World Oral Health Day – 20 March 2015
The Impact of Oral Health on Overall Health
Vice Chairperson Professional Board for Dental Therapy & Oral Hygiene
Did You Know?
Periodontal diseases are among the most prevalent in the world with 70% of the world population thought to be affected by some form of the disease. In addition, up to 900 million people suffer from severe periodontal (gum) disease, which is considered a potential risk factor for severe serious health conditions
If you smoke you are four times as likely to have periodontal disease as someone who has never smoked
Pregnant women who have periodontitis, an advanced form of gum disease, may have a seven-fold increased risk of delivering a preterm, low birth weight baby
Findings suggest that severe periodontitis may be an important risk factor in the progression of diabetes
Gum disease affects all ages – more than half of all teenagers in the UK have some form of gum disease; 3 out of 4 adults over the age of 35 years suffer from gum disease
Only 60% of women over the age of 45 can claim to have all their own teeth
Research suggests that pneumonia can be caused by breathing in bacteria known to cause periodontal disease
What is saliva?
Saliva is a liquid that is produced by our glands, called salivary glands, and released into the mouth. Its role is to keep the mouth moist and to help our bodies swallow food more easily. Saliva also contains enzymes that break down certain types of food. When we sleep, our saliva production rate drops letting our mouths dry out and acid-producing bacteria flourish. So, night-time brushing and rinsing are particularly important to ensure excess bacteria is removed appropriately. When we sleep our salivary glands rest so there is insufficient saliva to wash away bacteria and food debris. This is however a temporary problem, which can be rectified by brushing and flossing regularly and rinsing with an antibacterial mouthwash.
Biofilm (Dental plaque)
Biofilm (dental plaque) is a build-up of various types of bacteria in the mouth. It is a soft white substance that is easily wiped or brushed off the tooth surface. Bacteria are normally present in the mouth, but when their numbers rise too high, we have a problem. Plaque forms within 24 hours of brushing and flossing and, within 48 hours, plaque builds up on the areas that are not brushed and flossed and is easily visible to the naked eye. It starts forming along the gum line and in between the teeth, but in a matter of days can cover a vast surface of the tooth.
Sugars are the main nutrient for the bacteria in plaque. The higher the content of sugar in your diet and more specifically, the longer the sugar is in the mouth, the more rapidly will the bacteria multiply and the greater will be their activity.
Calculus is a hard deposit and is the result of deposits of calcium and other salts, which are present in normal healthy saliva, within the plaque itself. It is a mineralising process and the speed with which it forms depends on two things:
How much plaque you leave behind after brushing and flossing
What the concentration of calcium etc. in saliva is
Calculus consists of up to 80% inorganic salts, mostly crystalline, the major components being calcium and phosphorus. The microscopic structure is basically that of randomly orientated crystal formation. Calculus is invariably associated with periodontal disease. This may be because it is invariably covered by a layer of plaque. Its principal detrimental effect is probably that it acts as a retention site for plaque and bacterial toxins. The presence of calculus makes it difficult to implement adequate oral hygiene.
Bacteria, viruses and fungi are the cause of disease in the body and bacteria in dental plaque are the cause of tooth and gum disease. Some of the bacteria cause ‘tooth disease’ (tooth decay or caries) and others are the cause of ‘gum disease’. Gum disease is an inflammation that starts in the surface layers of the gum and slowly over time works its way down into the bone around the teeth with various stages of severity, and can be divided into two general categories:
This is the first and reversible stage of gum disease. Gingivitis is an inflammation of the gums, which means that it become swollen, reddened and bleeds easily when touched. It is a local reaction to the plaque, not an infection. It can be localised or it can affect the entire mouth. Areas not cleaned for more than 48 hours would develop gingivitis. But at this stage it is totally reversible – good brushing and flossing will clear it all up within a few days. Gingivitis hardly causes any discomfort at all, which is why it is so easy to ignore. Even at later stages there is little pain, except in the case of an acute flare up of infection. Smoking somewhat masks the effects of gingivitis, because smoking reduces the blood flow in the smaller veins and arteries and therefore, less bleeding is evident.
If gingivitis is allowed to continue untreated over a period of time, it may result in an infection, which spread into the lower layers of bone and tooth attaching fibres. Once the infection has progressed to this level and the bone itself is infected, it is called periodontitis. According to the World Health Organisation (WHO), 10 – 15% of the world population or 600 – 900 million people are suffering from severe periodontal disease.
Initially the disease will not be visible from the outside; this is because it manifests first as ‘pockets’ around the teeth. A pocket is the opening next to the tooth which is covered by gum and not visible unless a probe (dental Instrument) is inserted. Such a pocket is usually filled with dental plaque and calculus and other debris and will bleed quite considerably if probed.
The progress of periodontal disease is sometimes so slow that the patient does not even become aware of the various side effects. The teeth become mobile and appear longer as the gum recedes. This is written off to ‘aging’ but it is simply the destructive progress of the disease. There is also a horrible odour that is associated with severe gum disease, but since it develops gradually, the sufferer does not become overly aware of it. On the other hand, the disease progress can be so rapid that tooth loss will occur within a few years. Periodontal diseases are chronic bacterial infections that affect the gums and bone supporting the teeth. Studies have shown that oral bacteria can enter the blood stream and can potentially lead to serious health problems.
Potential effect of moderate to severe periodontitis on the body:
Stroke 2 times
Chronic respiratory diseases 2 – 5 times
Coronary artery diseases 2 times
Adverse pregnancy outcomes 4 – 7 times
Diabetes 2 – 4 times
While inflammation can help fight disease, that assistance comes at the cost of suspending the body’s normal immune processes. In the short term this is often a legitimate trade-off, but in the long term it causes progressive damage. When inflammation is misdirected, autoimmune diseases may result.
There has been increasing attention paid in recent years to the possibility that oral bacteria and oral inflammation, particularly periodontal disease, may influence the initiation and/or progression of systemic disease processes. This, of course, is not a novel concept. Indeed, the focal-infection hypothesis, which grew from the principles of infectious disease first established by Koch and Pasteur in the mid-19th century, put forth the notion that the invasion of the bloodstream by bacteria from a localized infection (such as periodontal diseases) could spread to distant organs and tissues to cause disease. In fact, this hypothesis was so convincing to practitioners of the time that tonsillectomy and full-mouth extractions enjoyed widespread implementation to treat many diseases, regardless of whether or not infection could be proven to be the cause. However, because it became clear that it was impossible to correlate with confidence a particular systemic disease with a preceding oral infection or dental procedure, the focal-infection hypothesis fell from favour by the middle of the 20th century. Yet, interest in the systemic effects of periodontal disease was reignited in the early 1990’s by a series of case-control and other epidemiologic studies that demonstrated statistical associations between poor oral health and several systemic diseases.
Atherosclerosis is the most common cause of coronary artery disease. The World Health Organization (WHO) statistics for 1993 showed cardiovascular disease to be the number-one cause of death in developed countries, accounting for 47% of all deaths in those countries. In 1999, a study was published in a Dental Journal presenting new evidence to suggest that atherosclerosis was associated with inflection and inflammation. This first study tied the herpes viruses to changes in blood vessel walls. Since then, cytomegalo virus (CMV) and C. pneumonia (Cp) have been found in blood vessel walls associated with atherosclerosis. Researchers at the University of Belgrade in Serbia evaluated artery samples for the presence of microorganisms. Samples were taken from 15 patients undergoing coronary bypass surgery. Involved coronary arteries and mammary arteries used to create the bypass graft were evaluated. Mammary arteries are used for bypass as they seem to be protected from the process of atherosclerosis. No periodontal pathogens were found in the mammary vessel samples. Periodontal pathogens were found in nine of the 15 coronary artery samples (60%). CMV was found in 10 (67%) coronary artery samples and seven (47%) mammary artery samples. Cp was detected in five (33%) coronary artery samples and six (40%) mammary artery samples.
The researchers speculate that since the periodontal pathogens were found in the coronary artery samples and not the mammary samples and CMV and Cp were found in both, the periodontal pathogens may be the more likely bugs to cause atherosclerosis. These findings add to our understanding of the perio/heart-disease link. Establishing and maintaining oral health is important to prevent the movement of oral bacteria to the coronary arteries.
Lung diseases, such as pneumonia and chronic obstructive pulmonary disease (COPD) also have been associated with poor oral health. It is possible that dental plaque may serve as a reservoir of infection for respiratory pathogenic bacteria. In subjects stratifies by periodontal attachment loss, those with more severe attachment loss tended to demonstrate less lung function than those with less attachment loss.
There also has been interest in the association between periodontal inflammation and adverse pregnancy outcomes. Unfortunately, adverse pregnancy outcome, such as premature birth and low birth weight, are quite common events. During parturition, the uterus is influenced by the hypothalamus through the production of oxytocin, which stimulates uterine contraction. Prostaglandins that are produced by the placenta also stimulate uterine contraction, which normally leads to birth in the 3rd trimester (37 weeks). It is thought that chronic infections drive the inflammatory process, which leads to the release of inappropriate levels of prostaglandins and TNF-a, which prematurely stimulates uterine contraction to promote preterm birth.
It has been suggested that periodontal infection and the release of lipopolysaccharides and other biologically active molecules drive the process of inflammation. This elevates the levels of prostaglandins and TNF-a in the crevicular fluid. Lipopolysaccharides released from the oral cavity into the bloodstream may stimulate prostaglandins in the placenta, causing preterm birth. It is also possible, such as in atherosclerosis, that cytokines in the periodontium may lead to elevated peripheral blood cytokine levels and stimulate hepatic production of acute-phase proteins that may influence the birth process.
Clinical research conducted in the United States indicates that pregnant women who have periodontal disease are seven times more likely to have a baby that is born too early and too small. Low birth-weight babies are more susceptible to breathing problems, anaemia, jaundice, mental retardation, cerebral palsy, congestive heart failure and malnutrition.
Oral Hygienists and Dental Therapists aim to promote quality oral health care. Through clinical services, education, consultative planning and evaluation, they seek to prevent oral diseases, provide treatment for existing diseases and assist people in maintaining an optimal level of oral health. Their primary concerns as primary oral health care practitioners are the promotion of overall health through the prevention of oral diseases.
There is growing acceptance that oral health is an essential component of overall health, renewed emphasis on setting and attaining oral health goals, and increasing recognition that oral hygiene services are an important element in attaining these goals. To reach the highest possible level of oral health, prevention is essential. To improve and maintain good oral health, try to visit your oral health practitioner at least twice to three times a year, because the status of your mouth affects your overall health and wellness.
World Health Organisation http://who.org
International Federation of Dental Hygienists http://www.ifdh.org