Mouthing infections

By definition, health is a state which allows people to lead an individually and socially productive life. This implies that good functional coordination is needed between different systems of our body to exist in a state of complete well-being.

Following this concept, the notion is that periodontal diseases (or gum diseases) may be a part of a more complex, systemic disorder affecting overall health. This also formed the basis for the evolution of a novel sub-discipline in oral sciences, termed “Periodontal Medicine”, exploring the plausible bidirectional associations between oral as well as periodontal diseases and systemic diseases which ultimately determine one’s state of health/illness. Awareness of the role of oral diseases on other health conditions has been documented throughout history dating back to ancient civilisations with recordings of Hebrews, Greeks and Romans citing strong healthy teeth as a sign of good health and diseased teeth as a source of illness to other parts of the body. In 1891, there were a series of articles, in the Dental Cosmos, titled “Human mouth as a focus of infections”.

This further formed the basis for the work of physician Willam Hunter, who explained “Oral Sepsis” in the British Medical Journal in 1911, describing the path through which oral infections can spread in the body. This line of reasoning came back to the fore over the last two decades re-appraising periodontal–systemic links, this time around with evidence-based research consolidating historic trends. Periodontal disease, simply referred to as gum infection, is the second most common oral condition worldwide and ranks as the fourth most frequently suffered illness on the Disease Global Burden list.

Owing to such widespread prevalence, it is vital to be conscious of its effect on the lifespan of our teeth and also recognise its role in breaching overall homoeostasis between different parts of our body. Systemic diseases and conditions that have an impact on public health and have also been examined for association with periodontal diseases include but are not limited to, heart diseases, diabetes, unfavourable pregnancy outcomes, respiratory diseases, rheumatoid arthritis, chronic kidney diseases, obesity, cognitive impairment, Alzheimer’s disease, inflammatory bowel disease and cancer.

According to the Consensus Report of the Joint American Academy of Periodontology & European Federation of Periodontology Workshop in 2013, infection of the gums is significantly linked with heart disease, increased HbA1c levels, increased insulin resistance, and diabetic complications like retinopathy, nephropathy, vasculopathy and so forth, and problems with pregnancy outcomes like low-weight birth, premature birth etc. In cardiac patients, bacteria, bacterial products and mediators in response to these irritants found in oral infections, can cross-react with the heart and bring about changes in the vascular system, priming patients to infections of the heart tissue called infective endocarditis, atherosclerosis, coronary heart disease, and stroke. Recently, Sanz et al in their detailed review in collaboration with the World Heart Federation, concluded periodontitis patients had a higher risk of cardiovascular diseases and recommended strict adherence to dental therapy to prevent cardiac complications. Furthermore, there are minimal but potential positive links demonstrated with other body system diseases.

These alliances can be attributed primarily to the common causative pathway for all of them, with inflammatory immune responses being the shared pathogenesis.

Periodontitis is one of the most common chronic inflammatory conditions globally, creating an infectious focus that can metastasise to other parts of the body, wherein they contribute to remote infections. Different areas of the oral cavity act as a reservoir for disease-causing bacteria from where oral bacteria as well as their toxins can enter the body’s circulation, get settled in other tissues such as the heart, pancreas, lungs, foetal-placental unit, and sow the seeds for inflammation, exaggerating an already existent disease. Additionally, bacteria within the gums produce inflammatory mediators starting the cascade of events that break down the structures supporting your tooth. This local inflammatory response can disseminate into your bloodstream, generating a systemic inflammatory response that can trigger your liver and aggravate existing damage at distant sites. Lastly, many shared risk factors like smoking, unhealthy lifestyle, and causal pathogens contribute to the frequently reported linkages between periodontal and systemic diseases. This is corroborated by Article 19 of the UN General Assembly Declaration of 2011, which stated that renal, oral and eye diseases pose major health burdens for many countries that share many common risk factors.

It follows from these propositions, that the treatment of oral diseases can have a dual benefit in the form of improving tooth function as well as alleviating the infectious burden of associated conditions in other parts of our body. Indeed, there is a bank of evidence demonstrating improvement of glycaemic control (reduced HbA1c levels) in diabetics following therapy for gum infections.

(The author is a cosmetic dentist.)