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.


Topic

Title and Link

Brief Description

Journal

Date

General

Burden of chronic diseases associated with periodontal diseases: a retrospective cohort study using UK primary care data

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

General

Human variation in gingival inflammation

 

Article: Study reveals new aspects of gingivitis and the body’s response

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

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

General

Periodontal Inflammation Primes the Systemic Innate Immune Response

Provides clinical rationale for perio-systemic disease links

Journal of Dental Research

2020

General 

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

Topic

Title and Link

Brief Description

Journal

Date

Diabetes

Number of teeth and masticatory function are associated with sarcopenia and diabetes mellitus status among community-dwelling older adults: A Shimane CoHRE study

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

Diabetes

The risk of tooth loss in patients with diabetes: a systematic review and meta-analysis

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 

Effect of Diabetes on Rotary Instrumentation of Dentin

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

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

Diabetes

Improved oral hygiene is associated with decreased risk of new-onset

diabetes: a nationwide population-based cohort study

Provides evidence that oral hygiene reduces new onset T2D

Springer Verlag

2020

Diabetes

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

Diabetes 

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

Diabetes

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

Diabetes

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

Topic

Title and Link

Brief Description

Journal

Date

Cardiovascular disease

 

Burden of chronic diseases associated with periodontal diseases: a retrospective cohort study using UK primary care data

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

Cardiovascular disease 

Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study

 

Articles:

·       Severe Periodontal Disease Increases Risk of Acute Myocardial Infarction and Stroke: 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

Cardiovascular disease

Pre-cardiac dental treatment does not increase the risk of adverse events

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

Cardiovascular disease 

 

 

 

 

 

Oral Bacterial Signatures in Cerebral Thrombi of Patients With Acute Ischemic Stroke Treated With Thrombectomy

 

Articles:

·       AHA News: How Oral Health May Affect Your Heart, Brain and Risk of Death

·       Dental cavities can raise risk of heart disease, stroke, according to scientists

 

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

Journal of the American Heart Association

2021

Cardiovascular disease

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

Cardiovascular disease

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

Cardiovascular disease 

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

Cardiovascular disease

Abstract P441: Dental Caries a Risk Factor for Intracerebral Hemorrhage

 

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

Stroke

2021

Cardiovascular disease

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

Topic

Title and Link

Brief Description

Journal

Date

Pregnancy

Adverse pregnancy outcomes and periodontitis: A systematic review and meta-analysis exploring potential association.

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

National Library of Medicine

2016

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

Pregnancy 

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

Topic

Title and Link

Brief Description

Journal

Date

Alzheimer’s Disease and dementia

Dose-Response Meta-Analysis on Tooth Loss With the Risk of Cognitive Impairment and Dementia

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

Alzheimer’s Disease and dementia

Obstructive sleep apnea treatment and dementia risk in older adults

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

Alzheimer’s Disease and dementia 

Association between number of teeth and Alzheimer’s disease using the National Database of Health Insurance Claims and Specific Health Checkups of Japan

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

Alzheimer’s Disease and dementia 

Periodontal dysbiosis associates with reduced CSF Aβ42 in cognitively normal elderly

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

Alzheimer’s Disease and dementia

Periodontal disease and incident dementia: The Atherosclerosis Risk in Communities Study (ARIC)

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

Neurology – American Academy of Neurology

2020

Alzheimer’s Disease and dementia

Clinical and Bacterial Markers of Periodontitis and Their Association with Incident All-Cause and Alzheimer's Disease Dementia in a Large National Survey

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

Journal of Alzheimer’s Disease

2020

Alzheimer’s Disease and dementia

Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors

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

Science Advances -- American Assoc for the Advancement of Science

2019

Alzheimer’s Disease and dementia

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

Topic

Title and Link

Brief Description

Journal

Date

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

Osteoporosis 

Oral implications of osteoporosis

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

Topic

Title and Link

Brief Description

Journal

Date

Kidney Disease

Periodontal Disease and Incident CKD in US Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos

 

Article:  Periodontal disease linked to kidney function decline in Hispanic, Latino patients

 

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

Kidney Medicine

2021

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

Topic

Title and Link

Brief Description

Journal

Date

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

Topic

Title and Link

Brief Description

Journal

Date

Anxiety and Depression

Burden of chronic diseases associated with periodontal diseases: a retrospective cohort study using UK primary care data

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

Anxiety and Depression 

Institutionalized old people, depressive disorders, and dental issues: what is the state of the art?

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

Anxiety and Depression

Relationship between cognitive impairment and oral health: results of the Health 2000 Health Examination Survey in Finland

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

Anxiety and 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

Anxiety and Depression 

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

Topic

Title and Link

Brief Description

Journal

Date

Arthritis

Dental Amalgams and the Incidence Rate of Arthritis among American Adults

 

Articles:

·       New Research Links Dental Amalgam Mercury Fillings To 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

Arthritis 

The oral microbiome in early rheumatoid arthritis patients and individuals at risk differs from healthy controls

 

Articles

·       Do bacteria in the mouth affect arthritis risk?

·       Oral Microbiome Linked to Onset of Rheumatoid Arthritis

 

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

Arthritis

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

Arthritis

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

Arthritis

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

Arthritis

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

Topic

Title and Link

Brief Description

Journal

Date

Cancer

Mouth pathogens may trigger oral squamous cell carcinoma

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

PLOS Pathogen

2020

Cancer

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

Cancer

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

Cancer 

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

Cancer

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

Cancer 

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

Cancer

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,

Biomarkers & Prevention

2017

 

VARIOUS RELEVANT ARTICLES

 

RESEARCHERS EXAMINE THE “ORAL MICROBIOME” TO LOOK FOR CLUES TO CANCER RISK.

 

STUDY: WOMEN WITH PERIODONTAL DISEASE HAD HIGHER RISK OF SEVERAL CANCER TYPES.

 

IN A STUDY, RESEARCHERS FOUND AN ASSOCIATION BETWEEN PERIODONTAL DISEASE, TOOTH LOSS, AND CONDITIONS ASSOCIATED WITH COLORECTAL CANCER.

Topic

Title and Link

Brief Description

Journal

Date

Other connections

Athletics

The impact of oral health on physical fitness: A systematic review

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

Other connections

Asthma

Association between asthma and periodontal disease: A systematic review and meta-analysis

 

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

Journal of Periodontology

2018

Other connections

COVID

Alveolar bone loss and tooth loss are associated with COVID-19 severity but are not independent risk factors. An explorative study

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

Other connections 

Auto-immune

Burden of chronic diseases associated with periodontal diseases: a retrospective cohort study using UK primary care data

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

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.