Dentistry beyond the mouth
The dental field is experiencing a paradigm shift in which the mouth is no longer viewed as an independent entity, but intricately connected to the rest of the body. Thus, whilst poor oral health negatively impacts on appetite, nutrition, self-esteem and quality of life, it has additional consequences that can affect general health (1).
Part of the reason for this is that our teeth have a very unique anatomical structure; whilst each tooth is rooted in our oral tissues, a part of it is exposed to a highly contaminated external environment; our mouths! As a result, our mouths serve as a gateway between the external environment and the rest of the body.
In a recent blog, DRG Abacus presented the current evidence supporting the association between gum disease and systemic diseases. Since then, DRG Abacus attended a Dentistry Research Showcase at the University of Birmingham to learn more about the significant advances in their understanding of oral health.
It is becoming increasingly evident that researchers in the dental field are applying new approaches to longstanding questions, including: How closely interlinked are oral and general health? How can oral health status be improved? Should medical and dental professionals work more closely alongside each other?
The link between oral and general health
In support of the oral/general health link, people with gum disease have a greater risk of obesity, diabetes, heart attack, and rheumatoid arthritis. It is also recognised that pathogens in the oral cavity can gain access to the airway passages, potentially causing illnesses such as pneumonia, or exacerbating conditions such as emphysema (2). Furthermore, many systemic diseases can manifest in the mouth, meaning that the oral cavity and saliva can be used as potential diagnostic tools; some of these diseases include chronic renal disease, diabetes and cancer (3-5). In addition, several therapies can affect the mouth, for example, many chemotherapies are associated with oral mucositis, and it is estimated that hundreds of over-the-counter prescription drugs can cause xerostomia (dry mouth) (6, 7).
Oral health status
Targeting education and the motivation of dental patients is likely to be vital to improving oral hygiene and nutrition, which may potentially result in far-reaching improvements in general health. Furthermore, research continues to strive for advances in the understanding of risk factors associated with gum disease, as well as exploring potential prevention and intervention efforts. There is also continued research into novel biomaterials to restore decayed or damaged teeth. Efforts are focused on identifying biomaterials for use in the mouth (e.g. dental implants) that are less likely to be rejected by the body, and also possess additional benefits, e.g. the material may have antibacterial properties.
Collaboration between medical and dental professionals
Multidisciplinary collaboration between medical and dental professionals may have substantial benefits, including streamlining diagnoses, increasing resource efficiency, and improving general health. It may become routine for doctors to investigate the status of their patients’ oral health, and likewise, dentists may become more involved in the diagnoses and management of illnesses affecting their patients’ general health.
In conclusion, significant in roads are being made into the association between oral health and general health. Given that one in four adults admit to not brushing their teeth twice a day, and that ~40% of children do not visit the dentist each year, oral health promotion is increasingly important (8). A multidisciplinary approach involving medical and dental health care professionals, patients, research groups, and pharmaceutical companies will likely be key to achieving oral health gains. Improvements in oral health may subsequently result in improvements in general health and wellbeing; thus, oral health status is intrinsic to systemic health promotion and disease prevention.
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- Sheiham A. Oral health, general health and quality of life. Bulletin of the World Health Organization. 2005;83(9):644-.
- Scannapieco FA, et al. Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. A systematic review. Annals of periodontology. 2003;8(1):54-69.
- Gupta M, et al. Oral conditions in renal disorders and treatment considerations–A review for pediatric dentist. The Saudi dental journal. 2015;27(3):113-9.
- Gibson J, et al. Oral manifestations of previously undiagnosed non‐insulin dependent diabetes mellitus. Journal of Oral Pathology & Medicine. 1990;19(6):284-7.
- Carter L, et al. Oral cancer awareness of general medical and general dental practitioners. British dental journal. 2007;203(5):E10.
- Naidu MUR, et al. Chemotherapy-induced and/or radiation therapy-induced oral mucositis-complicating the treatment of cancer. Neoplasia. 2004;6(5):423-31.
- Sreebny LM, et al. A reference guide to drugs and dry mouth–2nd edition. Gerodontology. 1997;14(1):33-47.
- National Smile Month, May 15-June 15 2017.