Critical Thinking About Oral-Systemic Health by Susan Maples, DDS, MSBA, PLLC

It’s time for those of us in the oral healthcare profession to help our patients cope with a looming crisis. According to a Global Burden of Disease study, people’s years of health are decreasing, and the incidence of disease worldwide is increasing.1

By using the mouth as a window to reveal early signs of disease in the rest of the body, we’re in an ideal position to help reverse the population’s steadily declining health.

When most dentists and hygienists think about the connections between oral and systemic health, they recall that periodontal disease is somehow linked to increased risk of heart attack and stroke. While it’s true that periodontal and periapical infection can act as a portal for some dangerous strains of bacteria to enter the bloodstream and find a new home in blood vessel walls and other vital organs, that’s just the beginning of the life-threatening maladies we can predict and pre-empt.

Here are a few other examples:

Diabetes/prediabetes
Insulin resistance, a chronic inflammatory condition and precursor to Type 2 diabetes, affects about 150 million Americans. The Centers for Disease Control and Prevention has predicted that one in three U.S. adults will be diabetic by 2050.

We have a huge opportunity to help if we learn to recognize signs of hyperglycemia in the mouth before patients lose eyesight, a kidney or a limb. Uncontrolled diabetes exacerbates periodontal disease progression and vice versa—the infection increases the challenge for diabetic patients to achieve glycemic control.

Oral Cancer
Persistent HPV infection from oral sex has replaced tobacco as the greatest risk factor for oral/pharyngeal cancer. This cancer is most often found not on the lateral tongue or floor of the mouth, but beyond the tonsillar pillars, making it hard to spot. We can detect the presence of the most threatening strains of HPV from a single drop of saliva and, if the infection persists, can help design a personalized approach to cancer screening for early detection.

Depression
In any given year, 14.8 million U.S. adults have clinical depression, which impairs mood, thoughts, behavioral patterns and the desire/ability to care for oneself, including the teeth. Depression has a higher fatality rate than breast cancer, and because we establish regular six-month relationships with our patients, we can often spot the signs of depression from the hygiene chair.

Obstructive sleep apnea (OSA)
The American Sleep Apnea Association reports that 22 million U.S. adults suffer from OSA, which can wipe years off your life and wreak havoc on the quality of life. Memory loss, increased risk of motor vehicle accidents and difficulty losing weight pale in comparison to the increased risk of atrial fibrillation, hypertension and heart attack. We can look in the mouth and spot risk factors, make referrals for diagnosis, and help our patients return to good health with CPAP or oral appliances.

Acid Reflux
From 1976 to the present, the incidence of reflux diagnosis has grown from 10 percent of the adult population to 40 percent. Stomach acid severely reduces the pH of the mouth and can be easy to spot. Early detection of “silent” symptoms—before the patient experiences mucosal changes such as heartburn—can prevent further risk of developing Barrett’s esophagus and esophageal cancer.

Erectile dysfunction
Chronic inflammation from periodontal disease damages the integrity of the vascular endothelium, the inner wall of blood vessels. Several studies have linked periodontal infection to a reduction in penile rigidity. A study in the American Journal of Periodontology reports that men are half as likely to receive preventive dental visits, and of the 64 million Americans with periodontal disease, 56 percent are men.