Dental Health Week: The connection between oral and general health
As it does every August, the ADA’s annual Dental Health Week campaign turns focus, for both the profession and the general public, onto particular aspects of oral health. This year, the ‘Mind, body, mouth – It’s all connected’ campaign opens up avenues to widen our reach and signify how oral health plays a part in systemic health.
Underpinning the ADA’s campaign has been a summarising of the current evidence base for how six chronic conditions are linked to the mouth. Through the public-facing platform of Teeth.org.au, the ADA has joined with prominent health advocacy and action-based organisations such as Diabetes Australia, Heart Australia and the Australian Medical Association to recognise how all health professionals can highlight the integral role oral health has in overall wellbeing.
Although the links between oral and whole-body, systemic health is now well understood within the profession,the ADA’s annual consumer survey has shown just how little awareness there is in the Australian general public, when it comes to the significance of their mouth health in their longevity and physical welfare.
For example, 65% of Australians identified that they did not know there was a link between their mouth and their body, while one in five Australians are still only brushing once a day, and 75% identified that they rarely or never floss. These findings support and explain the persistent prevalence of periodontitis and dental caries in the community; accordingly, the ADA structured its DHW campaign to prioritise oral health education by providing the same summary of the current evidence to consumers in easy-to-understand language.
But the 2023 campaign does not end here. “There is growing evidence on more links between our oral cavity and systemic health,” says Dr Janani Ravichandran, the ADA’s oral health promoter. “Though the focus has been on six conditions for Dental Health Week this year, there are plenty more conditions with emerging evidence. The aim is to keep educating patients and other health professionals on the links and expand the database as the evidence expands. We want to keep a focus on oral health and ensure people are aware of just how important it is.”
Members have shown their involvement in Dental Health Week through downloading the resource kits available on Teeth.org.au and by organising school trips to provide oral health education with the Brighter Smiles Brighter Futures donations from Colgate. “There were many oral health promotive activities run by our members from visiting pre-schools to refugee playgroups,” adds Dr Ravichandran.
The six chronic conditions linked to oral health
This year, DHW is focusing on the mouth and whole-body connection, considering the proven links between diseases in the mouth and diseases in the body. Bacteria in the mouth can travel to different sites of the body, and inflammation in the mouth can increase overall inflammation throughout a patient’s body. Six conditions have been explored by this year’s DHW campaign in how they link with the mouth:
1. HEART DISEASE
The spread of bacteria from the mouth to the bloodstream can potentially cause inflammation and contribute to the development of cardiovascular problems.
The impact of periodontal disease on insulin resistance and blood sugar control potentially exacerbates diabetic complications. As this year’s resources detail: “severe gum disease is now considered to be the sixth issue with diabetes. It makes controlling diabetes harder and diabetes will make gum disease worse”.
3. ALZHEIMER’S DISEASE
The presence of periodontal pathogens can travel to the brain, trigger an inflammatory response, and contribute to neurodegenerative processes.
4. ADVERSE PREGNANCY OUTCOMES
Maternal periodontal infections and inflammation can increase the risk of preterm birth and low birth weight in infants.
5. LUNG CONDITIONS
The aspiration of oral bacteria into the respiratory tract, potentially causes or exacerbates lung infections and inflammation.
6. INFLAMMATORY BOWEL DISEASE (IBD)
The dysbiosis of oral microbiota may contribute to gut inflammation and the development or exacerbation of IBD.
The common thread of inflammation/inflammatory response is not lost on the academic community, which is teaching our next generation of dental professionals with this firmly in mind.
“Yes, we’re teaching DDS (Doctor of Dental Surgery) and Bachelor of Oral Health students about a number of different systemic interactions,” says Professor Ivan Darby, head of periodontics at the Melbourne Dental School and editor of the Australian Dental Journal.
“Diabetes is the number one, but pregnancy interactions and outcomes are also in there. Outside of these, we even talk about obesity. There is evidence to suggest that people who are obese tend to have more periodontal disease, and this is probably due to underlying inflammatory mechanisms.
“It’s the same with cardiovascular issues and the same with diabetes and rheumatoid arthritis, which we talk about with our students; the same with mental health, which I’ll be presenting on at FDI Congress [next month]. They all have an underlying inflammatory component which may be linked.”
The bacterial nature of periodontic disease is also firmly linked to a number of systemic diseases, backed up by published research that mentions a full spectrum of health issues, says Prof. Darby. “Alzheimer’s disease is a very interesting one indeed: there’s been research showing that one of the main bacteria that causes periodontal disease is found in the brain. This bacteria species has also been found in fatty plaques in cardiovascular disease, in amniotic fluid, as well as in the pathogenesis of rheumatoid arthritis.”
On the other hand, some of the information brought to the fore by this year’s DHW theme is not new at all; instead, it is enjoying a much-needed refresher for both practitioners and patients.
“It takes five to 10 years for the research done in academic circles to translate to the student curriculum,” he says, “but actually, the initial data for cardiovascular disease was published in the late 1980s or early 1990s. So we’ve known about it since then, and the mechanism has really been elucidated. In this case, it’s really come off the boil recently; you can see the number of research papers done on this subject matter has drastically reduced, but it remains something we have to be talking with patients about.”
Collaborate and listen
DHW has given fresh opportunities this month not only to raise awareness of preventive and early detection strategies, but this year’s theme especially highlights professional development and collaboration with other healthcare practitioners.
“There’s no doubt that there’s a need to raise the awareness of all health practitioners and dental hygienist therapists,” says Prof. Darby. “But first and foremost, patients know very little about the relationship between diabetes and oral health, and there’s a need for more education there. My other little bugbear is that it’s extremely difficult to get more general medical practitioners to look in the mouth, or to send a patient with diabetes to see a dentist.”
Helping with professional development, DHW coincides with the release of the first updated Oral Health Consensus Statement since 2009 (for more on the statement, see our story from page 27). This statement is the result of massive collaboration with a group of experts in the oral health space, who in turn engaged extensively with public consultation, to refresh the messaging around the most important actions to take in order to look after oral health and, by extension, general health and wellbeing.
Funded by the ADA and run through the University of Melbourne, the consensus statement project was headed up by Dr Mihiri Silva – a paediatric dentist who understands the power of preventive dentistry through her work at the beginning of the patient lifecycle.
“Child oral health is really important from an Australian population perspective,” says Dr Silva. “Dental causes are among the highest causes of preventable acute hospitalisation of children, and while dental disease in childhood is increasing, it is not only incredibly burdensome for the child but also their family and the community in general.
“Prevention from the very beginning is an important focus of this statement, and there are a number of statements within the consensus statement as a whole that are quite relevant and important from a childhood perspective. As we understand more, we’re getting a full picture of how the first 2,000 days of a patient’s life shapes their later health, so this focus on prevention is really for the entire life course.
“The link between oral health and general health is still underappreciated, I think, and this campaign gives us a huge opportunity for prevention. If people appreciated that connection better, for example, I think that would certainly help reduce the huge problems that I see in clinical practice as a specialist in paediatric dentists. And to have big oral health issues when a patient is young, unfortunately opens the door to all kinds of health problems as they move forward into their adult life.
“Dentists are really supporting programs that help us to address that connection,” continues Dr Silva. “The Medicare CDBS program, for example, has been a really important scheme to support children in the community who need access to care. That gives us the chance to talk with patients and their caregivers about the connection between oral health and systemic health and how that’s really important to childhood when kids are developing. There’s so much growth and development that happens in those early years, and it’s vital to have good oral health from the outset. Understanding how much that can impact wellbeing through the life course really helps us to hammer that point home.”