The Oral Systemic Connection: A Risk Reduction Approach

I have greatly enjoyed being a dental hygienist for over 30 years. Something that still fascinates me is the oral health and whole-body health connections. As a constant student, I have studied bidirectional and causal relationships amongst oral pathogens and a host of chronic diseases. In fact, over two decades ago, the surgeon general spoke about periodontal disease effects, and we now know there are established associations to 57 adverse health conditions, associated with periodontal disease.1

When Parkinson’s disease (PD), vascular dementia and Alzheimer’s disease (AD) come to your own family, you take notice. I, not altruistically, began to research and deeply understand a connection between cognitive decline, specifically AD and PD and poor oral health. You see, I needed to do everything I could to reduce my own risk and pieces started connecting. In the grand puzzle for prevention of cognitive decline, I believe dental providers have a front seat for assessing risk factors and in some cases treating those risk factors. I asked myself, can we as prevention specialists be utilized to help change the trajectory of Alzheimer’s disease?

Brain changes in AD begin decades before symptoms manifest, a slow burn so to speak. I would say it is like gingivitis and the slow burn to periodontal disease. I am saddened how an industry like ours knows a disease has begun and we wait to see when it will progress and then ultimately treat. Daily seeing a concerning host response with red tissue and bleeding but because we don’t measure “deep pockets,” we digress to the slow burn technique.

In Alzheimer’s prevention it’s about risk reduction. Doing things now not later. In lots of areas, small changes reap huge rewards. Things like blood pressure and insulin control, not smoking and reduction of air pollution and secondhand smoke, keeping a healthy weight, good diet, lower cholesterol, productive sleep, and lowering inflammation.

We – dentistry – can be used to leverage risk reduction for every patient every day. Blood pressure monitoring and referral, council for smoking cessation, sleep assessments, possibly apnea treatment, and of course lowering our patient’s inflammation. Did you know that by reducing oral inflammation you positively affect not only sugar control and cholesterol but the brain?

I loved all I learned, and it ultimately led to consulting with a host of neurology clinics including Weill Cornell Alzheimer’s and Prevention Clinic about the oral health connection and the brain. Part of our protocol is using OralDNA® Labs. The patients involved in the clinics have their saliva checked and we then compare those findings with their blood work. As expected, high-risk pathogens equal higher C-reactive proteins, fibrinogen, lipoprotein-associated phospholipase A2 (Lp-PLA2) and elevated myeloperoxidase which is an inflammatory marker for periodontal disease. Then we can cross-check their specific pathogens as related to the bidirectional relationship to AD. We then refer those patients to qualified dental providers to help treat their pathogens.

When you use oral diagnostics, a few important things happen. We are not just using a calibrated metal instrument trying to measure a complex disease process. You can treat pathogens specifically, not a willy-nilly, shooting fish in a barrel approach. Having the ability to find out if a pathogen needs an antibiotic, laser, or even ozone in addition to scaling and root planning. Lastly, when working in medicine there must be metrics. You must know what’s working, what’s not and not by just an observational assessment.

Here is an example. Patient A, after periodontal treatment specific for their pathogens, dropped their CRP 99%, Lp-PLA2 64%, MPO 20%, fibrinogen 14%, ApoB 72% and the cholesterol numbers dropped so much most of us were scratching our heads. Thankfully, there are large teams including cardiologists that work in that area. We drove down specific pathogens that have a relationship with cognitive decline that we would have never known about unless we did the oral diagnostics. The point is this. We test saliva to help not only in an objective diagnosis but in treatment. The oral microbiome is complex and helps put the puzzle pieces together to benefit the patient. That’s our job, to help each patient in the very best way possible.

To learn more, please visit Anne Rice’s page on our Protocol Directory.

1. Monsarrat P, Blaizot A, Kémoun P, et al. Clinical research activity in periodontal medicine: a systematic mapping of trial registers. J Clin Periodontol. 2016;43(5):390-400. doi:10.1111/jcpe.12534

Anne O. Rice
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