Dental Hygiene: Looking Beyond

Dental health has never been more important. We know the mouth plays a critical role in systemic health. It is a bellwether for what is really happening deep within the body. The mouth is the proverbial “canary in the coal mine.” The infections we see clinically are symptoms of bigger problems, and vice versa; inflammation in the mouth affects the entire body.

We know:

  • 50% of the US population has some level of gum disease.1
  • Dementia affects 55 million people worldwide, and this number is set to triple by the year 2050.2
  • Cardiovascular diseases are the number one cause of death.3

The question we need to address as a profession is how do we change from oral janitor to true healer? Looking beyond clinical signs is a lofty goal, but dental hygienists are the professionals poised to accomplish this!

We know bacteria can leave the mouth, translocate, and infect other areas of the body. It takes them less than one minute to visit every nook and cranny. Studies have shown that bacteremia occurred in 100% of patients after extractions, 70% after prophylaxis, and 20% after root canal therapy.4-6

Research supports the possibility that a patient could have a heart attack or other cardiovascular event up to 30 days after a dental procedure due to introducing these pathogens into the bloodstream.7 Bacteremia is the cause of bacterial endocarditis.

Another concern is that the blood-brain barrier can be breached by some oral pathogens. Specifically, Porphyromonas gingivalis (P.g.) has been detected in the brains and cerebral spinal fluid of dementia patients. P.g. infects the neurons of the brain and gives off toxic enzymes called gingipains. The presence of gingipains is the virulence factor contributing to the onset of Alzheimer’s disease.8-12

Another oral pathogen to monitor is the spirochete. Postmortem, spirochetes are noted in 90% of the brains of Alzheimer’s disease patients.13 It is not just the virulent factors of these foreign invaders, but the body’s inflammatory response. The toll-like Receptor 2 part of the innate immune system can destroy the neural tissues of the brain too.

One good thing about spirochetes and P.g. is the very long time it takes them to create a biofilm and achieve this destruction. The great thing we, as a profession, can do is to test everyone and prevent these chronic and destructive diseases.

Using easy-to-administer salivary diagnostics testing, we can identify these pathogens many years before damage occurs. Knowing what pathogens are present and in what quantities gives us an understanding of what we need to do and a clear endpoint. Testing allows us to know we have achieved our goals.

As a biological dental hygienist, I focus on identifying and preventing these dental diseases long before they destroy oral tissues and invade the brain and arteries. Dental hygiene is not only about cleaning teeth, but truly about contributing to the health of the entire patient. Looking beyond the teeth and gums, reconnecting the mouth back onto the body, and treating the entire body is what dental hygiene is meant to do. Oral and systemic health should not be so elusive.

References:

  1. Gum Disease (cdc.gov)
  2. Dementia cases to nearly triple worldwide by 2050, study says – UPI.com
  3. Cardiovascular diseases (who.int)
  4. Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors | Science Advances
  5. pdf (medicinaoral.com)
  6. Systemic diseases caused by oral infection – PubMed (nih.gov)
  7. Invasive Dental Treatment and Risk for Vascular Events: A Self-Controlled Case Series: Annals of Internal Medicine: Vol 153, No 8 (acpjournals.org)
  8. Invasive Dental Treatment and Risk for Vascular Events: A Self-Controlled Case Series: Annals of Internal Medicine: Vol 153, No 8 (acpjournals.org)
  9. Porphyromonas gingivalis in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors | Science Advances
  10. Porphyromonas gingivalis is a Strong Risk Factor for Alzheimer’s Disease – IOS Press
  11. Haditsch U, Roth T, Rodriguez L, Hancock S, Cecere T, Nguyen M, Arastu-Kapur S, Broce S, Raha D, Lynch CC, Holsinger LJ, Dominy SS, Ermini F. Alzheimer’s Disease-Like Neurodegeneration in Porphyromonas gingivalis Infected Neurons with Persistent Expression of Active Gingipains. J Alzheimers Dis. 2020;75(4):1361-1376. doi: 10.3233/JAD-200393. PMID: 32390638; PMCID: PMC7369049.
  12. Nonaka, S., Kadowaki, T. and Nakanishi, H. (2022) Secreted gingipains from Porphyromonas gingivalis increase permeability in human cerebral microvascular endothelial cells through intracellular degradation of tight junction proteins, Mendeley. Available at: https://www.mendeley.com/catalogue/de5c1e86-aad7-3c63-968f-df499a2e42f9/#:~:text=Secreted%20gingipains%20from%20Porphyromonas%20gingivalis%20increase%20permeability%20in,proteins.%20Neurochemistry%20International%2C%20154.%20https%3A%2F%2Fdoi.org%2F10.1016%2Fj.neuint.2022.105282%20Readers%20over%20time (Accessed: 8 August 2022).
  13. Alzheimer’s Disease: A Novel Hypothesis Integrating Spirochetes, Biofilm, and the Immune System (researchgate.net)

Barbara Tritz RDH
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