Our teeth are notorious for their flaws: they are crowded, out of alignment, covered in cavities, and have inflammatory gums. The level of meticulous daily maintenance required to keep our teeth and gums healthy makes modern humans unique.
Our oral health affects a wide range of factors, ranging from our nutrition to our general welfare and the risk of dying from any cause within a given year. It is far more than just toothaches and sore gums.
This is because oral illnesses occasionally spread outside of the mouth. The mouth serves as a mirror of health and sickness as well as a sentinel for our general wellbeing. A strong correlation is emerging between oral health and some of the most serious diseases in the world, such as cardiovascular disease, diabetes, and Alzheimer’s.
Unfortunately, the most obvious sign of dental health is routinely disregarded. More than 47% of adults over the age of 30 have periodontitis, also known as deep gum disease, which is the second most common oral illness after cavities. 64 percent of adults 65 and older have moderate or severe periodontitis. It ranks as the 11th most prevalent disease in the globe overall.
Long-term infection by disease-causing bacteria in the bloodstream and gums affects human health in ways that go far beyond oral health.
Deep beyond the gum’s surface, where you cannot see it when you smile, is where periodontitis is an infection. The structures that hold the tooth in place are eroded by bacteria that travel below the gumline into pockets by the tooth root after an initial phase of superficial inflammation in the visible section of the gum (gingivitis). Due to periodontitis’ concealed nature, many people who have it are unaware of it until it has reached very advanced stages. In addition to having a genetic component, dental hygiene has an impact on the condition.
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According to Sim K. Singhrao, a senior research fellow at the dental school at the University of Central Lancashire in the UK, the majority of people don’t discover the disease until they are in their 40s or 50s. By this point, extensive damage may have already compromised the tooth’s structural integrity, posing a threat of tooth loss. For decades, the infection has been continuously circulating germs like Porphyromonas gingivalis and Treponema denticola throughout the bloodstream.
Our overall health is shaped by the persistent presence of disease-causing bacteria in the bloodstream and gums.
According to Singhrao, “If you think of the bloodstream as a bus, it will carry passengers on it, like bacteria from the mouth, and it will travel all over the body.” Some will fragment in the liver, some in the pancreas, some in the arteries, and some in the brain.
Microbes generate inflammation and either initiate or worsen other inflammatory disorders if there are weak points in these organs or when they aren’t adequately removed.
A long list of the most common non-communicable diseases in the world is associated with periodontitis, including heart disease, diabetes, Alzheimer’s, obesity, several malignancies, rheumatoid arthritis, Parkinson’s, pneumonia, and pregnancy difficulties.
It has a reciprocal link with several of these conditions. For instance, patients who already have atherosclerosis, which is a condition in which the walls of the arteries stiffen, are more likely to develop periodontitis. The gold standard of medical research, randomized controlled trials (RCT), has not been conducted to examine this association (these would be hard to carry out ethically, denying one group treatment of their periodontitis for a prolonged period to see how it affected their atherosclerosis). But researchers have uncovered periodontitis-causing bacteria trapped in atherosclerotic plaques, which are typically only found in the mouth.
Diabetes has the strongest two-way relationship with periodontitis of all these chronic health disorders. Periodontitis is three times more likely to occur in patients with type 2 diabetes than in those without. The infection makes it harder for persons with type 2 diabetes and periodontitis to keep their blood sugar levels under control.
It all comes back to the constant entry of bacteria into the bloodstream from crevices deep within the gums. Immune cells unleash a flurry of cellular communications molecules known as inflammatory markers wherever the immune system identifies bacteria or other pathogens. The immune system uses these inflammatory indicators to target and eliminates invasive invaders. This rapid inflammatory reaction causes swelling and redness to form around a wound within seconds. In the near term, inflammatory markers are great indicators of infection sites for the immune system. However, when these sentinels remain in the body, they bring about a variety of issues.
Most disorders connected to periodontitis include a well-known inflammatory component. For instance, it was discovered over 30 years ago that the inflammatory marker tumor necrosis factor-alpha causes diabetics to have higher levels of insulin resistance. A wave of other inflammatory markers that worsen both obesity and type 2 diabetes were soon after discovered. This extensive network of inflammatory indicators has sparked research into ways to manage chronic inflammation to treat diabetes.
However, the steady trickle of bacteria from a gum infection that is undetected does the exact opposite.
Palle Holmstrup, an emeritus professor in the University of Copenhagen’s department of odontology, asserts that all inflammatory disorders are interconnected and affect one another. “Periodontitis is one of the most prevalent inflammatory diseases in humans, if not the most prevalent.
The same inflammatory mediators are involved in rheumatoid arthritis, heart disease, diabetes, and other inflammatory illnesses. You will have more systemic low-grade inflammation if you have periodontitis.
For the same moral considerations as with atherosclerosis, it is challenging to determine in humans how treating periodontitis could improve diseases like diabetes. You cannot refuse a patient treatment for their ailment, especially if you fear it could exacerbate their other conditions. It makes analyzing this intricate web of linked inflammatory disorders very challenging and makes determining causal linkages challenging.
It is relatively simple to reduce your chance of developing periodontitis or to treat it if you already have it to lessen inflammation.
However, Holmstrup’s team has assessed how periodontitis affects diabetes in rats. His team looked at how diabetic rats with a periodontitis-like condition and diabetic rats without differed in their blood sugar responses. A 30 percent larger rise in blood sugar after eating was associated with periodontitis.
If aggressive and left untreated, periodontitis will ultimately result in tooth loss. A new set of health hazards, including dementia and cognitive decline, are brought on by tooth loss in addition to decades of chronic inflammation.
According to Bei Wu, dean’s professor of global health at New York University’s Rory Meyers College of Nursing, the risk of dementia and cognitive deterioration increases in direct proportion to the number of teeth lost. In the largest study of its kind, Wu examined the medical records of 34,000 people in the US and discovered that the chances of dementia and cognitive impairment rise by 1.4 and 1.1 percent, respectively, for every tooth lost. In comparison to persons who had all of their teeth, those who had lost teeth had a 48 percent higher chance of cognitive impairment and a 28 percent higher risk of dementia.
When Wu brings up the connection between tooth loss and dementia, she says she is frequently met with astonishment because the two have been largely disregarded as dementia risk factors. Wu claims that the “missing piece” is oral health. “We’re attempting to present the evidence to demonstrate that it should be taken into consideration.”
Although tooth loss may be frequently caused by periodontitis, other factors than inflammation may also be to blame. Wu wants to study the impact of nutrition in this link, among other things, as thus far her studies on tooth loss have only looked at correlations and not causality.
According to Wu, “a decent denture could boost dietary intake as well as your mastication” (chewing). That might potentially improve blood flow, which could enhance cognitive performance, but this is just a theory.
Every time we wash our teeth, we have the chance to enhance our overall health (Credit: Alamy)
Every time we wash our teeth, we have the chance to enhance our overall health (Credit: Alamy)
It is simple to reduce your chance of developing periodontitis and to properly treat it if you already have it, which is a very important result of the newly discovered connections between our oral health and this wide range of other disorders.
According to Wu, if we clean our teeth thoroughly and practice good oral hygiene, we may be able to delay the beginning of periodontitis.
Scaling and root planing, which removes germs from the lower tooth surface above and just below the gum line, is a treatment option if the illness does develop. According to Holmstrup, surgical therapy may be necessary if you have severe periodontitis since it “means you release the soft tissue of the gums and clean the root surfaces, then put the tissue back.”
Due to the disease’s sometimes asymptomatic nature and the widespread belief that you shouldn’t visit the dentist unless you are experiencing excruciating tooth pain, the challenge is detection. Again, the answer is straightforward: if you have an appointment, keep it immediately.