THE ORAL-SYSTEMIC

CONNECTION:

CHRISDINA P. SARI., DRG., M.SC.

“YOU ARE NOT HEALTHY WITHOUT
GOOD ORAL HEALTH…”

• Oral disease can severely affect systemic health

• Strong evidence shows clear links between oral health and

respiratory disease, cardiovascular disease, and diabetes.

• Because oral health is linked to overall health, the effects of poor

oral health are felt far beyond the mouth.
 IT’S A TWO-WAY STREET

• • “The mouth mirrors the body” – Many systemic diseases have oral
manifestations. – E.g. HIV, diabetes mellitus, anemias
• • Oral disease can affect treatment for systemic disease. – E.g. Solid organ
transplants; Cancer Chemotherapy; Osteoradionecrosis; Glycemic control in
diabetes mellitus
• • Treatment for systemic disease can affect oral health. – Oral mucositis from
chemotherapy; Xerostomia from medications
 IT’S A TWO-WAY STREET

• Oral health affects quality of life. – Xerostomia, Missing Teeth, Tooth Pain and
Quality of Life
• • Oral disease can increase risk for systemic disease. – Periodontal Disease
and Cardiovascular disease, Adverse pregnancy outcomes
 ORAL MANIFESTATIONS OF SYSTEMIC
DISEASE

• • Early detection of systemic disease through oral examination and

recognition of oral manifestations – an opportunity for oral health
professionals – Oral manifestations of HIV/AIDS; Accelerated periodontal
bone loss and diabetes
• • Control/lack of control of systemic disease can be detected in the mouth
through oral examination – E.g. glycemic control of diabetes
 PREVALENCE

Tooth Decay
• Nearly 40% of kindergarteners have tooth decay
• Nearly 1 in 4 adults have untreated tooth decay

Periodontal Disease
• 47% adults have some form of periodontal disease (>
with age)
• 40% of pregnant women have some form periodontal
disease
• 70% of adults 65+ have some form of periodontal
disease
NORMAL TOOTH ANATOMY
PERIODONTAL DISEASE SYSTEMIC DISEASES

• People with serious gum disease are more likely to have a chronic condition

• Periodontal disease—correlated with a variety of conditions with systemic

implications
• Cardiovascular disease, heart disease, respiratory infections, diabetes, HIV, adverse
pregnancy outcomes

• Systemic diseases can have an impact on oral health

• Dementia
• Chronic disease medications that cause xerostomia
 CONSEQUENCES

Oral diseases are largely preventable but untreated oral disease can lead to:

• Pain that makes it difficult to work, learn in school, sleep, eat

• Poor eating habits and nutrition

• Reduced self-confidence and/or problems obtaining employment

• Complications of chronic diseases like diabetes, heart disease, and stroke

• Transmission of cariogenic bacteria from mothers to infants

 TOOTH DECAY PROCESS: A BACTERIAL
INFECTION
Bacteria + Refined Carbohydrates = Acid

Acid + Time (20 min) = Enamel Demineralization

& Risk for Decay

Untreated Decay  Infection, Abscess, Loss of Tooth

TOOTH DECAY PROGRESSION
 TOOTH DECAY [CARIES]
• Broadly caries are of 4 types

1. Pit and Fissure caries.

2. Smooth surface caries.

3. Cervical caries.

4. Nursing bottle caries.

 EARLY DECAY: WHITE SPOTS/LINES

Appearance
• White spots and lines—first clinical
signs of demineralized enamel
• Begins along the gum line
• Without intervention, lesions will
progress to cavities that are initially
yellow
Treatment
• Fluoride varnish application to
reverse or arrest lesions
• Dietary and oral hygiene counseling
• Dental referral Photos: Joanna Douglass, BDS, DDS
TOOTH DECAY, ABSCESSED TEETH, FACIAL
SWELLING
Tooth Decay

Abscesses

Abscessed Facial
Teeth Swelling
TOOTH DECAY - RISK FACTORS

• Prior decay and/or fillings

• Existing white spot lesions
• Frequent consumption of sugar & carbohydrate
• Inadequate fluoride Recurrent Cariesr

• Special health care needs

• Physical disabilities and dementia
• Medications that:
• Decrease salivary flow (xerostomia)
• Contain high levels of sucrose
Malocclusion of drifting teeth after
extraction
 GUM DISEASE

Gingivitis Periodontal Disease

 GINGIVITIS

• Inflammation of the
gingival tissue.
• Bleeding gums.
• Factors may also be
hormonal, drug induced.
PERIODONTAL DISEASE

Image from www.periotherapy.com

 PERIODONTITIS

• Infected gum recedes.

• Plaque and Ca++ continue to increase.
• Pockets become infected.
• Bone loss starts.
• Periodontal disease causes 70% of tooth loss.
• It affects 3 out of 4 people .
 RISK FACTORS FOR
PERIODONTITIS
• Lack of oral hygiene
• Systemic diseases (e.g. diabetes)
• Tobacco use
• Poor nutrition
• Dry mouth/ xerostomia – drugs
• Broken fillings/teeth
• Misaligned/crowded teeth
SYMPTOMS OF PERIODONTAL DISEASE.

• Red ,puffy gums.

• Gum tenderness[pain]
• Gum that bleed during brushing.
• Persistent bad breath.[halitosis]
• Shifted/loosened teeth.
• Pus.
 PREVENTION

CARIES-
• Reduce sugar intake.
• Brushing twice a day.
• Flossing once daily.
• Use of mouthwash.
• Healthy snack habit.
• Proper brushing method
PREVENTION OF GINGIVITIS.

• Maintain good oral hygiene.

• Cleaning of teeth.
• Interruption of bad habit.[smoking , mouth
breathing.]
• Proper brushing technique .
PREVENTION OF PERIODONTITIS.

• Scaling.
• Maintenance of oral hygiene.
• Flap operation.
• Bone grafting.
RELATIONSHIP BETWEEN ORAL AND
SYSTEMIC HEALTH
 RELATIONSHIP BETWEEN ORAL AND
SYSTEMIC HEALTH

The general mechanism is believed to involve a systemic inflammatory

response to blood-born bacterial endotoxins (lipopolysaccharides) and/or
oral bacteria including: Porphyromonas gingivalis and Treponema denticola

DIABETES

CANCER CARDIOVASCULAR

AUTOIMMUNE NEUROLOGICAL
DISEASES INFLAMMATION DISEASES

PULMONARY
ARTHRITIS
DISEASES PERIODONTAL
DISEASE
 ORAL PATHOGENS AND
SYSTEMIC DISEASE

• In response to noxious stimuli (bacteria) or tissue injury, local inflammatory cells secrete a
number of cytokines (IL-1, IL-6, and IL-8) and other pro-inflammatory mediators (TNF-alpha).

• In response to bacterial products, gingival epithelium also secrete IL-1, TNF-alpha, and
prostaglandins which also promotes the inflammatory process.
 ORAL PATHOGENS AND
SYSTEMIC DISEASE

• Recent studies have shown the presence of periodontal pathogens (T.

denticola and P. gingivalis) in aneurysmic aortic walls. (Haraszthy et. al. 2000,
Cavrini et al. 2005)

• Li and colleagues have shown an increase in aortic lesion development in

animals inoculated with P. gingivalis. In addition, they also found P. gingivalis in
the aortas and hearts of the inoculated animals. (Li et al. 2002, Gibson et al
2004)
 ORAL PATHOGENS AND SYSTEMIC
DISEASE

Results from these studies indicate:

1) Oral pathogens can enter the circulatory system.

2)Periodontal pathogens may increase the risk of developing systemic

disease.
GASTROESOPHAGEAL REFLUX
DISEASE

• Mucosal & gingival erosion caused

by acid

• Erosion of tooth enamel

DIABETES MELLITUS

• Oral manifestations- variable &

nonspecific
• Fungal & bacterial infection
• Gingivitis, periodontitis, xerostomia,
glossodynia, taste change, halitosis
• Oral hygiene
RENAL DISEASE
(URAEMIC STOMATITIS)

• Painful plaques and crust on buccal mucosa,

dorsum of tongue, & floor of mouth covered
with gray pseudomembrane exudate, & painful
ulcers
• Bleeding diathesis: inhibited platelet
aggregation eg. petechiae, ecchymoses
• Irritation & chemical injury of mucosa-
ammonium compounds
• Xerostomia, unpleasant taste, burning mouth,
uriniferous breath odour
 LEUKAEMIA

• Leukaemia– acute & chronic, myeloid or

lymphocytic
• All forms - Oral manifestations
• Oral lesions:
-Ulcerations, spontaneous gingival
hemorrhage, petechiae, ecchymosis,
tooth loosening, & gingival hypertrophy
 ORAL LESIONS ASSOCIATED WITH
HIV

• Early recognition, diagnosis, & treatment of HIV

associated oral lesions - reduce morbidity

• Oral lesions-
-Early diagnostic indicator of HIV infection
-Stage of HIV infection
-Predictor of the progression of HIV disease
ORAL LESIONS ASSOCIATED WITH HIV

• Fungal Infection: Bacterial Infection:

-Candidiasis -Linear Gingival Erythema
-Histoplasmosis -Necrotizing Ulcerative Periodontitis
-Cryptococcosis -Mycobacterium Avium Complex
• Viral Infection: Neoplastic:
-Herpes simplex -Kaposi’s Sarcoma
-Herpes zoster -Non-Hodgkin’s Lymphoma
-HPV Infection Others:
-CMV Infection -Recurrent Aphthous Ulcers
-Hairy Leukoplakia -Salivary Gland Disease
QUESTIONS?
THANK YOU