Why Oral Health?
“More subtle and sinister are the medical consequences of PD, in which PD might set the stage for the patient’s experiencing diabetes mellitus, respiratory disease, stroke and myocardial infarcts.” JADA, Vol. 138 http://jada.ada.org September 2007 29S
Periodontal disease is one of the most common diseases among man. Dentists are no longer the only health professionals urging their patients to follow an oral health regime. Mounting evidence is emerging from various studies showing a distinct, positive link between oral health and systemic health. The consensus is widespread, and comes from studies ranging from those conducted in an academic environment, to those financed with corporate funds by insurance giants like Aetna and Blue Cross Blue Shield.
According to the National Center for Health Statistics, the six leading causes of death in the United States in 2005 were as follows:
1.) Heart Disease (652,091 deaths)
2.) Cancer (559,312)
3.) Stroke/cerebrovascular diseases (143,579)
4.) Chronic lower respiratory disease (130,933)
5.) Unintentional accidental injuries (117,809)
6.) Diabetes (75,119)
Five of these chronic diseases have been linked to periodontal disease. Therefore, it is imperative to manage and improve oral health in order to concurrently promote and advance overall health.
It is especially important for the elderly to adopt a thorough and complete oral health regime. This is because studies have shown a drastic increase in the prevalence of periodontitis as age increases. Statistics compiled by Brown and Loe found that 36% of the adult population over the age of 19 has some degree of periodontal disease . The number dropped to 29% when considering only those between the ages of 19 and 24, and increased to 44% in the population over the age of 45. Results from a national survey conducted by the Center for Disease Control (CDC) showed an astonishing 89% of 80-year-old participants reported attachment loss ≥ 3 mm—a sign of periodontitis.
How can simple bacteria in the mouth pose such a threat to overall health? The answer lays not in the bacterial biofilm so much as the body’s host response to it. When excess plaque accumulates, it becomes a prime location for harboring bacteria. As the bacterial levels continue to rise, it initiates the body’s auto-immune response. This inflammatory response produces cytokines and enzymes that have a destructive effect on the surrounding periodontal tissue. This can lead to detachment, the formation of deep pockets, and even bone loss if left untreated.
If bacteria still persist, they may enter the connective tissue and then the blood circulation, causing a systemic inflammatory response. This initiates a chain of events that inspire action from the liver and lymph nodes. Several different antibodies and biomarkers are released into the bloodstream that target the infection sight and are involved in fighting the bacteria.
The products of the pro-inflammatory response are associated with the diseases listed above. Evidence has shown that certain inflammatory biomarkers reach high levels years in advance of a patient’s first heart attack. These same markers were also shown to be highly predictive of a second heart attack, stroke, and death due to cardiovascular disease (CVD) .
Systemic inflation also has a very high association with Type 1 and Type 2 diabetes. In cases of diabetes, like in cases of CVD, certain biomarkers have been shown to be a predictor of developing the disease later on. One example is white blood cell levels. Over a period of 20 years, those with white blood cell counts in the highest tertile were more likely to develop Type 2 diabetes. Systemic inflation may also lead to insulin resistance, which is also associated with Type 2 diabetes.
There has been another distinct link between oral health and respiratory disease. The oral cavity can serve as a reservoir for bacteria. These bacteria can be easily aspirated into the lungs, making infection more likely. This is especially common in patients with diminished swallowing capacity.
To combat the obvious health risks that accompany periodontal disease, a specific oral health regime must not only be established, but also carried out on a regular basis. A study done by Loe et al. in 1965 showed that students who abstained from practicing oral hygiene for 10-21 days developed marginal inflammation of the gingiva (or gingivitis) due to plaque accumulation. The study also found that once oral hygiene was reestablished, health of the gingiva returned, eliminating the inflammation.
This is vital to the understanding of oral health for two reasons. For one, it shows that after a mere 10 days, poor oral hygiene can have a negative impact on the surrounding gum and tissue. As previously stated, this inflammation marks the beginning of a very destructive process, which can lead to the aggravation or worsening of several serious chronic diseases. The second important aspect worth noting is that the inflammation was relieved after re-introducing an oral health practices. In short, with the absence of an oral health regime, periodontal disease may start to develop in a little over a week. This phenomenon can be easily quelled by reintroducing oral hygiene. This study has shown that for the preventative effects and positive overall health benefits to take hold, oral health must be maintained on a consistent and regular basis.
If a patient is able to do this, the positive impact can be astounding. Not only can health be improved, but there are positive financial implications as well. Recently, insurance giant CIGNA conducted a study in tandem with several distinguished doctors from the likes of the University of Pennsylvania School of Dental Medicine and University at Buffalo Schools of Dental Medicine. Their main purpose was to analyze the effects oral health may have on reducing health care costs, to determine if adding dental care to diabetic patients’ plans would prove economical.
Their main concern was saving money, and maintaining oral health proved a viable option for doing just that. The study found that diabetic patients who received an initial treatment for gum disease and subsequent maintenance after that had lower overall costs than those who did not receive the regular maintenance. These savings were on average 23 percent, or $2,483 lower each year per patient.
“With the increase in the prevalence of diabetes, and great concern for our ever-increasing medical costs, this study suggests that periodontal therapy may help reduce the disease burden, as well as medical costs of treatment for patients with diabetes,” said Dr. Robert Genco.
After the findings, CIGNA launched its “Oral Health Integration Program.” Currently, health care insurance customers who have certain conditions, like diabetes, are now eligible for a complete reimbursement of any out-of-pocket costs related to sustaining oral health with no increase in premium rates. These procedures may include periodontal scaling, root planning, and any other type of maintenance. The program is expanding to include more conditions, and more customers.
WHY ORAL HEALTH?
Janeway C, Traveres P, Walport M, Shlomchik M. Immunobiology. The immune system in health and disease. 5th Edition. Garland Publishing, New York; 2001:44
Christan C, Dietrich T, Hagewald S, Kage A, Bernimoulin JP. White blood cell count in generalized aggressive periodontitis after non-surgical therapy. J Clin Periodontol 2002;29:201-206.
Ridker PM, Silvertown JD. Inflammation C-reactive protein, and atherothrombosis. J Periodontol 2008;79:1544-1551.
Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. C-reactive protein interleukin 6, and risk of developing type 2 diabetes mellitus. JAMA 2001;286:327-334.
Loe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol 1965;36:177-187.
