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The Oral-Systemic Link

Fact: bacterial conditions in the mouth can adversely affect the entire body.

New information about this "oral-systemic link" is changing the way dentists, doctors and patients view oral health. We know now that oral infections have a role in heart disease and stroke, diabetes, respiratory illness and pregnancy outcomes.

Periodontal disease is now the most common cause of tooth loss in adults and affects about 75% of the population in North America and without effective methods of control, this number is expected to increase. A more disturbing fact is that untreated periodontal disease generates a destructive immune response that elevates systemic inflammation and that gingivitis may be as damaging as periodontitis. As bacteria accumulate on the surfaces of the teeth, they form sticky, durable, reef-like colonies. When biofilm is left undisturbed, a group of virulent anaerobic species emerge that activate the host immunoinflammatory processes. Although these bacteria initiate periodontitis, it appears that host modifying risk factors contribute to the severity and extent of the disease.

Anti-inflammatory substances are produced by the immune defence system and these chemicals find their way to other parts of the body. These substances are seen as the trigger that increases chronic systemic illnesses. As the stages of periodontal infection continue, tiny ulcerations allow bacteria to enter the blood stream and travel throughout our body. This stimulates white blood cells to fight the invasion of microorganisms. Chemicals are released intended to destroy the invading foreigners but these same chemicals can also damage the tissues.

It is increasingly apparent that we have to find new approaches to the treatment and control of periodontal disease. New research in 2011 found that various types of periodontal pathogen spirochetes were detected in the brains of patients suffering from Alzheimer's Disease. The Lancet published a 2008 study showing that after controlling for smoking and other risk factors, periodontal disease was statistically significantly associated with an increased risk of lung, kidney, pancreatic and hematopoietic cancers. Further, literature published in 2013 supports a bidirectional relationship between chronic kidney disease and periodontal disease. As dental professionals, we are obligated to meet the challenge to keep our patients orally and systemically healthy.

"Forget "minimal invasive" or "minimal intervention" dentistry. We do not want to do the minimal amount. We do not want to "watch and wait". We need to properly diagnose, assess risk, and proactively intervene before the situation requires more extensive treatment. Welcome to the concept of Proactive Intervention Dentistry.


"Proactive Intervention Dentistry gives us the tools to do our part in creating a healthy mouth within a healthy body. In this way, we as dentists contribute to the overall well-being of our patients. We are instrumental in enhancing their active lifestyle of relationships, physical activity, family and friends. We have reconnected the body parts and we have reconnected dentistry with its medical source. The patient is the ultimate winner."

Fay Goldstep DDS, FACD, FADFE
ORAL HEALTH: Editorial, December 2010

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