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Oral diseases and their relation to the general health of our body

Oral Diseases.

Oral Diseases

Table of Contents

In the past, the mouth and its diseases were considered totally alien to the rest of the body. Today, the importance of good oral health is becoming increasingly clear, as its deterioration can affect any part of our body. These repercussions can range from worsening our quality of life to a risk of suffering diseases that can be fatal.

1. Your mouth reflects the health of your body

Advances in recent years in medicine have allowed us to know that diseases of oral origins, such as periodontitis, share a close relationship with different systemic diseases, such as diabetes mellitus, cardiovascular disease, digestive problems, rheumatoid arthritis, respiratory problems, and problems during pregnancy, among others.

Periodontal diseases suffered by human beings are characterized by gingival inflammation and loss of connective tissue, including the alveolar bone that supports the teeth, leading to the eventual loss of the tooth. In addition, periodontal pathogens and their products, as well as inflammatory mediators produced in diseased periodontal tissues, enter and circulate through the bloodstream, contributing to the development of the manifestations of various systemic diseases.

It has been observed that suffering from periodontitis can lead to an increased risk of the appearance and/or progression of certain systemic conditions such as cardiovascular diseases, diabetes, certain respiratory diseases, rheumatoid arthritis, obesity, and metabolic syndrome, as well as pregnancy disorders such as premature birth or low birth weight.

To explain the relationship between these diverse systemic pathologies and oral infections, different possible mechanisms of interaction have been proposed. However, the main ones would be:

  •     Bacteremias, the direct passage of oral bacteria into the bloodstream, can occur after routine tooth brushing or therapeutic techniques such as scaling and root planing (Kinane et al. 2005).
  •     Systemic inflammation is characterized by the presence of elevated levels of markers of inflammation, such as C-reactive protein (CRP). This state of systemic inflammation may be due to a generalized condition, such as obesity, or local infection, such as periodontitis.
Periodontal disease is a chronic infection caused by anaerobic bacteria growing inside the gum line.

Gingivitis is the mildest form of periodontal disease; it is an inflammatory condition caused primarily by bacterial plaque accumulating on the teeth adjacent to the gum without compromising the underlying supporting structures. On the other hand, periodontitis is a bacterial infection that results in chronic tissue inflammation, characterized by gingival bleeding, periodontal pocket formation, destruction of connective tissue, and alveolar bone resorption.

Advanced periodontitis is associated with an up to 24% increased risk of cancer, especially lung and colorectal cancer.

There are certain diseases, such as chronic obstructive pulmonary disease (COPD), pneumonia, chronic kidney disease, rheumatoid arthritis, metabolic syndrome, and other types of cardiovascular lesions or brain damage that can affect cognitive decline, including the development of specific cancerous lesions, which has been linked to risk factors in the presence of certain types of periodontitis.

Therefore, this review provides us with an overview that exists between periodontitis and systemic diseases, mentioning: chronic obstructive pulmonary disease (COPD), pneumonia, chronic renal disease, rheumatoid arthritis, arteriosclerosis, diabetes mellitus, cardiovascular diseases, digestive system diseases, chronic renal disease, Alzheimer's disease, dementia, brain abscesses, oral cancer and finally its repercussions during pregnancy.

In 1910, William Hunter, an English physician, spoke of bacterial infections at the brain, heart, and lungs level from infected teeth.

W.D. Miller1 published 1991 his theory on focal infection, in which he indicated that microorganisms and their products can access other parts of the body adjacent to or distant from the mouth.

At the end of the 20th century (1992), Rams and Slots proposed that oral infections can be integrated into the causes capable of leading the patient to death.
The mechanisms by which periodontal infections can influence systemic health have been described as follows:

  1.     Oral hematogenous spread of periodontal pathogens and the direct effects on target organs
  2.     Transtracheal spread of periodontal pathogens and the direct effects on target organs.
  3.     Cytokine and antibody production with effects on distant organs.

2. Respiratory System

The oral cavity is colonized by an infinite number of microorganisms that, under normal health conditions, are in balance with the host. However, when environmental conditions change, certain pathogenic species, which may be present in tiny numbers, find a way to develop and cause an increase in the aggressiveness of dental plaque or biofilm at the gum level.

Consequently, they cause an inflammatory reaction that, at first, is limited to the gingival tissue (gingivitis). When it advances, it can compromise the support of the tooth and its long-term survival (periodontitis).

The mouth is considered the gateway to many systemic diseases that afflict human beings, including respiratory diseases.
Some respiratory conditions are genetic, and others are caused by lifestyle or environmental factors. The most common respiratory infections are asthma, bronchitis, pulmonary emphysema, tuberculosis, and sinusitis. In addition, respiratory conditions can have an undesirable effect on oral health.

Bacterial aspiration occurs primarily when gram-negative bacteria found in periodontal pockets and other oral pathogens penetrate and spread through the respiratory tract (larynx, pharynx, trachea, bronchi, lungs, and diaphragm).

Certain respiratory conditions can hurt oral health. For example, people with respiratory diseases who use anti-inflammatory drugs may experience dry mouth (xerostomia), increased plaque, periodontal problems, and be more susceptible to fungal infections.

Hospitalized older adults or those in nursing homes and patients with impaired immune functions are particularly susceptible to severe respiratory problems.

Adult bacterial pneumonia, bronchitis, and chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease of the lungs that obstructs airflow from the lungs due to the narrowing of the airways and excess production of mucus (sputum). Symptoms include high fever, chest pain, shortness of breath, dry cough, mucus (sputum) production, muscle pain, and wheezing.

There are 2 primary forms of COPD:

  •     Chronic bronchitis, which involves a prolonged cough with mucus.
  •     Emphysema, which involves damage to the lungs over time
Most people with COPD have a combination of both conditions.

Likewise, studies have also confirmed that people with COPD are at greater risk of developing periodontal disease compared to patients who do not have it.

The most frequently identified microorganisms are Staphylococcus, Streptococcus pneumonia, Streptococcus pyogenes, Mycoplasma, Haemophilus influenza, Lactobacillus, and Actinobacillus.

Pneumonia is a disease of the respiratory system, usually caused by a bacterium, fungus, or virus, along with the flu.

It can be fatal, especially in immunocompromised people (with low body defenses) and older adults. In the most severe cases, it causes fever, chest pain, coughing, spitting up, muscle pain, and shortness of breath.

This disease contributes to morbidity, a decrease in quality of life, and a significant increase in hospital medical expenses.

Bacterial pneumonia comprises several subtypes: community-acquired pneumonia, aspiration pneumonia, hospital-acquired pneumonia (nosocomial)associated with mechanical ventilation, and residential pneumonia. In all cases, correlations have been made with oral health status.

In hospital pneumonia, those associated with aspiration in patients in intensive care units (ICU) and mechanical ventilation are particularly severe. This type of pneumonia is the most common hospital infection of ICU patients and, in many cases, leads to a more extended hospital stay. Hence, the costs of hospitalization are also considerably increased. In addition, they increase mortality risk by about 15-45%, according to the studies.

The leading cause would be the aspiration of oropharyngeal secretions into the lower respiratory tract. This is because, through intubation, the natural barrier between the oropharynx and the trachea is lost.

In addition, there may be more significant bacterial colonization in the mouth due to the lack of proper oral hygiene and less salivary secretion, which increases the passage of potentially pathogenic oral bacteria along the tube.

Strategies to decrease the probability of pneumonia in this patient will be aimed at reducing oral microorganisms through mechanical removal of dental plaque and chemical control of pathogenic organisms.

Bronchitis is an inflammation of the bronchial tree, a milder situation than pneumonia. It can be chronic but is rarely a significant cause of death. It can be caused by viruses, bacteria in the mouth, or irritants such as smoke, so not smoking is one of the main preventive measures to consider. It does not usually cause fever and is characterized by a persistent cough.

In recent years, different mechanisms have been suggested by which oral bacteria could play an essential role in the origin of respiratory diseases. These include oral pathogens such as Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans.

It also points to the fact that the enzymes of periodontal pathogens could modify the adhesion receptors on the surface of the mucosa and promote the adhesion of respiratory pathogens, which are inhaled into the lungs.

It has also been pointed out that cytokines from periodontal tissues alter the respiratory epithelium, which is more vulnerable to respiratory pathogens.

In fact, it has been determined that periodontal disease is an independent risk factor for developing this frequent and severe respiratory disease.

Tobacco is an ally of many diseases; it is a common enemy to oral and respiratory health. In many of these diseases, it is considered an additional risk factor; in others, it is the main trigger and/or aggravating element.

The damage caused by tobacco smoke and nicotine in oral health not only stains the teeth and produces halitosis but is closely related to periodontal disease, causing the loss of teeth, and is, along with alcohol, the leading cause of the appearance of oral cancer.

The habit of smoking has a direct and negative influence on the response to the treatment of periodontal disease. It is also one of the main factors associated with the failure of the placement and permanence of dental implants.

Chronic bronchitis irritates the bronchial airways and causes sufficient mucus secretion to cause coughing with the expectation.

Risk Factors.

  1.     Tobacco, in any of its forms and presentations, is the most common cause of developing oral cancer.
  2.     Alcohol. The risk of cancer increases with the number of alcoholic drinks consumed daily (the risk doubles if 3-4 alcoholic beverages are finished).
  3.     The combination of tobacco + alcohol increases the risk of cancer.
  4.     A personal history of head and neck cancer increases the risk of oral cancer.
  5.     Poor dietary habits and lack of exercise: overweight, sedentary lifestyle, and dietary deficiencies may favor an increased risk of oral cancer.
  6.     Genetic factors.
  7.     Infection with human papillomavirus (HPV) increases the risk of oropharyngeal (sexually transmitted) cancer.
  8.     Chronic trauma to the lining of the mouth from sharp teeth, poor restorations, and ill-fitting or damaged dentures
  9.     Exposure to ultraviolet light for long periods increases the chances of developing skin cancer and the risk of lip cancer.

Lung cancer.

During the last few years, many observational studies have been carried out in which associations between periodontal disease and different types of cancer have been found.

The biological mechanism would respond to factors such as the previous existence of diseases related to the affected organ or tissue, the passage of pathogenic bacteria to the affected tissues, and, above all, an increase in systemic inflammation. For example, a recent analysis of several studies found a positive risk for lung cancer incidence and periodontal disease.

3. Pregnancy gingivitis

The cause of pregnancy gingivitis is caused by an increase in the hormone progesterone, which can contribute to increased blood flow in the gum tissues, causing them to be more sensitive and swollen and bleed more easily during brushing or flossing.

These hormonal changes encourage the growth of bacteria that cause gingivitis and can destroy the supporting tissues and eventually lead to the loss of teeth.

Another critical factor is nausea and vomiting since the latter can cause enamel erosion, leading to dental hypersensitivity.

Pregnancy gingivitis can occur at any time, but it is usually more intense during the second trimester of pregnancy.

During pregnancy, bacteria in the mouth "travel" through the bloodstream to the uterus, where they are "discharged" into the amniotic fluid, where they become cloudy. As a result, a woman tends to develop blood pressure disorders and risk premature delivery (between 21 and 37 weeks) and low birth weight babies (less than 2500 grams). Thispreeclampsiapre-eclampsia or eclampsia.

Other risks include alcohol, tobacco, drugs, mothers under 17 and over 34, genetics, multiple births, genitourinary disease, oral disease or infection, heart disease, thyroid disease, diabetes, and severe anemia.

Periodontal pathogens, including P. gingivalis have been detected using a PCR assay in the amniotic fluid of pregnant women with a diagnosis of threatened premature delivery and in the placentas opreeclampsiapre-eclampsia. The etiology of preterm birth is multifactorial; inflammation is the standard route leading to uterine contractions and cervical changes with or without premature rupture of membranes. The biological plausibility of the relationship between periodontal disease and preterm birth can be summarized based on 3 possible pathways. The first potential pathway is the hematogenous spread of inflammatory products from a periodontal infection. The second pathway involves a fetomaternal immune response to oral pathogens. The third pathway proposed to explain the theoretical causal relationship between periodontal disease and preterm birth involves bacteremia from oral infections.
During pregnancy, it is usually normal for "hyperplasia" to form on the gums, known as a "pregnancy tumor" or pyogenic granuloma, which in most cases disappears after delivery.

It develops due to an exaggerated inflammatory response to an irritative stimulus, which in most cases, is the etiological factor in dental tartar.

Clinically it corresponds to a growth mass (inflammation) involving the gingival margin and interproximal tissues in the anterior area of the jawbone.

It is characterized by rapid growth, bleeds easily, and can vary from purple-reddish to intense blue. It is not cancerous or contagious.

These hormonal changes influence the proliferation of bacteria that cause gingivitis, which can lead to the destruction of support tissues and, finally, the loss of teeth.

This inflammation usually occurs during the second month of gestation and reaches its peak in the eighth month. A notable decrease or disappearance is observed after delivery due to reduced secretion of sexual hormones (estrogen and progesterone).

Studies have shown that the prevalence and severity of gingival inflammation are significantly higher during pregnancy compared to gingival inflammation present after delivery.

Pregnancy gingivitis is prevalent and affects 35-100% of all pregnant women.

The presence of periodontitis may be related to adverse pregnancy outcomes such as premature delivery, low birth weightpreeclampsia preeclampsia in the most severe cases. Preterm birth is a delivery that occurs before the 37th week of pregnancy.

Babies born prematurely must stay in an incubator for some time, which puts their health at risk because there is a danger that complications may occur, including problems in their brains.

Premature births before 37 weeks and low-birth-weight fetuses of less than 2 500 g are the main determinants of infant morbidity and neonatal mortality.

Periodontal pathogens, including P. gingivalis have been detected using a PCR assay in the amniotic fluid of pregnant women with a diagnosis of threatened preterm delivery and in the placentas opreeclampsiapre-eclampsia.

At a systemic level, the presence of periodontitis may be related to adverse pregnancy outcomes, such as preterm delivery and/or low birth weightpreeclampsiapre-eclampsia in the most severe cases. Preterm birth occurs before the 37th-week ofPreeclampsiaPre-eclampsia is characterized by increased blood pressure above 140/90 along with increased protein in the urine, as well as edema in the ePreeclampsiaPre-eclampsia can cause an increase in your blood pressure and lead to a risk of brain damage. It can also cause impaired liver and kidney function and lead to complications of blood clotting, pulmonary (fluid in the lungs) edema, and seizures may occur.

Eclampsia is characterized by seizures followed by coma; it affects the mother's placenta, kidneys, liver, brain, and other organs and blood systems.

4. Periodontitis

Periodontitis is the most advanced stage of gum disease, in which the soft tissues that support and the bone that supports the teeth are gradually destroyed. A dental abscess or pocket is progressively formed below the gum margin due to the progressive accumulation of dental plaque, tartar and bacteria, causing inflammation and even loosening and loss of teeth, in addition to other general severe health complications.

5. Halitosis (Bad Breath)

Halitosis or bad breath is usually due to the buildup, decay, and growth of bacteria from food debris in the mouth (around all the soft tissues of the mouth and teeth).

It may be due to poor oral hygiene, consumption of strong-tasting foods such as garlic, onions, fish, etc., or as a result of suffering from some type of periodontal disease or caries; also due to the habit of smoking, alcohol, or respiratory, gastrointestinal or endocrine problems such as sinusitis, gastroesophageal reflux, and diabetes.
Some disorders that produce different types of breath are

  •     In diabetes, a characteristic breath is a fruity smell.
  •     Breath that smells like feces may occur with prolonged vomiting (bulimia) or when there is a blockage in the intestines.
  •     It may also occur temporarily if you have a tube placed through your nose or mouth to drain your stomach's contents (nasogastric tube).
  •     In people with chronic kidney failure, the breath may have an ammonia-like odor (also described as urine-like or fishy).

6. Bad morning breath (morning halitosis)

While we sleep, the mouth's pH becomes more acidic than usual, reducing the amount of salivary flow, which favors the concentration and proliferation of microorganisms and, therefore, the appearance of bad breath.

This is a symptom that anyone can suffer during sleep. As a general rule, halitosis comes from the degradation of food remains by bacteria that live in our mouths and give off volatile sulfur compounds with an unpleasant smell.

This unpleasant smell is more intense when we wake up in the morning, as the bacteria have had many hours to multiply on the tongue surface and in the other hard and soft tissues of the oral cavity, together with the marked decrease in salivary flow during sleep.

Some of the causes of bad morning breath are:

  •     Consumption of healthy foods. Dinners with smelly foods like onions, garlic, and fish.
  •     The intake of alcoholic beverages. (beer, red wine, etc.)
  •     The habit of smoking. Tobacco and alcohol contribute to drying up your oral cavity.
  •     Medication. Bad breath in the morning is very common in older people who are on medication.
  •     Poor or no oral hygiene technique.
  •     Dry mouth (xerostomia) Saliva helps with mouth cleaning because it removes the particles that cause a terrible odor. However, Xerostomia contributes to bad breath because it decreases saliva production. 
  • Breathing with the mouth open when sleeping or snoring causes the mouth to dry out.
  •     Mouth, nose, and throat conditions Bad breath can also be caused after oral surgery, tooth decay, periodontal disease, or some type of oral injury. It can also be caused by sinusitis, laryngitis, tonsillitis, cancer, vomiting (bulimia), and chronic gastroesophageal reflux.
  •     Prolonged fasting. By not eating the first meal of the day, the foul smell in the mouth remains, even after brushing the teeth.
  •     Diabetes, renal or hepatic insufficiency.

7. Bacterial or Infectious Endocarditis

Several studies on the direct relationship between chronic periodontitis and cardiovascular disease provide evidence that chronic periodontitis increases inflammation, C-reactive protein (CRP) levels, and other biomarkers.

Continuous and prolonged exposure to oral cavity bacteria or bacterial toxins may initiate pathological changes in blood vessel walls and thus act as a precursor to atherosclerosis in susceptible hosts.

This way, periodontal pathogens can penetrate the epithelial barrier of periodontal tissues and achieve systemic spread through the bloodstream.28 By this dynamic mechanism, periodontal pathogens can infect vascular epithelium and atherosclerotic plaques, causing inflammation and plaque instability followed by acute myocardial ischemia. In addition, periodontal pathogens produce a variety of virulence factors (e.g., neurotoxins, hemolysins, membrane vesicles, and LPS) that have detrimental effects on the vascular system, resulting in platelet aggregation and adhesion and the formation of cholesterol lipid-laden deposits that contribute to the formation of atheromas.

Infectious or bacterial Endocarditis is a disorder that causes inflammation, oozing, and growth of bacteria that grow on the inner lining of the heart valves and chambers (endocardium), causing severe damage.

Gum disease can cause bacteria to enter the bloodstream, which attach to fatty deposits in blood vessels and receptive areas on the surfaces of the endocardium.

Bacterial Endocarditis can lead to blood clots and blocked blood flow in the arteries, heart failure, valve abscesses, fistulas, and valve failure, increasing the risk of myocardial infarction, ischemic heart disease, stroke, thromboembolism, or varicose veins.

Endocarditis is caused by bacteria entering the bloodstream. It can be the origin and cause of periodontal disease and then travel to the heart. Bacterial infection is the most common cause of Endocarditis.

The microorganisms most associated with bacterial or infectious Endocarditis are streptococcus, staphylococcus aureus, Candida Albicans, and gram-negative.

Periodontitis is closely associated with the development of cardiovascular disease.

Patients who are carriers of valve prostheses or suffer from rheumatic fever are considered at high risk, and prior antibiotic therapy should always be performed before each dental maneuver.

Possible causes

    Some people who get Endocarditis may have a congenital heart abnormality, a new heart valve after surgery, or a damaged or abnormal heart valve.
    Patients with prosthetic valves or rheumatic fever are considered to be at high risk for IV drug addiction.
    Suffering from some type of periodontal disease.
    For some kind of recent dental surgical procedure.
    Other surgeries or minor respiratory tract procedures include the urinary tract, infected skin, bones, and muscles.
    Within the protocol of medical management of the compromised patients that will be operated on is indispensable to count on good buccal health and to make a previous antibiotic therapy.