Oral Health: Your First Line of Defense

Oral Health: Your First Line of Defense

Oral Health: Your First Line of Defense

The McAlvany Health Alert


            The terms "oral health" and "general health" should not be interpreted as separate entities.  Oral health is integral to general health and is essential to the overall health and wellbeing of all individuals.  The early identification of oral disease may contribute to the early diagnosis and treatment for a number of systemic diseases.

            Oral health means more than healthy teeth.  The word "oral" refers to the mouth which includes not only the teeth, gums, and supporting tissue, but also the hard and soft palate, the mucosal lining of the mouth and throat and tongue, the lips, the salivary glands, the chewing muscles and the jaw.  The salivary glands are a model of other exocrine glands, and an analysis of saliva can provide clues of overall health or disease.  A thorough oral examination can detect signs of nutritional deficiencies as well as a number of systemic diseases, including infections, immune disorders, injuries and some cancers.

            Microbial infections, including those caused by bacteria, viruses, and fungi, are the primary cause of the most prevalent oral diseases.  Periodontal diseases have been linked to a variety of conditions with systemic implications.  Studies have demonstrated an association between periodontal diseases and cardiovascular disease, stroke, diabetes, osteoporosis, HIV, and adverse pregnancy outcomes.

Some of the "Systemic Diseases" related to oral health are:

Cardiovascular Disease and Stroke:  Bone loss in the portion of the jaw containing tooth sockets (a measure of periodontal disease) is a significant predictor of chronic heart disease.  Bacteria found in periodontal disease can also lead to blood clots, a condition that occurs during heart attacks.  According to the National Institute of Dental and Craniofacial Research, people with periodontitis may be more likely to develop cardiovascular disease.

Diabetes:  Diabetes manifests orally and is recognized by the U.S. Centers for Disease Control and Prevention (CDC) as the fourth leading cause of death in America.   High blood sugar helps bacteria grow, which can lead to gum disease.  Red, sore and bleeding gums are the first sign of gum problems, which can lead to periodontal disease.

Osteoporosis:  Signs of osteoporosis, a condition affecting more than 20 million people in the United States, can also be detected through oral examinations and dental x-rays.  There is a strong relationship between bone metabolism and oral health.  Routine dental x-rays could be used to screen for bone loss.

HIV/AIDS:  A disease which often manifests itself first in the mouth is HIV/AIDS.  Inflammation of the gums and lesions are often present.  Spontaneous bleeding is a frequent finding.  These can be precursors of periodontal disease.

Pregnancy:  Periodontal disease has been linked to premature births and under-weight babies.  Researchers estimate that as many as 18 percent of the 250,000 premature low-weight infants born in the United States each year may be attributed to infectious oral disease.  Elevated levels of hormones in expectant mothers may cause the gums to react differently to the bacteria found in plaque, which can cause gingivitis.  This excessive bacteria can travel to the uterus, triggering other health conditions.


            The mouth is colonized by hundreds of different bacterial species that inhabit dental plaque.  These species form firm clusters adhering in layers to oral surfaces that are not easily eliminated by the body's natural immune responses, and must be mechanically removed.  Bacteria beneath the gums, or gingiva, have been reported to be involved in numerous systemic diseases.  Dental plaque becomes more difficult to remove as it matures, forming a harder substance called calculus, which must be removed professionally by a dentist. 

            A clean mouth contains several hundred billion bacteria, and this number increases tenfold when the mouth is not sufficiently cleaned.  Using saliva and gingival fluid as their main nutrients, bacteria inhabit tooth surfaces, gingival crevices, saliva, the tongue, and the oral mucosa, threatening oral and systemic health.  Oral health care, primarily mouth cleaning, is an important component of a healthy lifestyle.

            Dental decay occurs when the plaque bacteria on the tooth surface produce acid following the consumption of carbohydrates.  These acids cause demineralization of the tooth.  Between meals, saliva normally replenishes the tooth minerals.  When fermentable carbohydrate foods are eaten frequently, acidic saliva is sustained for a period of time, resulting in a net loss of minerals from the tooth and possible cavity formation.

            Gingival disease, or gingivitis, occurs when bacteria and dental plaque cause an inflammatory reaction in the gums that cannot be defended by the body's immune response.  Clinical signs of gingivitis include local redness, swelling , bleeding, and visible pus. 

            Gingivitis can be divided into two categories:  1) that affected by local factors such as plaque; and 2) that affected by local factors and modified by systemic inflammatory factors found in the host.  If left untreated, gingivitis can progress to periodontal disease, or periodontitis.

            Periodontal infections most often involve anaerobic bacteria that discharge various compounds such as hydrogen sulfide, ammonia, amines, and toxins that elicit an inflammatory response.  Periodontal disease can cause loss of periodontial tissue, pocket formation, and loosening and loss of teeth.  This condition may be painless until its later stages, when abscesses, bleeding gums, and bad breath may occur.  Your susceptibility to periodontal disease is affected by numerous factors, including genetics, immune health, and inflammatory status.

            Periodontitis can cause tooth loss and may thus compromise your health by making eating difficult.  Individuals who cannot chew or bite comfortably are less likely to consume high-fiber and nutrient-rich foods such as fruits and vegetables, thereby reducing their intake of essential nutrients.  Thus, periodontitis may affect nutritional status and food selection, which can have very harmful effects on the body's general health.


            Periodontitis is a chronic inflammatory oral disease that affects approximately 75% of US adults.  It is known to have harmful effects on overall health, due to the accumulation of oral gram negative bacteria and resultant inflammatory mediators that enter the bloodstream.  Periodontitis has been shown to predispose people to diabetes, insulin resistance, respiratory diseases, rheumatoid arthritis, obesity, osteoporosis, complications of pregnancy and cardiovascular diseases such as atherosclerosis, heart attack, congestive heart failure, and coronary artery disease.  Some of these conditions may in turn increase the incidence and severity of periodontal disease by modifying the body's immune response to periodontal bacteria and their byproducts.  Thus, an increasing body of evidence suggests a bidirectional relationship between periodontitis and systemic diseases.

            People with periodontitis have increased levels of inflammatory markers in their blood.  These occur when pathogenic bacteria and their byproducts and cytokines enter the circulation from the periodontal lesion, stimulating the liver and white blood cells to increase their production of inflammatory proteins such as C-reactive protein, inflammatory cytokines (IL-1 beta, tumor necrosis factor alpha, and IL-6), blood coagulation and adhesion factors, and increased blood lipid levels.  These blood markers were associated with an increased risk of developing cardiovascular and other diseases.

            Periodontal pathogenic bacteria have been recovered from atherosclerotic plaques and major arteries, and may directly affect blood platelet activation and aggregation, causing the initiation and progression of atherosclerosis.  A direct relationship between periodontitis and thickening of the cartid artery ahs also been reported.


            Gingivitis, periodontitis, and an increase in decayed, filled and missing teeth have all been associated with excess body weight and obesity.  Conditions associated with obesity, including syndrome X, insulin resistance, hypertension, and type II diabetes, may also worsen periodontitis.  Moreover, research has established links between periodontitis and increased fat levels in the blood, which have serious negative impacts on overall health.

            Periodontitis has been called "the sixth complication of diabetes mellitus" as it is twice as prevalent in diabetic individuals as in non-diabetics.  Experimentally produced periodontitis has been shown to increase blood glucose levels in uncontrolled diabetic animals, and it may increase insulin resistance in diabetic patients.  One study demonstrated that the treatment of periodontitis using systemic antibiotics in addition to mechanical cleaning improved levels of glycated hemoglobin, a measure of long term blood glucose control.  Periodontitis is characterized by the loss of oral bone and soft tissue attachments to the tooth.

            Studies have reported significant relationships between periodontitis and systemic bone metabolism, and investigators have suggested different theories.  Some believe that poor bone metabolism may predispose the host to periodontitis or modify its progress.  Others believe that poor systemic bone metabolism may initiate periodontitis.  Both theories suggest that nutrition is an important modifiable factor in bone mass development and maintenance, osteoporosis prevention and treatment, and periodontal disease prevention.  Dietary calcium may affect oral health, with some studies reporting tht calcium supplements improve periodontal condition.


            Researchers have found the pregnant women with periodontitis were 7.5 times more likely to have a preterm low birth weight infant than were unaffected pregnant women.  Other researchers report that the risk of preterm birth is directly related to the severity of periodontitis.  It has also been suggested that periodontal pathogens may disseminate systemically and gain access to the fetal environment.  Early intervention studies of patients at risk for periodontitis and adverse pregnancy outcomes, including low birth weight infants, are ongoing in several cities.  Early data indicate that periodontal therapy administered to pregnant mothers with periodontitis can reduce the incidence of preterm low birth weight deliveries.  Thus, oral health care is a crucial component of comprehensive prenatal health care.

            Female hormone levels play a role in determining periodontal health.  Estrogen deficiency is a risk factor for periodontal health.  Estrogen deficiency is a risk factor for periodontal disease, and also plays a role in the increased risk of osteopenia and osteoporosis in women.  Studies have reported that estrogen users had more teeth remaining than nonusers.  Women using hormone replacement demonstrated decreased indicators of gingivitis and periodontitis severity compared to estrogen deficient females.  Oral and eathing changes during pregnancy have been documented for many years, and gingivitis and pyogenic granulomas (small, reddish bumps on the skin that bleed easily due to an abnormally high concentration of blood vessels) often accompany pregnancy.  Oral contraceptives have also been shown to cause periodontal destruction.

            Studies have suggested a relationship between poor oral health and respiratory infections and compromised lung function.  The increased presence of decayed, missing, and filled teeth has been found to increase pulmonary impairment.  One study found a nearly fivefold increase in chronic respiratory disease in subjects that had poor oral hygiene when compared to those with good oral hygiene.  Periodontal bacteria have also been cultured from infected lung fluids and lung tissues.

            Oral health may likewise be related to joint health.  People with moderate to severe periodontitis have been found to be at increased risk of suffering from rheumatoid arthritis.  The relationship between periodontitis and rheu;matoid arthritis may be due to the common underlying systemic dysregulation of the inflammatory response.


            Lifestyle factors may play a role in promoting oral health.  Physical activity in the form of walking has been shown to benefit periodontal health.  Smoking, stress, depression, and alcohol consumption are risk factors for periodontal disease as well as for heart disease and diabetes.

            The scientific community has shown renewed interest in the relationship between nutrition and oral infectious diseases.  Nutrition significantly influences the immune response and the integrity of the hard and soft tissues of the oral cavity.  Nutritional deficiencies may play a role in the incidence and severity of periodontal disease.  Conversely, nutritional deficiencies may play a role in the incidence and severity of periodontal disease.  Conversely, nutritional supplementation may improve treatment outcomes in periodontal disease, and may also be beneficial in addressing associated systemic diseases.

            Treatment of gingivitis and periodontal disease includes:  1) removal of bacteria by mechanical cleaning; 2) training of patients to maintain optimal oral hygiene; 3) dietary evaluation, nutritional counseling, and/or supplementation; 4) immune system support; and 5) using the best available oral health care products.  This comprehensive approach will help to prevent oral disease and related systemic illnesses (Nelson Wood, DMD, DSc., MS, Writing in Life Extension magazine, Nov. 2004).



            The latest word is that gum disease is associated with an increased tendency for blockages in the carotid arteries which upwardly traverse the neck to feed the brain.  A stroke (or heart attack) can be caused by significant partial arterial blockage due to thickening plaque that breaks off and flows to a smaller vessel which obstructs blood flow to the brain.  Since gum disease has recently been associated with increased buildup of plaque in the carotid arteries, it is possible that a person lax about his or her oral hygiene is at greater risk for stroke.  At an annual meeting of the American Academy of Neurology, Dr. Mitchell Elking, assistant professor of neurology at Columbia University College of Physicians and Surgeons in New York made his case along with his colleagues.  "If the association proves true, it may be that antibiotic treatment of periodontal disease could have a role to play in preventing stroke and heart disease"  said Elking.

            In a study of 62 people (averaging 66 years of age, those with the most diseased gums also tended to have the greatest amount of plaque in their carotid arteries.  Using ultrasound to measure thickness of the buildup in the carotid artery, Elking and associates found that the plaque thickness of those with the most severe gum disease was more than 50% greater than those with the healthiest gums.  This thicker plaque build-up was an increased risk of stroke.  Periodontal gum disease is in effect a chronic low-grade infection.  Becasue it develops gradually, it generally is not though of as a serious health threat.  But because gums and teeth involve such a significant area of tissue and bone, periodontal disease allows bacteria and toxic inflammatory compounds to gain access to the bloodstream.  Once in the blood vessels, bacteria insult the lining of the blood vessels, which makes the lining more susceptible to plaque formation and buildup.  This situation can increase risk of stroke.  Other research supports the periodontal-stroke connection as well.  At the University of Heidelberg in Germany, researchers found that people who experience a stroke are more than twice as likely as other neurology patients to have a history of chronic bronchitis or periodontal disease.


            There hasn't always been a willingness to consider far ranging connections between oral health and the overall health of the body.  But epidemiological analysis has indicated that there is a highest correspondence between periodontal disease and conditions such as arthritis, endocarditis, metabolic disorders such as diabetes, female hormonal alterations, hematologic disorders such as leukemia, and immune system disorders, strokes, pneumonia, and premature births.  Systemic disease has commonly been associated with periodontal disease with the connection historically viewed as a one-way street.  Periodontal disease was presumed an associated result of particular systemic disease.  But these disordered relationships are increasingly being seen as two way streets now that periodontal disease seen as two way streets now that periodontal disease may be contributing to and/or causing systemic disease.

            Dr. Robert Genco, presented a study at the international Association for Dental Research meeting in Orland, Florida.  He found that "people with periodontal disease are 2.7 times as likely to suffer a heart attack as those with healthy gums."  Allowing for factors such as age, sex, weight, cholesterol, and high blood pressure, as well as diabetes and insulin use, explained Dr. Genco, "we found that among the sample population under age 60, gum disease was an even more important risk factor for cardiovascular disease than was high blood pressure."

            More and more dentists are prescribing antibiotics for those undergoing dental work who have artificial heart valves or even artificial joints.  Some are even prescribing antiobiotics for those who have a predisposition for heart valve disease, including mitral valve prolapse.  The reason:  Periodontal bacteria may enter the bloodstream during dental work and result in serious infections that can even be life threatening for those who are vulnerable.

            Diabetics are predisposed to bacterial infections, including those of the upper alimentary canal including the oral area.  Periodontal problems have been known to worsen in diabetics.  Recent studies strongly indicate that periodontitis can make diabetes worse.  This is because diabetics with advanced periodontitis are not easily able to maintain normal blood sugar levels.  Bacteria thrive on sugars.  When diabetics are treated for periodontal disease, the need for insulin may be lessened.  There is a growing belief that a better diabetic protocol includes treatment for periodontal inflammations to the point of elimination.  There is growing evidence that doing so can help reduce the injury to eyes and arteries that is a common result of diabetes.

            Pneumonia is a bacterial infection of the airways; the infection is started with either new bacteria are introduced into the lungs or when bacteria (that live in the mouth or throat) are inhaled into the lungs.  If immune function is normal, your body's defenses will normally take care of invading bacteria.  When compromised (as in diabetes for example), the results can be pneumonia.  Not surprisingly the causal bacteria can survive and multiply in the respiratory system when periodontal infection has the upper hand.  This is also true of other disease causing bacteria such as those responsible for bronchitis and emphysema.  In one Japanese study, an oral topical antimicrobial was found to lessen the incidence of pneumonia.

            When oral infection reaches a critical stage, bacteria can spread from the mouth into the bloodstream.  When periodontitis advances enough, chewing and even brushing and flossing can instigate the spread of the bacteria and increase body wide problems.  One recent paper attributed rapid ageing to periodontal disease in the form of an aging marker, called advanced glycation end product amplification (AGE) elevated AGE is now considered a strong benchmark for premature aging.  Thus, periodontal disease is tantamount to accelerated aging.


            Alternative health practitioners knowledgeable in energy medicine and biological dentistry have noted for some time a link between dental problems and degenerative illness.  When a tooth is infected or otherwise affected, it can block the energy flow along one or more of the body's acupuncture meridians, causing the deterioration of a corresponding organ or tissue, which may in time lead to cancer.  These blockages can also be caused by the use of dental amalgam material, namely the silver fillings most people have in their mouth.  "These so-called silver fillings actually contain 50 percent mercury and only 25 percent silver," says Joyal Taylor D.D.S., of Rancho Santa Fe, California, President of the Environmental Dental Association.  this makes such fillings especially harmful, since mercury is a noted carcinogen, as well as having the ability to impair immune function and create blockages.

            Practitioners in the field of energy medicine have been able to use this relationship between certain teeth and various organs and tissues of the body in order to diagnose cancer in its earliest stages.  Also, by removing or correcting the dental problems which may have helped lead to the cancer formation in the first place, they are able to aid in the treatment of the disease as well.  In addition, dentists in the field of biological dentistry advocate the proper removal and replacement of all toxic amalgams as a preventative measure, regardless of the patient's current health.

            The public is becoming more aware of such connections as represented in recent remarks by the American Academy of Periodontology.  Preseident Robert Ferris confirms, "As research surrounding the interface between periodontics and medicine emerges, the media is more receptive to stories about periodontal disease.  Suddenly, these messages can compete with stories about life-threatening illnesses because periodontal disease is linked to a person's overall health."


1.  PANELISTS' LINK TO PHARMACEUTICAL COMPANIES NOT DISCLOSED — Experts who authored new cholesterol guidelines closely tied to makers of statin drugs.

            Experts on a panel for the National Cholesterol Education Program in mid-July called for the aggressive and increased use of statin medications to treat high cholesterol.  However, the recent guidelines published by the panel did not list the panelists' links to drug manufacturers of statin drugs.

            According to Dr. James Cleeman, the coordinator of National Cholesterol Education Program, a division of the National Heart, Lung and Blood Institute, called the initial omission an oversight and reassured the public that the panelists' relationships with the drug companies would be posted on the National Heart, Lung and Blood Institute's website within days.  Six out of a total of nine panelists were linked to companies that produce some of the most popular statin medications.  These six panelists received grants from the pharmaceutical companies or fees for speaking or consulting.

            Despite the lack of disclosure of this information, cardiologists did not seem to doubt the quality of the research behind the guidelines that the panel produced.  As Dr. Steven Nissen stated, "It should have been there," but "it is hard to work in the lipid field and not have gotten a grant from a pharmaceutical company."

            Statin drugs currently earn pharmaceuticals $20 billion dollars a year, and about 36 million Americans are on statin therapy for cardiovascular problems.  The new recommendations set forth by the panel drastically lower the cholesterol level that is considered safe and suggests that the increased use of statin medications will help doctors lower patients' cholesterol to this new recommended level.  But consumer watchdogs say that the new standard of care set by these guidelines will only serve to increase the drug industry's bottom line.

            One of the authors, Dr. H. Bryan Brewer was recently the subject of a letter to the director of the National Institutes of Health because he failed to disclose his ties to the pharmaceutical company AstraZeneca, the producer of the statin medication Crestor.

            Brewer authored a report in a medical journal that praised Crestor without disclosing the fact that he is a paid consultant for AstraZeneca.  Dr. Sidney Wolfe wrote the letter because he feels that the public needs to be made aware of ethical conflicts of interest such as this one.  "The public has the right to know every amount,"  Wolfe said.  The Source:  Newsday.com

2.  FIGHTING FAT IN SCHOOLS: — Washington DC is the most recent school system to get rid of junk food and soda in vending machines.

            In a resolution that stated "most vending machine snacks have little nutritional value, and are in direct competition with a healthy school lunch program" the Washington, DC school system unanimously voted to replace junk food and sodas in school vending machines.  The school system intends to fill the machines with healthier snack and food options–an effort designed to improve the health of DC school children and help combat the nation's obesity epidemic.

            The DC board of education will implement the resolution in October in seven schools and hopefully have all public schools involved by February.  In addition to the marketing campaign that will raise student awareness about healthy eating, the resolution also puts very specific dietary restrictions on vending machine snacks.  Snacks can have no more than seven grams of fat and 15 grams of sugar with an exception for nut, seed and dried fruit mixes, and beverages are restricted to water, low-fat and skim milk, and other drinks that must contain at least 50% fruit juice.  The implementation of maximum portion sizes will be used to control the consumption of empty calories. 

            The resolution has met with overwhelming support.  Many experts testified in favor of the resolution, including Joy C. Johanson, a researcher at the District-based Center for Science and in the Public Interest.

            Johanson stated, "Schools should practice what they teach.  Selling low-nutrition foods in schools contradicts nutrition education and sends children the message that good nutrition is unimportant."  Skeptics have argued that the resolution will simply send children elsewhere for junk food, but according to Barry D. Sackin of the American School Food Services Association, many school districts that have sold enough low-fat fare to make up for the loss of junk food revenue.

            "You can make substitutions in your vending program and still show a profit, a good profit without the negative nutrition impacts," Sackin said.  In recent years, Philadelphia, New York City and Los Angeles school systems have also made moves to encourage healthy eating in schools as a result of growing concerns associated with the rise of childhood obesity.  Source:  Washington Post

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