Dentists and physicians now more clearly understand the correlation and impact that oral health has on systemic health. However, the idea of an oral-systemic link is not new, it has been considered for decades. HBO is about to air the second series of “The Knick” which follows the lives of Dr. John W. Thackery and the staff at a fictionalized version of the Knickerbocker Hospital in New York during the early part of the twentieth century. In season 1 they touched on Dr. Henry Cotton who served as medical director of the New Jersey State Lunatic Asylum between 1907 and 1930. Dr. Cotton routinely practiced “surgical bacteriology” which includes removing potentially diseased parts of the head and body. This particular treatment seemed so scientific and promising that Dr. Cotton pulled more that 11,000 teeth. Dr. Cotton also removed all of his children’s teeth as a precautionary measure. If a patient had their teeth pulled and did not recover, Dr. Cotton interpreted it as a sign that he hadn’t gone far enough. The patient would then have their spleen, stomach and colon removed.
Don’t worry, there is not a dental office in Knoxville that subscribes to Dr. Cotton’s “focal elimination” practices (we hope). However, some dental offices are beginning to understand the very real connection between oral health and systemic health. Current research is allowing us to understand the impact that chronic inflammation, such as that in untreated gum disease, can have on our systemic health. We have found relationships between many systemic health issues and discuss them below.
Human Papilloma Virus (HPV) and Oropharyngeal Cancer
Head and neck cancer, including oral cancer, is the sixth most common cancer in humans worldwide. More than 90% of oral cancers are of squamous cell carcinoma type. Recent studies have shown a strong relationship between human papillomavirus (HPV) infection and head and neck cancer. This relationship is especially strong with oropharyngeal squamous cell carcinoma and oral squamous cell carcinoma.
Diabetes Mellitus and Periodontitis
Periodontal disease is a very commom form of gum disease. Studies have shown a two-way relationship between diabetes and periodontitis. As an infectious process with a prominent inflammatory component, periodontal disease can adversely affect the metabolic control of diabetes.
Cardiovascular Disease (CVD) and Gum Disease
Periodontal infections are a leading culprit for cardiovascular disease, with studies reporting associations between periodontal disease and CVD. More recently we have been able to associate systemic antibodies to selected periodontal pathogens. In the past these associations have not conclusive, however as we learn more about the oral systemic connection we are able to better link the positive associations between periodontal disease and CVD.
The big question now is if the infectious and inflammatory periodontal disease process contribute causally, or are these conditions coincidentally associated to systemic health problems. Continued research and understanding of the human body will better answer this question.
As we make advances in our understanding of the human body, it is redefining the role of the contemporary dental office. Properly trained dentists are able to recognize undiagnosed hypertension or diabetes and make an appropriate referral to a physician for treatment. Dentists are now discussing with their patients the relationship between oral health and systemic health, using scientific evidence as a basis for discussion. The mouth and teeth do not exist independent of the rest of the body. How they are intertwined is now coming into focus. Dentists should not just restore smiles with veneers and whiten teeth. There exists a professional duty to care for the health and wellness of patients, and many dentists are fulfilling this duty.