The Mouth-Body Connection (2016)

Oral health contributes significantly to self-esteem and quality of life. The ability to smile without embarrassment, to articulate speech clearly, to taste and chew food, and to be free of pain are key for well-being. The high prevalence of dental caries (cavities) and periodontal (gum) disease is a major public health concern with attendant costs for treatment, loss of productivity, diminished comfort and function, and increased risks to systemic health.Dental caries is a complex disease process resulting from a shift in the plaque biofilm on teeth in the presence of sugars. The microorganisms in this biofilm produce acids that demineralize the calcified tooth structure and, if the process is not disrupted, teeth are demineralized until a cavity forms. If untreated or uncontrolled, the caries process may affect the dental pulp, or tooth center, which is rich with vascular, nerve, and connective tissue, resulting in pain and infection.Periodontal disease occurs when plaque (the biofilm with bacteria) is inadequately removed, and destructive inflammation results, affecting the soft and hard tissues (bone) supporting the teeth. Gingivitis is characterized by swelling and bleeding of the gingival tissues. When the inflammatory process progresses from gingivitis to periodontitis, it affects the periodontal ligament (the tissue that attaches the teeth to the bone) and the alveolar bone (the bone that supports the teeth), and can lead to recession, tooth mobility, and eventual tooth loss. Periodontitis affects more than 60 percent of older adults and is severe in 10 percent to 15 percent (Chapple and Genco, 2013). The bacteria, inflammatory mediators (molecules that play a role in inflammation), and antibodies that contribute to periodontitis enter the circulatory system and are carried to other parts of the body (Borgnakke, 2015); this represents a biologically plausible contributing factor to many systemic diseases.Several studies have identified associations between oral health and chronic systemic dis- eases. According to the Centers for Disease Control and Prevention (CDC), chronic diseases such as cardiovascular disease, stroke, diabetes, arthritis, and cancer are responsible for 70 percent of U.S. deaths (CDC, 2016a). The complex associations between chronic systemic diseases and oral disease include common risk factors such as high sugar consumption, obesity (Slotwinski and Slotwinski, 2015), smoking, shared inflammatory pathways, access to the bloodstream via ulcerations of inflamed epithelium (Borgnakke, 2015), medications that increase the risk of oral diseases, and diminished function required to maintain oral health.Data from a large insurance database showed high medical costs and frequent hospitalizations to be common in patients with diagnoses of type 2 diabetes, cerebrovascular disease, rheumatoid arthritis, or coronary artery disease and periodontal disease. Patients with these comorbidities who received periodontal therapy at least four times per year were compared with those who did not. The treatment group (approximately 1 percent) had significantly fewer hospital admissions and significantly lower medical costs than the non-treatment group for diabetes, cerebrovascular disease, and coronary artery disease (Jeffcoat et al., 2014).The Periodontal Disease and Diabetes ConnectionThere is a public health imperative to conduct prevention and intervention programs for diabetes because there are more than 29 million people with diabetes and 86 million who are pre-diabetic in the United States, at a cost of $245 billion per year and a 50 percent increase in risk of death (CDC, 2016b). People with diabetes are at greater risk of developing periodontal disease and at risk for more severe disease. A bi-directional relationship between periodontal disease and diabetes is well established (Chapple and Genco, 2013). Poorly controlled diabetes increases the risk of periodontal disease, and the presence of periodontal inflammation contributes to poor glycemic control, the risk of developing type 2 diabetes, and diabetic complications (Chapple and Genco, 2013; Borgnakke, 2015). …