Why it is important to prioritise oral health?

Most of us often completely ignore our oral health, giving it no particular importance in the general well being of our body. It is not until a tooth begins to ache considerably that we find a reason to visit a dentist. However, that is not the only reason why you should consider giving your oral health a genuine thought. Maintenance of the oral hygiene practices and a regular check up may help prevent many systemic complications that might otherwise seem unrelated to the mouth. Today’s article discusses just that.

image source: https://gently.curaden.com/the-mouth-is-the-gateway-to-the-whole-body/

Oral cavity is a gateway to the body and also serves as a mirror that reflects the internal status of the body’s health. It is the most used organ of the body and hence, understandably, requires an additional effort for its maintenance. 

The most common ailment of the oral cavity is the inflammation of the soft tissues supporting the teeth, known as Periodontitis. It is believed to be caused by an imbalance between the symbiotic bacterial species comprising the gingival microbiomes.

The periodontopathogenic microbiota such as Porphyromonas gingivalis, Fusobacterium nucleatum, Prevotella intermedia, Actinobacillus actinomycetemcomitans and Treponema denticola cause the destruction of the periodontal tissues by way of release of various inflammatory mediators like cytokines (IL-1,IL-6, IL-8), tumour necrosis factor (TNF-a) and prostagandins.

These mediators, not only affect the tissues locally, but also in the chronically inflamed tissues, they cause the breakdown of the connective tissue attachment and may invade the systemic circulation and get attached to distant anatomic sites within the body. Such bacterial invasions act as nidi of inflammatory processes and may either aggravate an existing complication or else, may invoke a de novo medical condition.

The common oral condition of periodontitis, which most often goes unnoticed and is overlooked by the patients seems to have a relationship with many serious and potentially threatening disorders such as Diabetes Mellitus, Alzhiemer’s Disease (AD), Adverse Pregnancy Outcomes (APO) and Aspiration Pneumonia. 

Diabetes and Oral Health

Periodontal infection can have an adverse impact on the glycemic control, compromising the diabetic state of the affected individuals. The incidence and severity of diabetes is high and much compounded, if it co exists with periodontal disease. Periodontal infections are characterised by a localised chronic state of bacterial overload in and around the supporting structures of the teeth. This localised condition can be translated into a more generalised state under the influence of heavy bacterial plaques in the gingival biofilm.

There have been multiple studies which have proved that the HbA1c levels have been substantially high(>9.0%) among the non diabetic individuals in presence of periodontitis (subjects having pocket depths 3.5-5.5mm). Treatment of periodontitis is associated with reductions in the overall HbA1c levels (0.4%). This is self explanatory to the direct relationship of the oral health status with the diabetic status of the individual.

Alzheimer’s Disease linked to Oral Health

Another very serious condition that can be linked to the periodontal status of the patient is Alzheimer’s disease. It is a neuro-degenerative disease that has its onset in the elderly (mostly commonly in patients nearing the age of 85). The disorder is characterised by the gradual degeneration of synapses and diminution of the neurotransmitters due to the deposition of beta amyloid in the brain tissues. Histopathologically, Treponema denticola is found in the isolates of CSF from patients of AD. This pathogen is also periodontopathogenic and can be isolated from the deep gingival pockets. It is thus suggested, that these pathogens can invade the BBB through the systemic circulation and might be implicated in the pathogenesis of AD.

Another suggested link of periodontal disease and AD might be the increased freight of inflammatory cytokines that are released in response to the high microbial load in the periodontal pockets. These inflammatory mediators are present in the systemic circulation and may eventually cross the Blood Brain Barrier (BBB) and lead to intense inflammatory response in the neuronal tissues which might start a degenerative response

https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&volume=12&issue=1&page=DE01&issn=0973-709x&id=11045

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488989/#idm140129771119824title]

Maternity and Oral Health

Not just the above mentioned medical complications, but also the physiological state of pregnancy is adversely affected by periodontitis. Preterm birth, low birth weight and pre eclampsia are the common complications that might be associated with pregnancy if compounded with periodontitis. Preterm birth is the commonest cause of neonatal deaths (in the first 4 weeks of life) and low birth weight (neonates born with <2500g) has a very high proclivity of premature deaths. The mortality rate for these individuals is 10-40 times higher than those born with a normal weight. Pre eclampsia is a multi system disorder characterised with elevated blood pressure and proteinuria after 20 weeks of gestation. The elevated inflammatory overload of the periodontal tissues due to the high bacterial plaques, leads to the release of cytokines and prostaglandins in the systemic circulation which breaks the homeostasis at the materno-fetal interface, prohibiting the immune privileges of gestation, leading to fetal losses. The evidence of a direct link of the periodontal pathogens in APOs is derived from the analysis of the isolates of amniotic fluid which reveals serotypes of the pathogens like P. gingivalis and F. nucleatum. These bacterial species are found in close association with the oral microflora, however, they cannot be obtained from the gastrointestinal tracts, leading to direct causal relationship between periodontitis and APOs.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4310218/]

Such disorders are completely unrelated to the oral cavity and yet it might boggle someone that they are so closely related to an oral condition that is so prevalent worldwide (it affects 20-25% of the global population) and so nonchalantly overlooked. Oral cavity is the gateway to the body in true sense in that all the complex activities initiate in this cavity. It is the portal of entry into the body and therefore, the a healthy mouth reflects a healthy body. 

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