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Dental dangers — Poor oral health and NCDs
The bare facts on why maintaining those bright pearly whites is important for physical health.
by Pearly Neo

Although it is common knowledge in educated communities that dentists recommend the proper brushing of teeth twice a day and daily flossing to maintain good dental hygiene, it is less commonly known that these practices aim not only to prevent oral and dental disease, but also to prevent the exacerbation of other, even more serious diseases, especially those that fall in the non-communicable diseases (NCDs) range. From diabetes to pneumonia, poor oral and dental health carries with far more risk factors for these NCDs than are obvious at first glance.

In and of itself, oral disease can already be considered a major issue. According to the Oral Health Atlas 2015, released by FDI World Dental Federation, 3.9 billion people worldwide suffer from oral diseases, with untreated dental caries or tooth decay affecting 44 per cent of the international population.1 Studies also show that the burden of untreated dental caries appears to be shifting from children to adults,2 which has potential for more permanent and long-term adverse effects due to the permanent nature of adult teeth.

NCDs, or chronic diseases, are on the other hand an even more prevalent and significant presence on the global burden of disease front. Each year sees 40 million casualties worldwide because of NCDs, which also adds up to 70 per cent of all deaths globally. Of these, four NCDs occupy a good 80 per cent of all premature NCD deaths (between the ages of 30 to 69), which are cardiovascular disease (17.7 million deaths), cancers (8.8 million deaths), respiratory diseases (3.9 million deaths) and diabetes (1.6 million deaths).3 The many risk factors associated with NCDs from tobacco use to physical inactivity and unhealthy diets mean that even without adding oral health into the mix, the risk of just about anyone being affected is already disproportionately high. As such, heightened awareness about the effects of poor oral health, which can be considered a ‘rescuable’ factor, needs to be spread.

Risk factors

Many oral diseases, and periodontitis in particular, have similar social and physical risk factors with major NCDs. One of the most obvious ones would be that of poor diet, e.g. a diet high in sugar, which is a risk factor for dental caries as well as various NCDs, especially diabetes. Tobacco and alcohol over-consumption has been linked to both dental diseases as well as cancers, both oral and otherwise.

That said, these risk factors are commonly seen in relatively more developed societies, but dental caries in particular is especially prevalent in developing countries and those of lower socio-economic status,4 mostly due to a lack of access to basic oral health and hygiene tools and services from fluoride-containing toothpaste to dentists.

Periodontitis and NCD links

Periodontitis, one of the most common and easily prevented oral diseases is considered the most closely-linked to NCD development.5 Periodontitis is a severe infection of the gums, which impairs both the soft tissue and bone surrounding the tooth. As a result, this infection can lead to loose teeth or tooth loss.6 That said, it is preventable via very regular practices like twice-daily brushing, daily flossing and dental check-ups to remove plaque from the teeth before it develops into tartar and leads to gingivitis, the first and mildest form of periodontal disease, which presents as gum inflammation.

During this progression of periodontitis, the first step, plaque development, takes place due to the interaction of food sugars with mouth bacteria. Tartar is formed by the hardening of plaque on the teeth, and contains large amounts of bacteria, which means that at this juncture, there is a lot more bacteria in the oral cavity than there normally would be, a situation termed dysbiosis. By the time this situation develops into periodontitis, the bacteria will turn pathogenic and inflammation will occur5, and the damage to the tissues surrounding teeth, or periodontium, means that both bacteria and plaque will be able to enter the bloodstream much more easily as compared to normal1. Even without entrance through the inflamed area, ingestion or inhalation of the pathogenic bacteria would increase the risk of diseases like pneumonia or gastritis5.

The link between diabetes and periodontitis is well-researched and established, and periodontitis is considered a complication of diabetes.7 There are several notable factors at play here, being that acute inflammation affects both glycaemic control and insulin efficiency, and glucose uptake by cells is increased as a result of infection. Although the link between the two diseases can be considered a recognised one, there is little evidence to suggest any causal associations between them, hence it cannot be expected that the treatment of periodontitis will lead to an improvement of diabetes, though leaving the former untreated would likely exacerbate the latter.

Another NCD that is said to be aggravated by periodontitis is cardiovascular disease, with atherosclerosis featuring prominently in this category. Here, it is important to first understand that atherosclerosis, or blood vessel occlusion, can begin as an inflammatory reaction that attracts various protective cells and factors. Periodontitis can worsen this condition via a number of mechanisms, one of the most prominent of which is by activating the body’s innate immunity.

When pathogenic bacteria in the dental plaque enters the bloodstream, this will cause the body to react by activating T-cells and producing other protective factors like cytokines and mediators as a defensive measure, a congregation of which could result in the formation of an occlusion. Some common examples of dental bacteria that can do this are Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Porphyromonas gingivalis has also been known to actively invade aortic and heart endothelial cells.8

Although practising good oral hygiene and maintaining good oral health may not be directly beneficial in treating chronic diseases, it is still crucial that its importance is not overlooked, to ensure that the occurrence and presentation of the relevant NCDs are not exacerbated by any means.

References:

  1. http://www.fdiworlddental.org/sites/default/files/media/documents/complete_oh_atlas.pdf
  2. Kassebaum, N.J. et.al. 2015. Global Burden of Untreated Caries: A Systematic Review and Metaregression. Journal of Dental Research. 94(5): 650 - 658. DOI: https://doi.org/10.1177/0022034515573272.
  3. http://www.who.int/en/news-room/fact-sheets/detail/noncommunicable-diseases
  4. https://www.fdiworlddental.org/sites/default/files/media/resources/ncda_fdi-policy_brief_oral_health_ncds.pdf
  5. Dörfer, C. et. al. 2017. The relationship of oral health with general health and NCDs: a brief review. International Dental Journal. 67: 14 - 18. DOI: 10.1111/idj.12360
  6. https://www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes/syc-20354473
  7. Löe, H., DDS. 1993. Periodontal Disease: The sixth complication of diabetes mellitus. Diabetes Care. 16(1): 329 - 334. DOI: https://doi.org/10.2337/diacare.16.1.329
  8. Bartova, J. et. al. 2014. Periodontitis as a Risk Factor of Atherosclerosis. Journal of Immunology Research. 2014: 1 - 9. DOI: http://dx.doi.org/10.1155/2014/636893

Pearly Neo is an experienced writer and editor with a particular interest in the food, travel and biomedical science fields.

 

 

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APBN Editorial Calendar 2019
January:
Taiwan Medical tourism
February:
Marijuana as medicine — Legal marijuana will open up scientific research
March:
Driven by curiosity
April:
Career developments for researchers
May:
What's cracking — Antibodies in ostrich eggs
June:
Clinical trials — What's in a name?
July:
Traditional Chinese medicine in modern healthcare — Integrating both worlds
August:
Digitalization vs Digitization — Exploring Emerging Trends in Healthcare
September:
Healthy Ageing — How Science is chipping in
October:
Disruptive Urban Farming — Microbes, Plasmids, and Recycling
November:
Evaluating cost effectiveness of genomic profiling
Editorial calendar is subjected to changes.
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