Oral & Overall health

Evidence that links Oral Health to Overall Health

Regularly scheduled oral evaluations are an extremely important part of your overall healthcare.  There are several reasons this is true.

First, oral exams allow your dentist to monitor your oral and overall health for emerging problems that you may not see or feel. These may be dental conditions, like tooth decay, gingivitis, and periodontal disease, or emerging medical conditions that have oral manifestations, like oral cancer, cardiovascular disease, diabetes, hypertension, and even some other cancers of the body. During a dental evaluation, your dentist may recognize these oral manifestations and refer you to a healthcare professional for evaluation, diagnosis, and treatment.

Second, many health conditions, medications, and treatments can negatively impact your oral health.  It is important to understand which conditions, medications, and treatments can put your oral health at risk. Through regular dental visits, you can better manage these risks.

Third, dental disease, most notably periodontal disease, has been linked to a broad spectrum of health conditions. The following are recent studies that are beginning to clarify the nature of the oral-systemic connection.

Last update: 9/16/22

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General

General

This study aims to investigate the link between oral health and mortality in community-dwelling older adults by adjusting for confounding factors with a doubly robust survival estimation. Edentulism was associated with a reduction in survival time.

American Journal of Preventive Medicine

2022

Time-varying periodontal status assessed using radiographic alveolar bone loss (ABL) was positively associated with all-cause mortality even after confounder adjustment.

Journal of Clinical Periodontology

2022

Preventive dental care is strongly associated with significant savings for diabetes and CAD patients, and such savings were highest for diabetes + CAD patients, followed by patients with only CAD and only diabetes. Most of these savings originated in costs associated with inpatient admissions, which were between 25% and 36% for all disease classifications for all years.

Compendium of Continuing Education in Dentistry

2022

Maintaining oral health is essential to general health and well-being. Oral conditions affect more than just the mouth and teeth. Poor oral health increases the risk of developing chronic conditions, such as cardiovascular disease and diabetes.

Pharmacy Times

2022

In this cohort, periodontal diseases appeared to be associated with an increased risk of developing cardiovascular, cardiometabolic, autoimmune diseases and mental ill health. Periodontal diseases are very common; therefore, an increased risk of other chronic diseases represent a substantial public health burden.

BMJ Journals

2021

Sheds important new light on why some people may be more prone to serious conditions that lead to tooth loss and other problems.

PNAS

2021

Observed that accessing preventive dental care by a large cohort of publicly insured individuals in New York State was associated with better health care outcomes, most notably for the rates and costs of inpatient admissions.

Journal of Dental Research

2021

Provides clinical rationale for perio-systemic disease links

Journal of Dental Research

2020

Provides support of correlative; not causative perio-systemic links

CDC – Systematic Review (Volume 16)

2019

Diabetes

Diabetes

T1DM negatively affected enamel and dentine microhardness, and enamel was influenced much more negatively and rapidly compared with dentine in diabetic groups.

Archives of Oral Biology

2022

Preventive dental care is strongly associated with significant savings for diabetes and CAD patients, and such savings were highest for diabetes + CAD patients, followed by patients with only CAD and only diabetes.

Compendium of Continuing Education in Dentistry

2022

The findings suggest that T2D is associated with increased risk of tooth loss.

BMC Endocrine Disorders

2022

Frequent tooth brushing was associated with reduced risks of incident hypertension and T2DM. Tooth brushing at least twice a day may prevent future hypertension and T2DM events.

Journal of Hypertension

2022

Findings suggest that improvement in oral health, including the maintenance of masticatory function and remaining teeth, may contribute to the prevention of sarcopenia and diabetes mellitus in older adults.

PLOS One

2021

There is moderate certainty for a small but significantly higher risk of tooth loss in Diabetes patients as compared to those without Diabetes.

International Journal of Dental Hygiene

2021

Diabetes mellitus may affect the physical and mechanical properties of dentin, which could potentially have an impact on root canal procedures.

Journal of Endodontics

2021

Implementation of an oral care protocol in primary diabetes care improved oral health–related quality of life in patients with type 2 diabetes

Annals of Family Medicine

2021

Provides evidence that oral hygiene reduces new onset T2D

Springer Verlag

2020

In this systematic review and meta-analysis, there is a significant reduction of Glycated hemoglobin and Fasting plasma glucose level on type 2 diabetic and periodontal patients with non-surgical periodontal therapy.

BMC Oral Health

2016

Supporting evidence that perio treatment improves T2D control

Journal of Clinical Periodontology

2013

Provides evidence to suggest that perio disease adversely affects diabetes outcomes

Journal of Clinical Periodontology

2013

Cardiovascular disease

Cardiovascular Disease

The authors histologically revealed the association of periodontitis with atrial fibrosis. This indicates that periodontitis, which is modifiable, is likely a risk factor for atrial fibrillation.

Journals of the American College of Cardiology

2022

Periodontal status was associated with incident heart failure, heart failure with preserved ejection fraction, and heart failure with reduced ejection fraction, as well as unfavorable changes in C-reactive protein and congestion.

JACC: Heart Failure

2022

Preventive dental care is strongly associated with significant savings for diabetes and CAD patients, and such savings were highest for diabetes + CAD patients, followed by patients with only CAD and only diabetes.

Compendium of Continuing Education in Dentistry

2022

We found that periodontal care was associated with more after acute myocardial infarction (AMI) visits. This suggests that there is a benefit to incorporating oral health care and medical care to improve AMI outcomes.

Journal of the American Dental Association

2022

Adults with a recorded diagnosis of a periodontal disease, including gingivitis and periodontitis, are more likely to develop CVD and other chronic diseases compared with patients without a diagnosis.

Healio

2022

Study concluded that specific oral bacteria are associated with baseline blood pressure status and risk of hypertension development among postmenopausal women.

Journal of the American Heart Association

2022

Frequent tooth brushing was associated with reduced risks of incident hypertension and T2DM. Tooth brushing at least twice a day may prevent future hypertension and T2DM events.

Journal of Hypertension

2022

Intensive gum disease treatment failed as a measure of secondary prevention for stroke survivors in the "stroke belt" of the U.S., a randomized study found.

PREMIERS

2022

This study aimed to evaluate the causal association of periodontal disease with acute myocardial infarction (AMI) and stroke, after controlling for various confounders among the Korean population. Our data confirmed that severe periodontal disease was causally associated with the new events of AMI and stroke.

Journal of Dental Research

2021

The results of this study suggest that elimination of oral infection prior to cardiovascular surgery does not increase the risk of morbidity or mortality.

Journal of Oral and Maxillofacial Surgery

2021

Streptococcal bacteria, mostly of oral origin, may contribute to the progression and thrombotic events of cerebrovascular diseases.

Journal of the American Heart Association

2021

Those who kept up with routine dental care had lower risks of atrial fibrillation than those who only went to the dentist when they experienced discomfort or needed dental work or who failed to keep a regular appointment schedule

American Heart Journal

2021

Study aimed to investigate the relationship between periodontitis and mean arterial blood pressure in a sample of otherwise systemically healthy individuals.

Hypertension

2021

Rheumatoid arthritis (RA) patients have elevated rates of perio and cardiovascular disease, suggesting that their immune responses to gum disease bacteria may be linked to higher heart disease risk.

Arthritis and Rheumatology

2020

Reports a significant association between dental caries and intracerebral hemorrhage (ICH).

Stroke

2020

Provides consistent and strong epidemiologic evidence that periodontitis increased risk for future cardiovascular disease

Journal of Clinical Periodontology

2013

Pregnancy

Pregnancy

Systematic review supports a low but existing association between perio and adverse pregnancy outcomes

National Library of Medicine

2016

In this article we describe the importance of the recognition, prevention, and treatment of oral health problems in pregnant women.

Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN)

2016

Aims to assess epidemiological evidence for the impact of perio disease on adverse pregnancy outcomes and identify potential underlying mechanisms.

Journal of Clinical Periodontology

2013

Alzheimer’s Disease and dementia

Alzheimer’s Disease and Dementia

Poor periodontal health and tooth loss appear to increase the risk of both cognitive decline and dementia. However, the available evidence is limited to draw firm conclusions.

Journal of the American Geriatrics Society

2022

This review suggests that periodontal infection is associated with Alzheimer’s Disease. The contributing microbiome remains unconfirmed, possibly because of different microbiome sampling sites or methods.

Journal of Dental Sciences

2022

The findings provide a theoretical basis for the study of the relationship between F. nucleatum and AD and lay a preliminary foundation for further exploring the mechanism of F. nucleatum impact on the onset and development of Alzheimer’s Disease

Frontiers

2022

Moderate-quality evidence suggested tooth loss was independently associated with cognitive impairment and dementia; risk of diminished cognitive function increased with incremental numbers of teeth lost. Further, timely prosthodontic treatment with dentures may reduce the progression of cognitive decline related to tooth loss.

Journal of Post-Acute and Long-Term Care Medicine

2021

PAP treatment and adherence are independently associated with lower odds of incident AD diagnoses in older adults. Results suggest that treatment of OSA may reduce the risk of subsequent dementia.

Sleep

2021

The results of the present study using Japanese dental claims data showed that older people visiting dental offices with fewer teeth present and a greater number of missing teeth are more likely to have Alzheimer’s disease.

PLOS One

2021

To our knowledge, this is the first report of an association between subgingival periodontal bacteria and CSF biomarkers of AD pathology in cognitively normal elderly people. We found that subgingival periodontal dysbiosis characterized by increases in periodontal‐associated bacteria and decreases in health‐related bacteria associated with reduced CSF Aβ42 but not with CSF P‐tau.

Alzheimer’s Association

2021

Supports a modest association between perio disease and incidence of mild cognitive impairment and dementia

Neurology – American Academy of Neurology

2020

This study provides evidence for an association between periodontal pathogens and AD, which was stronger for older adults.

Journal of Alzheimer’s Disease

2020

Evaluates the mechanisms underlying the potential link between perio disease and Alzheimer’s disease

Science Advances -- American Assoc for the Advancement of Science

2019

Evaluates the potential link between perio disease and Alzheimer’s disease with goal of identifying novel mechanisms and interventional strategies to improve patient outcomes

NIH – US Library of Medicine

2015

Osteoporosis

Osteoporosis

Low bone mass was associated with the risk of Periodontal Disease among young adults

International Journal of Environmental Research and Public Health

2021

Evidence from (97) prospective studies supports the contention that individuals with osteoporosis may be at increased risk for the manifestations of oral osteoporosis; however, such risk is not definitively proven.

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

2005

Kidney Disease

Kidney Disease

Found that select measures of periodontal disease were associated with incident low estimated glomerular filtration rate (eGFR)

International Journal of Environmental Research and Public Health

2021

This article reviews the current understanding of the oral and dental aspects of chronic renal disease (CRD).

The Saudi Dental Journal

2015

Psoriasis

Psoriasis

The aim of this meta-analysis was to quantitatively evaluate whether the periodontal status of psoriasis patients is worse than that of nonpsoriasis subjects.

Frontiers in Medicine

2019

Anxiety and Depression

Anxiety and Depression

The purpose of this systematic review and meta-analysis was to assess the prevalence of psychological disorders in patients with temporomandibular disorders (TMDs). Patients with TMDs who seek clinical care show a high prevalence of depression and somatization.

The Journal of Prosthetic Dentistry

2022

In this cohort, periodontal diseases appeared to be associated with an increased risk of developing cardiovascular, cardiometabolic, autoimmune diseases and mental ill health.

BMJ Open

2022

The present study identified that there is a communication between some oral health conditions (xerostomia and tooth loss) and the prevalence of depressive disorders in institutionalized old people.

SciFlo Brazil

2021

Cognitively impaired subjects among older adults in Finland have more carious teeth, are more often edentulous without using a denture, and have poorer denture hygiene than cognitively healthy persons.

Taylor and Francis Online

2021

There was a positive and significant association between chronic gingivitis and depression in the overall sample. These findings were corroborated in men and women and in all age groups except patients 65+ years.

Journal of Psychiatric Research

2021

The results of our study have shown that among people aged 65 and over, the severity of depression increases with a higher number of missing teeth, the number of decayed teeth, as well as prevalence of oral dryness.

Medicine

2018

Arthritis

Arthritis

This hypothesis-testing study evaluated the relationship between mercury (Hg)-based dental amalgams and arthritis diagnoses among US adults. A significant association between dental amalgam filling surface (DAFS) and arthritis risk and a dose-dependent DAFS associated immune-stimulation / immune-suppression with arthritis risk were observed.

Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders

2021

The results show similarities in the oral microbiome between ERA patients and at-risk individuals, both presenting with increased relative abundance of potentially pro-inflammatory species compared to healthy controls, suggesting a possible association between the oral microbiome and RA onset.

Arthritis Rheumatol

2021

Rheumatoid arthritis (RA) patients have elevated rates of periodontal and cardiovascular disease, suggesting that their immune responses to gum disease bacteria may be linked to higher heart disease risk.

Arthritis and Rheumatology

2020

Aims to determine sequences and magnitude of causality among perio disease, diabetes and chronic kidney disease

Journal of Clinical Periodontology

2020

This article reviews the current understanding of the oral and dental aspects of chronic renal disease (CRD).

Saudi Dental Journal (republished on US National Library of Medicine -- NIH)

2015

Evaluates the potential link between perio disease and rheumatoid arthritis with goal of identifying novel mechanisms and interventional strategies to improve patient outcomes

NIH – US Library of Medicine

2013

Cancer

Cancer

Evaluates the impact of periodontal disease on the development of oral cancer

PLOS Pathogen

2020

Concludes that a history of perio disease and possibly higher number of tooth loss may modestly increase the risk of developing colorectal precursor lesions.

American Association for Cancer Research

2020

Oral bacteria appeared to be more abundant in patients with esophageal cancer compared with otherwise healthy controls

Cancer (American Cancer Society)

2020

Provides additional evidence that cancer risk, especially for lung and colorectal cancer, is elevated in individuals with perio disease.

Journal of the National Cancer Institute

2018

Provides a review of the literature to determine the relationships between dental care in the cancer patient to provide strategic suggestions.

NIH -- US Library of Medicine

 

2018

Reviews appropriate care strategies (perio maintenance, extractions) before and after head and neck cancer treatment and strategies to prevent osteoradionecrosis.

NIH -- US Library of Medicine

 

2018

Study findings support the need for further understanding of the effect of periodontal disease on cancer outcomes

Cancer Epidemiology, Biomarkers & Prevention

 

2017

Other Connections

Other Connections

Oral health problems may have numerous effects on general health, including physical fitness and performance. In this review, we aimed to systematically review the available evidence to assess the effect of oral health on general physical fitness.

Heliyon

2020

Data from this systematic review strongly suggest the association of asthma with periodontal disease.

Journal of Periodontology

2018

In this retrospective explorative pilot study, alveolar bone loss and tooth loss are associated with the severity of COVID-19, however they are not independent risk factors.

Advances in Oral and Maxillofacial Surgery

2021

In this cohort, periodontal diseases appeared to be associated with an increased risk of developing cardiovascular, cardiometabolic, autoimmune diseases and mental ill health.

BMJ Open

2022

The purpose of our study was to explore further the association between chronic periodontitis and glaucoma in a retrospective case-control study design.

Investigative Ophthalmology and Visual Disease

2022

(Saudi) children with Celiac Disease had a greater number of clinical findings of recurrent aphthous stomatitis (RAS) and dental enamel defects (DEDs) than healthy controls.

BMC

2022

We found that an increase in BMI was associated with a decrease in the number of residual teeth from younger ages independently of smoking status and diabetes in the large scale of Japanese database.

Plos One

2020

Combined symptom and microbiome evaluation may help in the early detection of pancreatic cancer.

World J Gastroenterol.

2020

According to the results, periodontitis has been shown to be associated with mild-to-moderate obstructive sleep apnea (OSA), but not with severe OSA.

Journal of Clinical and Experimental Dentistry

2022

Patients with hemophilia have an increased risk of developing dental caries.

European Journal of Dentistry

2022

Oral health may be impaired in these patients related to the disease itself, due to cytopenia, or related to the drugs the patients use, such as glucocorticoids.

Pediatric Dental Journal

2022

Lack of dental care during inpatient stays may be responsible for hundreds of thousands of hospital-acquired infections each year, including nonventilator hospital-acquired pneumonia, which can be fatal in up to 30% of infected patients, especially those lying flat or staying immobile for long periods of time. A greater focus on brushing patients' teeth regularly during hospital stays is needed, some experts say.

Kaiser Health News

2022