Oral Health

Evidence that links Oral Health to Overall Health

Oral Health and Overall Health

Regularly scheduled oral evaluations are an extremely important part of your healthcare. 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, like oral cancer, cardiovascular disease, diabetes, hypertension, and even some other cancers of the body. It may surprise you to learn that over 90% of all diseases in your body have effects on your oral health.  Individuals with dental coverage visit the dentist more often and receive the care they need when compared to individuals without coverage. The NADP 2019 Consumer Survey reported 75% of persons with dental benefits have seen a dentist in the past year compared to only 47% of those without dental benefits.

The following studies demonstrate how maintaining oral health lowers health care cost. In addition, recent news articles provide insight into the role oral health plays in maintaining overall health.

Title and Link Brief Description Journal/ Source Date
GENERAL
Dental Services and Health Outcomes in the New York State Medicaid Program 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
Periodontal Inflammation Primes the Systemic Innate Immune Response Provides clinical rationale for perio-systemic disease links Journal of Dental Research 2020
The Missing Link That Connects Gum Disease to Inflammatory Diseases Researchers at the University of Toronto studied the effect of a substance called "polymorphonuclear neutrophils," which can be found in abundance at inflammation sites, including teeth impacted by periodontal disease.  They concluded that the ensuing hyperactive immune system response may contribute to the worsening of other inflammatory conditions.  Genetic Engineering & Biotechnology News 2020
Current Knowledge on Correlations Between Highly Prevalent Dental Conditions and Chronic Diseases: An Umbrella Review Provides support of correlative; not causative perio-systemic links CDC – Systematic Review (Volume 16) 2019
Oral Health: A Window to Your Overall Health Explores connection between oral and overall health. Lists following conditions that can be linked to oral health: Endocarditis, Cardiovascular disease,
Pregnancy and birth complications,
Pneumonia.
Lists conditions that might also affect oral health: Diabetes, HIV/AIDS,Osteoporosis and Alzheimer's disease		  Mayo Clinic. Mayo Foundation for Medical Education & Research 2019
ALZHEIMER'S DISEASE 
Dose-Response Meta-Analysis on Tooth Loss With the Risk of Cognitive Impairment and Dementia Cardiovascular disease Journal of Post-Acute and Long-Term Care Medicine 2021
Obstructive sleep apnea treatment and dementia risk in older adults Pregnancy and birth complications Sleep 2021
Association between number of teeth and Alzheimer’s disease using the National Database of Health Insurance Claims and Specific Health Checkups of Japan Pneumonia PLOS One 2021
Periodontal dysbiosis associates with reduced CSF Aβ42 in cognitively normal elderly Lists conditions that might also affect oral health: Alzheimer’s Association 2021
Periodontal disease and incident dementia: The Atherosclerosis Risk in Communities Study (ARIC) Diabetes Neurology – American Academy of Neurology 2020
Clinical and Bacterial Markers of Periodontitis and Their Association with Incident All-Cause and Alzheimer's Disease Dementia in a Large National Survey HIV/AIDS Journal of Alzheimer’s Disease 2020
Mouse study links chronic periodontitis to Alzheimer's risk Osteoporosis PLOS ONE 2020
Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors Alzheimer's disease Science Advances -- American Assoc for the Advancement of Science 2019
Association between Periodontitis and Alzheimer's Disease 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
ANXIETY & DEPRESSION
Relationship between chronic gingivitis and subsequent depression in 13,088 patients followed in general practices 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
Oral health condition and occurrence of depression in the elderly 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
Dental Amalgams and the Incidence Rate of Arthritis among American Adults 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 oral microbiome in early rheumatoid arthritis patients and individuals at risk differs from healthy controls 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
ARTICLE:  Do bacteria in the mouth affect arthritis risk?  Further insights regarding study above Medicall News Today 2021
Oral Microbiome Linked to Onset of Rheumatoid Arthritis Further insights regarding study above RheumatologyNetwork 2021
Associations of Antibodies Targeting Periodontal Pathogens with Subclinical Coronary, Carotid, and Peripheral Arterial Atherosclerosis in Rheumatoid Arthritis 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
Does Periodontitis Affect the Treatment Response of Biologics in the Treatment of Rheumatoid Arthritis? This study aimed to examine the relationship between the extent of periodontal disease and the treatment response to biologics in Rheumatoid Arthritis patients.  It concluded that periodontal disease may undermine the effectiveness of this common form of arthritis treatment.  Arthritis Research and Therapy 2020
Periodontitis as the risk factor of chronic kidney disease: Mediation analysis Aims to determine sequences and magnitude of causality among perio disease, diabetes and chronic kidney disease Journal of Clinical Periodontology 2019
Oral conditions in renal disorders and treatment considerations – A review for pediatric dentist 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
Periodontal disease and rheumatoid arthritis: the evidence accumulates for complex pathobiologic interactions 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
Article: RESEARCHERS EXAMINE THE “ORAL MICROBIOME” TO LOOK FOR CLUES TO CANCER RISK. What your mouth says about your health American Association for Cancer Research 2021
Article: STUDY: WOMEN WITH PERIODONTAL DISEASE HAD HIGHER RISK OF SEVERAL CANCER TYPES. Assessing Gum Disease and Cancer Risk American Association for Cancer Research 2021
Article: IN A STUDY, RESEARCHERS FOUND AN ASSOCIATION BETWEEN PERIODONTAL DISEASE, TOOTH LOSS, AND CONDITIONS ASSOCIATED WITH COLORECTAL CANCER. Oral Health and Colorectal Cancer Risk American Association for Cancer Research 2021
Mouth pathogens may trigger oral squamous cell carcinoma Evaluates the impact of periodontal disease on the development of oral cancer PLOS Pathogen 2020
Periodontal Disease, Tooth Loss, and Risk of Serrated Polyps and Conventional Adenomas 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
Certain oral bacteria linked to higher risk for esophageal cancer Oral bacteria appeared to be more abundant in patients with esophageal cancer compared with otherwise healthy controls Cancer (American Cancer Society) 2020
ARTICLE, Forbes: Gum Disease and Tooth Loss Linked To Development Of Precancerous Cells In The Gut Past research has been inconclusive as to whether periodontal disease may increase colorectal cancer risk.  This study, considered to be a "large well-designed, prospective study," provides stronger evidence that a link does exist. American Association for Cancer Research 2020
Periodontal Disease Assessed Using Clinical Dental Measurements and Cancer Risk in the ARIC Study 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
Periodontal Treatment in Cancer Patients: An Interdisciplinary Approach 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
Periodontal therapy for patients before and after radiotherapy: A review of the literature and topics of interest for clinicians 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
Periodontal Disease and Incident Cancer Risk among Postmenopausal Women: Results from the Women's Health Initiative Observational Cohort Study findings support the need for further understanding of the effect of periodontal disease on cancer outcomes Cancer Epidemiology, 2017
Biomarkers & Prevention
Tooth Loss, and Conditions Associated with Colorectal Cancer   American Association for Cancer Research  
CARDIOVASCULAR DISEASE
Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study                                                                                                                                   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
ARTICLE: Severe Periodontal Disease Increases Risk of Acute Myocardial Infarction and Stroke: Study Additional insight regarding study listed above. Medical Dialogues 2021
Oral Bacterial Signatures in Cerebral Thrombi of Patients With Acute Ischemic Stroke Treated With Thrombectomy Streptococcal bacteria, mostly of oral origin, may contribute to the progression and thrombotic events of cerebrovascular diseases. Journal of the American Heart Association 2021
ARTICLE: AHA News: How Oral Health May Affect Your Heart, Brain and Risk of Death Dental cavities could significantly increase the risk of a life-threatening stroke from bleeding in the brain, according to new research. American Heart Associatoin News 2021
ARTICLE: Dental cavities can raise risk of heart disease, stroke, according to scientists A new study has revealed that dental cavities could significantly increase the risk of life-threatening stroke from bleeding in the brain. Healthwise 2021
Periodontal Disease, Atrial Fibrillation and Stroke 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
Association Between Periodontitis and Blood Pressure Highlighted in Systemically Healthy Individuals Study aimed to investigate the relationship between periodontitis and mean arterial blood pressure in a sample of otherwise systemically healthy individuals. Hypertension 2021
Abstract P441: Dental Caries a Risk Factor for Intracerebral Hemorrhage Reports a significant association between dental caries and intracerebral hemorrhage (ICH). Stroke 2021
Associations of Antibodies Targeting Periodontal Pathogens with Subclinical Coronary, Carotid, and Peripheral Arterial Atherosclerosis in Rheumatoid Arthritis 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
Pediatric dental infections linked with adult cardiovascular disease Adults are 87% more likely than average to develop subclinical atherosclerosis if they had one of four signs of oral infection as children, and the risk rises to 95% in adults who had all four signs -- bleeding during dental exams, cavities, fillings and pocketing around teeth -- in childhood, according to research published in JAMA Network Open. Hypertension and high body mass index are also associated with poor pediatric oral health, which may be a cause of these health conditions or an indicator of poor nutrition or other causal factors, says Dr. Salim Virani, who wrote an accompanying editorial.  JAMA Network  2019
Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Provides consistent and strong epidemiologic evidence that periodontitis increased risk for future cardiovascular disease Journal of Clinical Periodontology 2013
DIABETES
Implementation of an Oral Care Protocol for Primary Diabetes Care: A Pilot Cluster-Randomized Controlled Trial 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
Regular Dental Appointments Could Help Diagnose Type 2 Diabetes Forbes article highlights how tests performed during a dental visit can help diagnose prediabetes and type 2 diabetes across the world. Original Study:  Clinical Journal of Periodontology  Clinical Journal of Periodontology 2020
Frequent tooth brushing may reduce diabetes risk A study published in Diabetologia found that brushing teeth at least three times a day decreases the risk of developing type 2 diabetes. The findings, based on a cohort of 188,013 diabetes patients from South Korea, also revealed that the presence of periodontal disease and missing teeth were tied to the occurrence of new-onset diabetes after adjustments for demographics, smoking status, regular exercise, alcohol consumption, vascular risk factors, history of malignancy and laboratory findings. Diabetologia 2020
Study links oral health to blood glucose levels in diabetes Patients with type 2 diabetes reduced their HbA1C levels by 7 mmol/mol on average one year after receiving intensive treatment for gum disease, compared with those who received standard care consisting of teeth cleaning and polishing, according to a study in The Lancet Diabetes & Endocrinology. Researchers analyzed 264 diabetes patients with moderate to severe gum disease and noted that intensive periodontal treatment "is similar to the effect that's seen when people with type 2 diabetes are prescribed a second blood glucose lowering drug," said lead researcher Francesco D'Aiuto. The Lancet Diabetes & Endocrinology. 2018
Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies Provides evidence that diabetes increases perio risk National Library of Medicine 2018
The effect of periodontal therapy on glycemic control and fasting plasma glucose level in type 2 diabetic patients 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
Evidence that periodontal treatment improves diabetes outcomes: a systematic review and meta-analysis. Supporting evidence that perio treatment improves T2D control Journal of Clinical Periodontology 2013
Effect of periodontal disease on diabetes: systematic review of epidemiologic observational evidence Provides evidence to suggest that perio disease adversely affects diabetes outcomes Journal of Clinical Periodontology 2013
HYPERTENSION
Study links poor oral health to higher risk of hypertension People with periodontal disease are more likely than those with good oral health to have hypertension, and their blood pressure might not respond well to medication, according to a study published in Hypertension. Physicians and dentists should be aware of the association and monitor patients' blood pressure and oral health accordingly, lead author Davide Pietropaoli said. Hypertension, American Heart Association, volume 72, No. 6 20200
KIDNEY DISEASE
Oral conditions in renal disorders and treatment considerations – A review for pediatric dentists This article reviews the current understanding of the oral and dental aspects of chronic renal disease (CRD). The Saudi Dental Journal 2015
OSTEOPOROSIS
The Association between Bone Mineral Density and Periodontal Disease in Middle-Aged Adults Low bone mass was associated with the risk of Periodontal Disease among young adults International Journal of Environmental Research and Public Health 2021
PREGNANCY
Oral Health in Pregnancy 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
Periodontitis and adverse pregnancy outcomes: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. 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
PSORIASIS
Psoriasis Patients Suffer From Worse Periodontal Status—A Meta-Analysis 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

If you have a study you'd like to share about how maintaining oral health lowers health care cost or even recent news articles provide insight into the role oral health plays in maintaining overall health, please contact us.