Dental and oral health
Dental and oral health

Contrary to what is generally assumed, what happens in the mouth does not stay in the oral cavity, but transcends the rest of the human body. Oral and periodontal health has a great impact on the general health of people.

The most recent research already indicates that gum diseases are associated with a greater risk of suffering from other pathologies , including some as frequent, important and serious as diabetes, myocardial infarctions, some types of tumors or Alzheimer ‘s disease .

The situation is even more worrying and transcendental if one takes into account that periodontal diseases are among the most frequent pathological conditions in humans; Severe periodontitis alone is estimated to affect more than 750 million people worldwide (11.2% of the population), being the sixth most common disease.


Health consequences

But, in addition, they are diseases that have important consequences that go beyond the mouth: general health and many of the indicators of quality of life associated with health depend, in part, on the health of the gums.

The infection and inflammation that characterize periodontitis causes, by different means, this disease present in the oral cavity to spread to other parts of the body , acting as a systemic disease. Periodontitis is an inflammatory, chronic, preventable disease that is related to other important disorders and is associated with risk factors that are common to many other diseases (smoking, alcohol, poor diet, sedentary lifestyle, stress, obesity…).

At the level of the oral cavity, there are many consequences derived from the existence of periodontal disease, ranging from the presence of frequent bleeding or halitosis to the loss of teeth.

But, at a systemic level, poor gum health has even more important repercussions : increased risk of the appearance of bacteremia (presence of bacteria in the blood), increased systemic inflammation, poorer control of diabetes, increased risk of developing or aggravation of some cardiovascular diseases, increased risk of adverse events occurring in pregnancy (such as premature birth or low birth weight),… But, even, there is already suggestive evidence about the relationship of periodontitis with diseases such such as erectile dysfunction, Alzheimer’s, some tumors or rheumatoid arthritis .

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An influence that ‘reaches’ the heart

The link between periodontitis and some cardiovascular diseases is moderate, but consistent, and it has even been shown that periodontal treatment can have a significant benefit on cardiovascular health, as has been observed from some indirect markers.

Bacteria from the mouth reach the circulatory system, the blood, and settle on the walls of the arteries, causing obstructions and collapses: strokes, heart attacks and cardiovascular problems are a consequence of this.

Bidirectional relationship with diabetes

Of special relevance is the bidirectional relationship that exists between periodontitis and diabetes. And it is that diabetes mellitus is a risk factor for the onset and progression of periodontitis and, at the same time, severe periodontitis is a risk factor for diabetes and compromises glycemic control in people with diabetes, also increasing the risk of complications associated with this metabolic disease.

From a therapeutic point of view, it has been confirmed that periodontal treatment is associated with improvements in glycemic control (average reductions of 0.4% in the glycosylated hemoglobin test -HbA1c-).

From Alzheimer’s to erectile dysfunction

So far there is consistent evidence that at least 54 systemic diseases are related to periodontitis, a link that according to the diseases and published studies is more or less solid and strong. There are some diseases in which their association with poor gum health is especially curious.

In the case of Alzheimer’s disease, the existence of oral bacteria in the brain, specifically in the cerebrospinal fluid, has been observed. In addition, irregular tooth brushing is associated with a greater probability of developing this disease and multiplies by 6 the cognitive deterioration of these patients.

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80% of erectile dysfunctions are due to systemic causes, related to vascular impotence, and it has been shown that there is an epidemiological relationship between patients diagnosed with erectile dysfunction and periodontal disease. It has been suggested that periodontitis could cause a situation of systemic inflammation, altering the endothelium of the blood vessels which, in the same way that it can affect the cardiovascular system, could interfere with the cavernous vessels of the penis.

In addition, it has recently been confirmed in a follow-up study that men with periodontitis who are also diagnosed with erectile dysfunction are almost four times more likely to suffer a severe cardiovascular event.

It has also been determined that patients with periodontitis have a higher risk and higher mortality from ischemic stroke compared to patients with gingivitis. In fact, it is estimated that a person with advanced periodontitis is 3 times more likely to suffer a future ischemic stroke than a person with healthy gums.

In relation to the risk of cancer, the evidence is not yet conclusive and solid, being necessary to confirm it with new studies, but there are already results that suggest how, for example, the presence of periodontal disease could be associated with a higher risk. of suffering from breast cancer.

And a recent study, published in Hypertension and led by the Spanish dentist Eva Muñoz, has confirmed that the presence of periodontitis doubles the risk of suffering from high blood pressure , suggesting that this gum disease could be at the origin of some cases of high blood pressure. elevated.

Also with the Covid-19

  • But, in addition, it is now known that having good oral health can help prevent the development and appearance of complications of infectious pathologies, such as Covid-19 . Hence the recommendation to achieve and maintain good oral hygiene as a preventive measure ; In this sense, it is considered that the decrease in the viral load in the oral cavity with the use of certain mouthwashes could help reduce the risk of transmission and the severity of Covid-19.
  • The mouth seems to be a very suitable place both to receive the virus that causes Covid-19 (SARS-CoV-2), and to keep it and transmit it to other people. In addition, there is indirect evidence that suggests how poor oral health could overexpress the receptors through which the virus enters our cells in the oral mucosa .
  • Although the currently available studies are observational and do not allow definitive conclusions to be drawn on the origin of this cause-effect relationship between poor oral health and Covid-19, different prospective controlled studies are being designed and launched to try to validate the main hypotheses .
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A worse prognosis is also seen in patients with Covid-19 who suffer from advanced periodontal disease; for example, a positive association is reported between periodontitis and hospital-acquired pneumonia in patients admitted to intensive care.

The impact of periodontitis on diseases as relevant as diabetes or cardiovascular diseases makes periodontal health a critical element to maintain general health, highlighting the importance of prevention and treatment of periodontal problems.