New Links in the Oral–Systemic Connection
Current research shows that the role of periodontal disease may have even more of an impact on overall health than previously thought.
By Allison M. DiMatteo, BA, MPS
Since Inside Dentistry launched its first issue in 2005, its publishers, editors, and staff have continued to conscientiously cover ongoing research associating conditions in the oral cavity with systemic effects throughout the body. Much has been learned since then regarding the link between periodontal pathogens and diseases affecting the heart, lungs, blood sugar levels, pregnancy, and other areas remote from the mouth. Once considered separate from the body, the oral environment is gaining acceptance as a reflection of an individual’s overall health.
“We are learning more and more about how the mouth is connected to the rest of the body,” says Donald S. Clem, DDS. “Therefore, it is crucial that as dental professionals we understand that periodontal disease may have a broader significance to overall health than previously believed.”
For example, Clem notes that current research makes it evident that respiratory disease must be added to the growing list of systemic, inflammatory disease states that may be impacted by periodontal disease.
Other research points to possible links between gum disease and anemia, suggesting that proteins produced as a result of chronic periodontitis negatively react with the blood and decrease red blood cell production.1 Different studies suggest that women with tooth loss caused by gum disease may experience higher incidences of breast cancer.2 Poor oral care also has been associated with memory loss and dementia, with researchers determining that study participants with the least number of natural teeth were at higher risk of memory loss and early onset Alzheimer’s disease.3 While the nature of these associations has been hypothesized, further research is needed to clarify and validate the association, as well as more clearly determine causality.
“The emerging concept of systems biology fundamentally states that no part of our body is in isolation,” notes David T.W. Wong, DMD, DMSc. “All parts are connected, despite the fact that we do not yet have readily the mechanistic underpinnings. The fact that we have been able to harness and develop salivary biomarker panels for systemic diseases including pancreatic, breast, and lung cancers substantiates this central concept.”
The significance of oral and systemic associations is significant not only to quality of health issues, but also quality of life issues. For example, burning mouth syndrome—which research suggests may be linked to systemic conditions—affects quality of life, not life or death, for 5% of the population, explains Gary D. Klasser, DMD.
“The more the association between systemic conditions and the oral environment is brought to both the public’s attention and politician’s attention, hopefully more money for more research will be devoted to this particular aspect,” Klasser hopes. “As it relates to burning mouth syndrome, the more that individuals write about this particular subject, the greater the potential for funding availability and more research, because it is very difficult, if not impossible, to do research without funding.”
This month, Inside Dentistry presents updates and current research initiatives underway to further the healthcare profession’s understanding of the connection between oral and systemic diseases. Our experts this month are those conducting the research themselves, or who have served as a conduit to disseminate and help apply that research within the dental profession. For their time and passionate dedication to pursuing a greater understanding of the association between oral and systemic conditions, we extend our sincere gratitude.
Conclusion
According to Clem, it is no longer good enough to “watch a couple of trouble spots.” Rather, controlling periodontal disease will become an integral part of controlling a patient’s overall inflammatory burden, he says.
“Our patients are not healthy unless they are periodontally healthy,” Clem notes.
“I think the most important issue or message here is that although in the past dentists focused on saving teeth and keeping them healthy, today we now have a broader dimension for why it is more important to maintain a healthy mouth,” Bissada explains. “If you have an inflammatory condition, which the most popular example here is periodontal disease, it puts the individual at a higher risk for a more serious systemic problem, whether it’s heart problems, diabetes, or rheumatoid arthritis. As we take care of the mouth, not only do we save teeth, which is a very good objective, but we also protect our general health.”
Bissada’s current research involving links between prostatitis and periodontitis is similar to previous research he and his associates conducted on rheumatoid arthritis, in which patients with rheumatoid arthritis were treated for periodontal disease by eliminating the inflammation. The signs of very severe rheumatoid arthritis in those patients were reduced to a significant level, he says. They are repeating the process relative to the prostate.
Brown believes that dental researchers should partner with health economists to increase the speed at which their field moves forward, since they have content, clinical expertise, and drive the research agenda. Health economists have a technical toolbox unrivaled in the social sciences and can use this toolbox to help push the research agenda established by dental researchers forward at much faster pace than would otherwise be possible, he adds.
“While the mechanistic rationale for salivary biomarkers for oral diseases are well in place, the rationale for systemic diseases is not. It is in this light that the scientific community must engage in collaborative efforts to study, determine, and establish the scientific underpinning of systemic disease detection in saliva,” Wong emphasizes. “It is only when the scientific connectivity and the definitive clinical validation of salivary biomarkers for a systemic disease combine that the credibility of salivary diagnostics for systemic diseases will be acceptable by the scientific communities.”
References
1. Pradeep AR, Anuj S. Anemia of chronic disease and chronic periodontitis: does periodontal therapy have an effect on anemic status? J Periodontol. 2011;82(3):388-394.
2. Söder B, Yakob M, Meurman JH, et al. Periodontal disease may associate with breast cancer. Breast Cancer Res Treat. 2001;127(2):497-502.
3. Okamoto N, Morikawa M, Okamoto K, et al. Relationship of tooth loss to mild memory impairment and cognitive impairment: findings from the Fujiwara-Kyo study. Behav Brain Funct. 2011;6:77.
