of a healthy pregnancy, and a healthy to be baby, please visit a specialized gum therapist. You will improve your oral health and protect your general and baby’s health.

Respiratory System

Your Breathing System
There are many diseases that affect the breathing system especially the lungs. Among the serious conditions, are the pneumonias, which are a group of diseases caused by a wide variety of infectious agents, including bacteria, fungi, parasites, and viruses, resulting in infection of the lung organ responsible for gas transfer (parenchyma). Pneumonia can be a life-threatening infection, especially in the elderly and patients with suppressed/depressed immunity (i.e. reduced ability to fight against infections and protect own body). ...

. Other respiratory diseases also include chronic bronchitis (which is an inflammatory condition associated with excessive mucous production) and emphysema (which is the destruction of the air spaces with destruction of the alveolar septa). These conditions whether separate or collectively may lead to chronic obstructive pulmonary disease characterized by chronic obstruction to airflow making breathing difficult.

It is possible that aspiration of (oral) bacteria may worsen the course of chronic obstructive pulmonary disease. It is also known that one of the most common routes of infection for bacterial pneumonia is aspiration of oral and throat contents. Bacteria that grow in the mouth and throat can be aspirated into the lower respiratory tract and lungs to contribute to respiratory diseases such as pneumonia or worsening lung conditions. Studies have also demonstrated that recurrent respiratory diseases and/or tonsillitis conditions may be related to the translocation of bacterial reservoir at areas of partially impacted wisdom teeth.

The possibility that bacteria in oral plaque influence respiratory infection suggests that good personal and professional (in dental office) oral hygiene may prevent the aspiration of large numbers of oral bacteria into the lower airway and thus prevent initiation or progression of respiratory infection in susceptible individuals.

Oral Health and Osteoporosis

Osteoporosis and advanced gum disease (periodontitis) have an important thing in common, bone loss. The link between the two, however, is controversial. Osteoporosis affects the long bones in the arms and legs, whereas gum disease/periodontitis attacks the jawbone. Others point to the fact that osteoporosis mainly affects women, whereas periodontitis is more common among men....

Though a link has not been well established, some studies have found that women with osteoporosis have gum disease more often than those who do not. Researchers are testing the theory that inflammation triggered by periodontitis could weaken bone in other parts of the body.

Bisphosphonates, a group of medications available for the treatment of osteoporosis, have been linked to the development of osteonecrosis of the jaw (ONJ), which is cause for concern. The risk of ONJ has been greatest in patients receiving large doses of intravenous bisphosphonates, a therapy used to treat cancer. The occurrence of ONJ is rare in individuals taking oral forms of the medication for osteoporosis treatment.

Erectile Dysfunction

Male impotence or erectile dysfunction is defined as the repeated inability to achieve or maintain an erection allowing a satisfactory sexual activity. Impotence or erectile dysfunction is a disease more frequently than we would think, and it affects both, the relationship the person suffering the disease maintains with his partner and family; as social and work environments ...

Causes for dysfunction are, among others, neurological, hormonal and mostly vascular.

In the last few years, several researches have detected a direct connection between men with erectile dysfunction and a previous gum inflammation problem –periodontitis-.

Chronic periodontitis is a group of infectious oral diseases caused by bacteria that provoke systemic inflammation problems. These problems may cause an impaired endothelial function of blood vessels, probably affecting the cardiovascular system and chambers that run along penis. Periodontal disease has been linked to a host of other diseases, most notable to an increased risk of heart disease as inflammation of the arteries occurs in all stages of heart disease. And as it turns out, heart disease is one of the contributing causes of erectile dysfunction. Besides, the chronic inflammation caused by gum disease can damage endothelial cells, which form the lining of the blood vessels (including the blood vessels in the penis). When these cells are damaged, it can result in impaired blood flow throughout the body, leading to erectile dysfunction.

A 2012 study published in the Journal of Sexual Medicine found that men in their 30s who had severe periodontal disease were 3x more likely to suffer from problems related to sexual arousal. The cause is thought to be related to inflammation. Researchers of the Inonu University in Malatya, Turkey, carried out an investigation in which they compared 80 men aged 30-40 who suffered erectile dysfunction with another control group with no erection problems. As a result, they proved 53% of men with erectile dysfunction also had gum inflammation, as compared to the 23% of the control group. After the investigation, other researchers have also confirmed this connection. In a study in 2015, conducted in Taiwan, researchers determined that men diagnosed with erectile dysfunction were almost 80% more likely to have been diagnosed with chronic periodontal disease than men without erectile dysfunction.

While poor oral hygiene may be linked to erectile dysfunction, a diligent oral care routine may actually improve symptoms of erectile function.

One study in Turkey reviewed 120 patients who were suffering from both moderate to severe erectile dysfunction and chronic periodontitis. Half of the patients received treatment for their gum disease, while the other half did not. A follow up questionnaire revealed that patients who received treatment for their gum disease reported that of the severity of their erectile dysfunction lessened after just three months. Studies in India have reached the same conclusion, leading to speculation that, at the very least, gum disease and the cause of erectile dysfunction are linked.

So, if you’re experiencing symptoms of ED, you may want to schedule a dentist appointment to check for gum disease. And while it may require a few appointments over time to get it in check, the results are definitely worth it.

Therefore, it is really important to keep gum healthy, especially teeth cleaned; not only to prevent sexual problems, but also because gum inflammation may lead to thrombosis and infective endocarditis.

The Bottom Line on Oral Health

One thing is clear: the body and mouth are not separate. "Your body can affect your mouth and likewise, your mouth can affect your body". Taking good care of your teeth and gums can really help you enjoy a healthy mouth, a healthy smile and a healthy life. It is known that poor dental hygiene and gum and/or dental infections may produce bacteraemias (spread of bacteria in the blood stream) even in the absence of dental procedures. Transient bacteremias can be provoked by chewing and oral hygiene procedures such as tooth picking, flossing and even tooth brushing. The extent to which bacteremia of oral origin occurs appears to be directly related to the severity of gingival inflammation.

Thus, the best means to prevent bacteremia from the oral cavity is the maintenance of periodontal and gum health. This means brushing twice a day, flossing once a day, and going for regular dental teeth cleanings and check-ups. This helps you maintain both your oral and general health.

If you have gum and periodontal disease, make sure you see your dentist and gum specialist frequently and get it treated promptly, before it progresses to the point where you begin losing teeth or it starts to affect your overall health.

That the mouth and body are integral to each other underscores the importance of the integration of oral health into holistic general health policies. Medical doctors and dentists working closely together creates responsible sharing and effective team approaches in the clinical management of their shared patients for better oral health and general health. The importance of long-term control of oral and gum diseases should be part of comprehensive health education for all people.

Aesthetic/Cosmetic Dentistry

Botox

Dental Implants

Oral Surgery

Temporomandibular Joint (TMJ) Disorders

Orthodontics

Periodontics “Gum Disease”

Restorative Dentistry

Root Canal “Endo” Treatment

Pediatric “Child's” Dentistry