Addressing Chronic Diseases from the Dental Chair

Chronic diseases pose a significant challenge to public health, necessitating an interdisciplinary approach to management and prevention. Dental professionals, often the first healthcare providers to identify systemic health issues through oral manifestations such as gum disease and overall poor oral health, are uniquely positioned to contribute to managing chronic diseases. This month’s In Focus Blog explores several specific chronic diseases that dentistry can address, focusing on cardiovascular disease, diabetes mellitus, and respiratory conditions, and explores the mechanisms through which dental interventions can impact these conditions.

Cardiovascular Disease - Pathophysiology and Oral Health Connection

Cardiovascular disease (CVD) encompasses a range of conditions affecting the heart and blood vessels, including coronary artery disease, hypertension, and heart failure. Periodontal disease, a chronic inflammatory condition affecting the gums and supporting structures of the teeth, has been consistently linked with CVD. The inflammation caused by periodontal disease can exacerbate systemic inflammation, contributing to the pathogenesis of atherosclerosis and other cardiovascular conditions. AAOSH Secretary and Board Member Ellie Campbell, DO, and author of the book The Blood Pressure BluePrint: The Holistic Guide to Defeating Hypertension, states that “The oral cavity, it turns out, may hold clues to a person’s cardiovascular health. The connection lies in the body’s inflammatory response – a shared element between the two conditions. Chronic inflammation, a hallmark of periodontitis, may contribute to systemic inflammation, affecting blood vessels and blood pressure” (Campbell, 2022).

A meta-analysis of cohort studies found that individuals with periodontal disease have a 19% higher risk of developing cardiovascular disease compared to those with healthy gums (Tonetti et al., 2017). Additionally, interventional studies have shown that periodontal treatment can reduce systemic markers of inflammation, such as C-reactive protein (CRP) and interleukin-6 (IL-6), which are known risk factors for CVD (D'Aiuto et al., 2013).

Dental professionals can mitigate the risk of CVD through regular screening for periodontal disease, providing periodontal therapy, and educating patients about the importance of oral hygiene. The dental chair thus becomes a critical site for the early identification and management of risk factors associated with cardiovascular disease. 

Diabetes Mellitus - A Bidirectional Relationship

Diabetes mellitus (DM) and periodontal disease share a bidirectional relationship. Diabetes increases the risk and severity of periodontal disease, and periodontal infection can exacerbate glycemic control in diabetic patients. Hyperglycemia in diabetic patients leads to changes in the oral environment, promoting the growth of pathogenic bacteria and reducing immune response, thereby increasing susceptibility to periodontal disease.

Research indicates that periodontal treatment in diabetic patients can improve glycemic control. A study by Teeuw et al. (2010) demonstrated that non-surgical periodontal therapy significantly reduced HbA1c levels, a marker of long-term blood glucose levels, in diabetic patients.
Regular dental visits for periodontal evaluation and treatment, coupled with patient education on the importance of oral hygiene, can significantly impact diabetic management. Dental professionals should collaborate with primary care providers to monitor and manage diabetic patients, ensuring comprehensive care.

Respiratory Conditions - Oral Health and Respiratory Disease

Respiratory diseases, including chronic obstructive pulmonary disease (COPD) and pneumonia, have been linked to poor oral health. Aspiration of oral pathogens into the lower respiratory tract can lead to respiratory infections, particularly in vulnerable populations such as the elderly and those with compromised immune systems.

Studies have shown that improving oral hygiene and providing regular professional dental care can reduce the incidence of respiratory infections. Scannapieco and Ho (2001) found that patients receiving professional oral health care had a lower incidence of pneumonia than those who did not.

Dental professionals can play a vital role in preventing respiratory infections by promoting good oral hygiene practices, especially in high-risk populations. Routine dental cleanings, patient education, and antimicrobial mouth rinses effectively reduce the bacterial load in the oral cavity and prevent aspiration pneumonia.

Conclusion

The intersection of oral health and chronic disease management underscores the importance of integrating dental care into the broader healthcare system. By addressing periodontal disease and promoting oral hygiene, dental professionals can significantly contribute to preventing and managing cardiovascular disease, diabetes mellitus, and respiratory conditions. Collaborative care models that include dental professionals as integral healthcare team members are essential for optimizing patient outcomes and addressing the global burden of chronic diseases.

AAOSH Resources

One of the 14 areas of the AAOSH Core Curriculum is Periodontal and Biofilm Diseases of the Mouth. AAOSH offers courses featuring various co-current topics - from maintaining a healthy heart and lungs through proper oral care to ensuring your best night’s sleep through treating breathing disorders. We hope you will enjoy these two sample courses from our core curriculum. (Please Note: These are sample courses; watching these videos here does not provide CE credit. Please visit members.aaosh.org to search for these courses and earn CE credit.)

Tooth Decay and Diabetes: A Connection We Cannot Forget!

Presented by: Erinne Kennedy, DMD, MPH, MMSc

Original Publication Date: June 12, 2020

Course Description:

In addition to periodontal disease, tooth decay is connected to systemic conditions such as diabetes mellitus. Using chairside screening, we will discuss how to understand the relationship between tooth decay and diabetes. We will discuss ways to achieve oral wellness by critically evaluating patient cases.

Learning Objectives:

• Understand the relationship between dental caries and diabetes mellitus.
• Identify how to use chairside screening of saliva, blood glucose, and HbA1c to measure oral and overall wellness.
• Review patient cases and preventive treatment plans that address oral wellness in diabetic patients.

Speaker Bio:

Erinne Kennedy, DMD, MPH, MMSc, is an Ohio State University graduate from Middleport, Ohio. She graduated from Nova Southeastern University’s College of Dental Medicine in 2015. Dr. Kennedy loved everything about dental school, especially being involved in organized dentistry. While in dental school, she was involved with ASDA (American Student Dental Association) as a local vice president and national contributing editor. After dental school, Erinne attended a one-year general practice residency at the VA Hospital in Baltimore, MD. Erinne has a passion for community health and is board-certified in public health dentistry after completing a residency at the Harvard School of Dental Medicine (HSDM) in 2018. In May 2019, she graduated as a pioneer student at HSDM with a Master of Medical Science in dental education. She currently practices at the Alliance Dental Center, a dental office focused on wellness, in Quincy, MA. She is a contributing editor for Dental Economics and on the Junior Editorial board for Dental Entrepreneur Women (DeW). Dr. Kennedy‘s professional affiliations include The American Dental Association, The American Association of Public Health Dentistry, The Massachusetts Dental Association, and The Academy of General Dentistry.

• Understand the underlying causes of sleep-disordered breathing, specifically obstructive sleep apnea.
• Analyze the co-morbid conditions associated with untreated obstructive sleep apnea.
• Comprehend the phenotypic characterizations related to obstructive sleep apnea.
• Apply knowledge to identify and recognize the role of dentistry in the diagnosis and treatment of obstructive sleep apnea.

Speaker Bio: 

John Comisi, DDS, MAGD, is an accomplished professional, serving as an Associate Professor within the Department of Oral Rehabilitation and Restorative Dentistry at the esteemed Medical University of South Carolina James B. Edwards College of Dental Medicine. Driven by a profound commitment to dental education and patient care, he brings a wealth of knowledge and expertise to his role. With a dedication to advancing the field of dentistry, Dr. Comisi continually inspires and educates the next generation of dental practitioners, shaping the future of oral healthcare.

References (In Order of Appearance):

Campbell, E. & The American Academy for Oral and Systemic Health. (2022). Beyond Blood Pressure: Unveiling the Hidden Link Between Hypertension and Oral Health. The Profitable Dentist. Retrieved June 23, 2024, from https://theprofitabledentist.com/beyond-blood-pressure-unveiling-the-hidden-link-between-hypertension-and-oral-health/  

Tonetti, M. S., D'Aiuto, F., Nibali, L., Donald, A., Storry, C., Parkar, M., ... & Deanfield, J. (2017). Treatment of periodontitis and endothelial function. New England Journal of Medicine, 356(9), 911-920. https://doi.org/10.1056/NEJMoa063186 

D'Aiuto, F., Orlandi, M., & Gunsolley, J. C. (2013). Evidence that periodontal treatment improves biomarkers and CVD outcomes. Journal of Clinical Periodontology, 40(s14), S85-S105. https://doi.org/10.1111/jcpe.12061 

Teeuw, W. J., Gerdes, V. E., & Loos, B. G. (2010). Effect of periodontal treatment on glycemic control of diabetic patients: A systematic review and meta-analysis. Diabetes Care, 33(2), 421-427. https://doi.org/10.2337/dc09-1378 

Scannapieco, F. A., & Ho, A. W. (2001). Potential associations between chronic respiratory disease and periodontal disease: Analysis of National Health and Nutrition Examination Survey III. Journal of Periodontology, 72(1), 50-56. https://doi.org/10.1902/jop.2001.72.1.50