What is the oral-systemic link?
It’s frequently said that the mouth is the gateway to the body. More and more, medical professionals have been discovering just how true this really is. This mouth-body connection is referred to as the oral-systemic link.
Dentists are often the first to detect conditions such as Crohn’s disease, diabetes, or cancer because the early symptoms may first show up in the mouth. Going in the other direction, we’re learning more and more how what happens in your mouth affects the health of the rest of your body.
The brain has the blood-brain barrier which protects it from toxins in the blood. In our mouths, there is a barrier between our gums and teeth and the rest of our body as well. In the case of periodontal disease, this barrier can break down and may cause disease or other problems in the rest of the body. Previously, it was thought that bacteria were the main factor in this, but more recent research has been indicating that inflammation may play a bigger role.
While the details of this connection between oral health and the health of the rest of the body is still being explored, it’s becoming increasingly clear that treating the inflammation of periodontal disease can help with the treatment of other inflammatory conditions (and, in some cases, vice versa).
Diseases with oral connections
Some conditions with strong connections to oral health include:
- Diabetes – Gum disease can make diabetes harder to control, and diabetes can exacerbate gum disease. We explore the topic in more detail in the dedicated section below.
- Heart disease and stroke – Conditions causing chronic inflammation, such as periodontal disease, have connections to the likelihood of heart disease and stroke. Read more about them on the page dedicated to the topic further down in the related section.
- Respiratory disease – The bacteria that grow in the mouth can find their way into the lungs as well. Respiratory diseases, such as pneumonia, can be caused by the same bacteria responsible for periodontal disease.
- Cancer – According to the American Academy of Periodontology, those with periodontal disease were more likely to develop cancer than those without:
-54% more likely to develop pancreatic cancer
-49% more likely to develop kidney cancer
-30% more likely to develop blood cancers
Other diseases that may be caused or complicated by oral infections include:
- Breast cancer
- Prostate cancer
- Weight gain
- Alzheimer’s and dementia
- Low birth weight and premature birth
- Rheumatoid arthritis
Some diseases can influence your oral health, as well, such as osteoporosis. Osteoporosis can lead to bone loss in the jaw which, in turn, can result in tooth loss, as there is no longer sufficient bone to support the teeth.
It’s critical to understand how important oral health truly is to our well-being, and to take it seriously in order to help prevent, or reduce the effects of other conditions. Periodontal disease, in particular, should be avoided or treated as soon as it is detected. According to the Centers for Disease Control (CDC), over 47% of individuals, 30 years and older, have some form of periodontal disease, and this percentage only increases with age. For individuals 65 and older, 70% of them experience gum disease. The best way to prevent gum disease is through proper dental hygiene, which includes brushing and flossing twice per day, and scheduling routine visits to the dentist.
Below, we’ll go into more detail on the connections between periodontal disease and many of the health issues we’ve mentioned.
Diseases with oral connections
Diabetes is a disorder that happens when the body has a higher-than-normal amount of blood sugar, known as glucose. Ordinarily, the hormone insulin regulates this sugar level and helps the cells of your body use this blood sugar for energy. Diabetes is a condition where the body doesn’t produce enough insulin leading to too much sugar in the bloodstream.
Insulin isn’t the only factor, however. It’s been found that the kind of inflammation from periodontal disease can impact the body’s ability to manage glucose as well. So, those who have both diabetes and gum disease may find themselves having an even harder time managing their blood sugar levels than they would otherwise. Diabetes, and the high blood sugar levels that result, also make for an environment where gum infections can be more likely to happen.
Heart Disease and Stroke
Very strong links have been established between oral health and cardiovascular disease, but researchers are still trying to clarify whether or not there is a cause-and-effect relationship. Evidence appears to be indicating a strong connection between heart disease and chronic inflammation such as what is found in gum disease. This chronic inflammation is tied to the narrowing or blockages of blood vessels, which, in turn, can lead to a stroke or heart attack.
In an article examining a number of related studies, it was pointed out that having gum disease could increase a person’s chance of having heart disease by nearly 20%. Another study showed that those with gum disease have nearly double the risk of suffering a stroke than those with healthy gums.
These are significant risk factors and should be enough to drive home the importance of treating periodontal disease for the sake of overall health.
A November 2020 study found more evidence of connections between rheumatoid arthritis and periodontal (gum) disease.
What Is Rheumatoid Arthritis?
Rheumatoid arthritis a chronic inflammatory and autoimmune disease, which causes the immune system to mistakenly attack healthy cells of the body. It results in painful swelling of the affected tissues. While RA primarily affects the joints of the body, it can also damage the skin, lungs, heart, blood vessels, and eyes.
How Is Rheumatoid Arthritis Connected to Gum Disease?
Although there’s still more to learn about whether or not one condition could be a cause of the other, past studies have found that people with RA are 8 times more likely to develop gum disease than those without RA. It’s also been found that the type of bacteria that causes periodontal disease, porphyromonas gingivalis, can lead to an earlier onset of RA and make it more severe.
Connections With Cardiovascular Disease
People with rheumatoid arthritis also face elevated risks for cardiovascular disease, which itself has links to periodontal disease.
The November 2020 study in Arthritis & Rheumatology found that a pathogen related to periodontal disease, called aggregatibacter actinomycetemcomitans, “had the strongest associations with atherosclerosis in the patients with rheumatoid arthritis that we studied,” according to Jon T. Giles, MD, MPH, of Columbia University.
While research into the connections between periodontal disease and other diseases continues, this should further reinforce the importance of a healthy mouth. Preventing or treating gum disease may very well prevent or lessen the impact of ailments such as rheumatoid arthritis.
A study done by the Federal University of Santa Maria Dental School in Brazil found that women with periodontitis (gum disease) are 2-3x more likely to develop breast cancer. This is yet another way that the health of our mouths is tied to our overall well-being. In this instance, the researchers believe that breast cancer may be triggered due to systemic inflammation resulting from gum disease.
The study was based on 67 women who have been diagnosed with breast cancer and 134 controls from 2013 to 2015. It is important to remember that this study does not mean that gum disease causes breast cancer, but it is an important study as we continue to find new ways of fighting cancer and learning what may cause certain kinds to develop.
In the United States, for every 100,000 women, there are 124.9 new cases of breast cancer. Breast cancer continues to be studied, and a possible connection to dental health issues would be a new opportunity to learn about and treat this form of cancer.
A 10-year study performed by NYU Langone Health’s Perlmutter Cancer Center has found that two types of bacteria that are present in individuals with gum disease can increase the chances of being affected by esophageal cancer.
The eighth most common type of cancer in the world, esophageal cancer can be highly fatal and is the sixth most common cause of cancer-related deaths. In the US, it affects around 1 in 125 men and 1 in 417 women. The American Cancer Society says that currently, only around 20% of those diagnosed with this form of cancer will live for more than five years following diagnosis.
The study by NYU Langone found that bacteria associated with periodontal (gum) disease can find their way into the upper digestive tract, and in the case of one of the types of bacteria in the study, tannerella forsythia, its presence may increase the chances of this kind of cancer by 21%.
It is important to note that while the bacteria involved demonstrates a link between gum disease and esophageal cancer, it has not yet been proven that periodontal disease directly causes this cancer. However, the connection should be reason enough to reinforce the importance of proper oral hygiene and the treatment of gum disease.