Recently in practice, a new patient came in with her family for evaluation and hygiene. After the appointment, mom inquired about the health benefits of different home care products. She wanted to ensure that she was providing her children with safe and healthy products. She was appropriately concerned about her one child missing several teeth and another with very poor oral hygiene and an early onset of gingivitis. She turned to me and very bluntly asked, “Do you really think it makes such a big difference what is going on in their mouths? I’m missing a few teeth . . . big deal. I use Colgate and get fluoride and I’m fine. How much does this all really matter?”
This conversation begins by investigating the link between our oral cavities and our bodies. Is there such a link? Can our lifestyle and over-all health affect our oral health? Perhaps more pertinent remains the question, does our oral health impact our systemic health? Dental fluorosis is a well-documented link between our systemic ingestion and our teeth; excessive intake of fluoride damages tooth development causing yellowing of teeth, white spots, and pitting or mottling of enamel. Researchers in Ireland have demonstrated tooth wear higher amongst those with fluorosis than those without. Japanese researchers decided to examine mineral deficient individuals. They were given magnesium, zinc, fluoride, calcium, and phosphorous in set ratios. Researchers discovered that not only the mineral density and mechanical strengths of their bones were significantly increased but of the dentition as well.
As we broaden our investigation to look beyond teeth, the connection becomes even more apparent. Early childhood malnutrition and salivary gland hypo function are associated in rural Haitian children. Sadly, not only is salivary quantity reduced, but the quality as well. With malnutrition, minimized buffering capacity in stimulated saliva is documented. This will lead to increase risk of cavities and gum disease. Taking this idea one step further, Pacific University in San Francisco looked at the effect of a nutritional supplementation on gum disease. Supplements containing some of the basic vitamins present in a multivitamin formula (vitamins A, C, E, B6, B12, folate, zinc, selenium, and copper) and several natural ingredients known to exert anti-inflammatory and antioxidant effects are beneficial as an adjunct to therapy in the management of periodontal disease.
Scientists in Chile began to record a person’s symptoms elucidated after periodontal treatment. They are able to show increased systemic inflammatory response to periodontal therapy. A closer look at the relationship between lifestyles and health in Southwestern Japan evaluates the effects of oral symptoms on mortality. This study reveals that some oral symptoms are independent predictors for coronary heart disease, cerebrovascular disease, and pneumonia; subjects complaining that their ‘mouth feels sticky' compared to those without this symptom had a higher risk of pneumonia. An increased risk of pneumonia was also observed among subjects complaining of ‘difficulty in chewing'. Men aged 50-59 years, complaining of ‘difficulty in chewing' or ‘bleeding gums', had a higher risk of cerebrovascular disease. While the underlying pathophysiologic mechanisms are unclear, several studies have suggested a chronic, sub-acute inflammatory state contributes to systemic disease; implicated in the pathogenesis and etiology of cardiovascular disease. Further insight was given with a rural community in West Virginia where nearly half of the population of adults and children reported not flossing regularly. Their flossing habits were related to blood pressure, cholesterol indices, immune system function, and blood sugar levels. In children, signaling molecules for the immune system were associated with flossing habits.
It is also widely recognized that periodontal infection is a significant risk factor for patients with diabetes. The presence of untreated or poorly controlled periodontal infection impacts negatively on the course of glucose control in diabetics. The chronic inflammation associated with periodontitis is associated with insulin resistance and must be addressed. Periodontitis patients also appear to suffer from liver injuries including steatosis, inflammation and necrosis. We know that proper oral hygiene promotes healing of periodontitis. A recent study was done; hypothesizing that adequate oral hygiene may offer clinical benefits in healing of not only periodontitis, but also periodontitis-induced liver injuries. It is very interesting to notice that when periodontitis rats were tested, mechanical stimulation by tooth brushing promoted healing of periodontitis-induced liver injuries via suppressing the increase in serum lipopolysaccharide concentration, which occurs in periodontitis. Mechanical stimulation of the gums not only serves to improve their periodontal disease but their liver function as well.
Periodontitis may increase the likelihood of having pre-term, low-birth-weight babies. Osteoporosis and osteopenia are less well understood, but merit further consideration particularly when patients present with advanced periodontitis in the presence of decreased bone density. Japanese researchers have suggested that spatial learning and memory is decreased by tooth loss in rats. Naturally, further study is needed to better understand underlying pathophysiologic processes, and the interactions with psychosocial, behavioral, and socioeconomic mediators of health. Systemic health is intimately related to oral health and quality of life. Retaining one's natural teeth improves the quality of the life by sustaining the ability to chew and digest food and by improving one's ability to interact socially with their peers.
Progress has led to the development of new treatment plans and products that have greatly benefited a patient's ability to control their disease. Comparing the periodontal disease status and cavities experience of individuals that lived during the nineteenth century in relation to the current prevalence from the adult population in the U.S., I expected to see marked improvement. Much to my chagrin, the collection of skulls assessed by the University of Pittsburgh revealed that Americans between the ages of 16 and 39 have the same prevalence of caries and periodontal disease as they did 150 years ago. Clearly there is a challenge to initiate preventive based treatments to maintain long-lasting health. These treatments, to be successful, must be holistic in nature and individualized to each patient. Gum disease improves dramatically after patients are supplied with a detailed instruction and training to assist in education and compliance. Successful therapy is dependent on anti-infective procedures aimed at eliminating pathogenic organisms found in dental plaque associated with the tooth surface and within other niches in the oral cavity. Anti-infective therapy includes both mechanical and chemotherapeutic approaches to minimize or eliminate bacterial plaque, the primary etiology of gingivitis and periodontitis.
Most patients are not skilled in mechanical plaque removal indicating professional cleaning almost universally to sustain long-term stability of the periodontium. Very few patients can maintain periodontal health over a lifetime without the benefit of regular dental care. Mechanical therapy consists of debridement of the roots by the meticulous use of hand or power-driven scalers to remove plaque, endotoxin, calculus and other plaque-retentive local factors. Tooth brushing combined with flossing results in significant reductions in gingivitis compared to tooth brushing alone. Clinical trials show up to 40% reductions in plaque between the teeth with flossing relative to brushing alone. A battery-operated flossing device is safe and effective when used properly and demonstrates great promise as an alternative to manual floss. Numerous studies have demonstrated that power toothbrushes can provide improvements in patient oral hygiene including post brushing and at diurnal plaque re-growth periods – viz. overnight and in afternoon re-growth.
However, clinical signs of disease activity persist following thorough mechanical therapy, such as increased pocket depths, loss of attachment and bleeding on probing. Deeper investigation is needed; augmenting scaling and root planning with adjunctive antimicrobial agents to control the bacteria, parasites, and fungus that can inhibit our mouths. Daily irrigation, using a powered irrigation device, with an antimicrobial agent, is very useful for decreasing the inflammation associated with gingivitis and periodontitis. Clinically, significant changes in probing depths and attachment levels are not usually expected with irrigation alone. Nonetheless, research validates that, when daily irrigation with antimicrobial rinse was added to a regular oral hygiene home regimen, a significant reduction in destructive changes to inflamed tissues and bone resorption occurs. Oral irrigation is an integral addition in regular oral hygiene. Enamel decalcification during orthodontic treatment is an important concern associated with poor oral hygiene. There is considerable evidence to show that oral hygiene status is significantly improved when therapeutic mouth rinses are added into daily oral hygiene measures
Very high concentrations of numerous pharmaceutical drugs are required in order to obtain bactericidal activity against many of the known periodontal pathogens. Chlorhexidine digluconate must be in contact with bacteria for ten minutes while Povidone iodine five minutes. Triclosan has good antimicrobial effects when exposed to biofilms for an adequate period of time to penetrate and kill pathogens. The nature of different ingredients was not intended to fall under the scope of this article. Nonetheless, it is important to highlight the concerns pertaining to the ingredients. The mouth-body relationship is understood and it is opportune to understand the health risks of some of the substances. Triclosan, as an example, is a chemical found in most over the counter oral hygiene products. It is used for its anti bacterial qualities. The United States Environmental Protection Agency has registered it as a pesticide and gives high scores both as a human health risk and as an environmental risk. This chlorophenol is suspected of causing cancer in humans. Externally, phenol can cause a variety of skin irritations, but since it can temporarily deactivate sensory nerve endings, contact with it may cause little or no pain. Taken internally, even in small amounts, phenol can lead to cold sweats, circulatory collapse, convulsions, coma and death. Additionally, chlorinated hydrocarbon pesticides can be stored in body fat, sometimes accumulating to toxic levels. Long-term exposure to repeated use of many pesticide products can damage the liver, kidneys, heart and lungs, suppress the immune system, and cause hormonal disruption, paralysis, sterility and brain haemorrhages.
Additionally, the shotgun bactericidal approach destroys the beneficial bacteria which occur naturally in the environment and in our bodies. These so-called friendly bacteria cause no harm and often produce beneficial effects such as aiding metabolism and inhibiting the invasion of harmful pathogens. Anti-microbial formulas and disinfectants can also cause genetic mutations resulting in drug-resistant bacterial and mutant viruses, producing new strains of harmful microbes for which the human immune system has no defense. Moreover, all natural essential oil/herbal rinses can be effective in reducing gingival inflammation and plaque in adult patients in addition to reducing whole mouth malodor. The essential oil/herbal extract rinse was significantly more effective than chlorhexidine in reducing malodor after a single rinse. It is so important to investigate the ingredients found in oral hygiene products and make prudent decisions.
Locally applied antimicrobial therapy is often insufficient in preventing, arresting, or reversing the associated systemic infection. No oral preventive program can completely control or eliminate the pathogenic plaques associated with periodontal diseases for extended periods of time. These pathogens are contagious, quite virulent, and can be found throughout the body. Ideal overall hygiene is critical. Balancing stress, nutrition, sleep, and exercise are the fundamental pillars of a strong vital force. Several modalities should be considered. Classical homeopathy can help the body deal with all chronic imbalances. Visiting a homeopath will not rid a person of their mechanical obligation but can reduce their susceptibility to pathogens and disease. Genetic susceptibility to periodontal disease cannot be discounted and is responsible for at least some disease occurrence. Nutritional consultation definitely shapes a treatment plan. The link between nutrition, the oral cavity, and systemic health has been well established in this article.
Traditional Chinese Medicine believes that kidney weakness is the main reason causing periodontitis. Bushenguchiwan is a Chinese Herbal medicine, which is put on record of the Chinese Pharmacopoeia (2000) and has contributed to improved kidney function and gum disease. Agrisept-L is formulated to maintain flora and fungus balance in the body for an overall sense of wellness every day. An all-natural non-toxic product, 100% citrus extracts: grapefruit seed extract, lemon seed extract, tangerine seed extract, orange and lime seed extract in a base of vegetal glycerin. Oil of oregano is another natural antimicrobial agent. Teeth and gums actually benefit greatly from oral application of oregano oil since it destroys the bacteria that form plaque and cause gum disease. You may put a drop or two under the tongue and then swish it around in your mouth before swallowing or put a drop on your toothbrush when you clean your teeth. This can provide both the local and systemic actions of the oil. Extracts of Green Tea, Galla Rhois, and pine needles have been shown to possess anti-cariogenic properties and anti-periodontal efficacies. These plant extracts inhibit the activity of matrix metalloproteinases which are involved in many inflammatory conditions such as periodontal diseases. It could prove beneficial to include the anti-inflammatory properties of these purified polyphenols in our hygiene products.
Attention to detail, patient compliance and proper selection of adjunctive antimicrobial agents for sustained plaque control are important elements in achieving successful long-term results. Frequent re-evaluation and careful monitoring allows the practitioner the opportunity to intervene early in the disease state, to reverse or arrest the progression of periodontal disease with meticulous nonsurgical anti-infective therapy. With the acknowledged link between mouth and body, we must all ensure to optimize our oral health and systemic health while maintaining an informed position towards what we ingest in our bodies.
References
Factors Associated with Enamel Fluorosis in the Republic of Ireland D. BROWNE, H. WHELTON, E. CROWLEY, D. O'MULLANE, M. HARDING, H. GUINEY, M. CRONIN, E. FLANNERY, and V. KELLEHER, University College Cork, Ireland
Factors affecting Toothwear in the Republic of Ireland M. HARDING, H. WHELTON, D. O'MULLANE, E. CROWLEY, D. BROWNE, H. GUINEY, M. CRONIN, E. FLANNERY, and V. KELLEHER, University College Cork, Ireland
Effect of Mg/Zn/F-CaP on BMD of ovariectomized rats Y. TOKUDOME1, M. OTSUKA1, A. ITO2, and R. LEGEROS3, 1Musashino University, Tokyo, Japan, 2National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki, Japan, 3New York University, USA
Relationship of Early Childhood Protein-Energy Malnutrition and salivary gland hypofunction R.P. SAINT JEAN1, W.J. PSOTER1, B.J. GEBRIAN2, S.E. PROPHETE3, and R.V. KATZ1, 1New York University, USA, 2Haitian Health Foundation, Jeremie, Haiti, 3State University of Haiti, Port-au-Prince, Haiti
Effects of Nutritional Supplementation on Periodontal Parameters and C-Reactive Protein L. HARPENAU, A. CHEEMA, J. ZINGALE, D. CHAMBERS, and W. LUNDERGAN, University of the Pacific, San Francisco, CA, USA
Effect of periodontal therapy on systemic markers of inflammation N.J. LOPEZ, A. QUINTERO, M.S. HIDALGO, and C. VALENZUELA, University of Chile, Santiago, Chile
Prospective study of oral symptoms and mortality in Japan R. IDE1, T. MIZOUE2, Y. FUJINO1, T. KUBO3, T.-M. PHAM1, K. SHIRANE1, I. OGIMOTO4, N. TOKUI1, and T. YOSHIMURA5, 1University of Occupational and Environmental Health, Japan, Kitakyushu, Japan, 2International Medical Center of Japan, Tokyo, Japan, 3Asahi Kasei, Miyazaki, Japan, 4Kurume University, Japan, 5Fukuoka Institute of Health and Environmental Sciences, Japan
Dental Health, Cardiovascular Disease and Inflammation in Adults and Children C.B. CHAMBERS1, S.J. FRISBEE2, J.C. FRISBEE2, and R.J. CROUT1, 1West Virginia University School of Dentistry, Morgantown, USA, 2West Virginia University School of Medicine, Morgantown, USA
Effects of SDD on Local Biomarkers in Diabetics with Periodontitis M.E. RYAN, O.I. CARNU, R. TENZLER, J. FARRELL, and H. AHN, Stony Brook University, NY, USA
Mechanical Stimulation of Gingiva Heals Liver Injuries in Rat Periodontitis T. YAMAMOTO1, T. TOMOFUJI1, D. EKUNI1, R. YAMANAKA1, T. AZUMA1, T. SANBE1, N. TAMAKI1, T. WATANABE1, M. MIYAUCHI2, and T. TAKATA2, 1Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan, 2Hiroshima University, Graduate School of Biomedical Sciences, Japan
Influence of tooth loss on spatial learning ability in rats K. YAMAZAKI, T. SUZUKI, T. KOBAYASHI, T. OHKUBO, J. FURUYA, and N. WAKABAYASHI, Iwate Medical University, Japan
Oral Health Assessment in the US within 150 Years E. ROSE, and A. VIEIRA, University of Pittsburgh, PA, USA
Effects of Sonicare Toothbrush in Slight to Moderate Chronic Periodontitis G.J. CHAE1, J.Y. HONG1, H.S.YOO1, S.W. JUNG1, S.H. CHOI1, C.K. KIM1, and D. STURM2, 1Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, K, South Korea, 2Philips Oral Healthcare, Snoqualmie, WA, USA
Unsupervised Use of Expanded Polytetrafluoroethylene Floss on Gingivitis R.W. GERLACH1, R.D. BARTIZEK1, R.E. AVILA1, A.J. HAMILTON1, P. ODONOGHUE1, and L. ARCHILA2, 1The Procter & Gamble Co, Mason, OH, USA, 2University of Texas - San Antonio / Health Science Ctr, USA
Comparative Plaque Removal with 4 Different Dental Flosses G.T. TEREZHALMY1, S. BSOUL2, A.R. BIESBROCK3, R.D. BARTIZEK3, and R.W. GERLACH3, 1The University of Texas Health Science Center at San Antonio Dental School, USA, 2The University of Texas Health science Center at San Antonio Dental School, USA, 3The Procter & Gamble Co, Mason, OH, USA
Evaluation of an Automated Flossing Device: A Randomized Controlled Trial A.L. HAGUE, M. CARR, and R.G. RASHID, The Ohio State University, Columbus, USA
Power Toothbrush Efficacy in Control of Dental Plaque M. KLUKOWSKA, D.J. WHITE, M.L. BARKER, and R.D. BARTIZEK, The Procter and Gamble Company, Mason, OH, USA
Anti-plaque Effectiveness of an Essential Oil Mouthrinse on Orthodontic Patients E. TUFEKCI1, Z. CASAGRANDE2, S.J. LINDAUER3, C. FOWLER2, and K. WILLIAMS1, 1Virginia Commonwealth University, Richmond, USA, 2Virginia Commonwealth University - VCU/MCV, Richmond, USA, 3Virginia Commonwealth University VCU/MCV, Richmond, USA
Full Mouth Disinfection with Subgingival Irrigations by Pvp Iodine 10% I. VOZZA1, F. FAILLA1, R. DI GIORGIO2, A. QUARANTA2, L. RISPOLI1, and G. POMPA2, 1University of Rome La Sapienza, Italy, 2UNIVERSITY OF ROME "LA SAPIENZA" AT ISERNIA, roma, Italy
Effect of Essential Oil Herbal Mouth Wash on Gingival Health H. MALMSTROM, R. CACCIATO, M. YUNKER, and Y. REN, University of Rochester Eastman Dental Center, NY, USA
Effect of an Essential Oil Herbal Mouthwash on Oral Malodor H. MALMSTROM, R. CACCIATO, M. YUNKER, and Y. REN, University of Rochester Eastman Dental Center, NY, USA
Purified Plant Polyphenols Inhibit Matrix Metalloproteinases W.K. KIM-PARK, M.J. KOWOLIK, K.K. PARK, and L.J. WINDSOR, Indiana University, Indianapolis, USA
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