The Oral-Systemic Connection – What the Latest Research Shows

Dr. Konstantin Rubinov an NYC Dental Surgeon specializing in longevity and anti-ageing with a focus on regenerative and aesthetic medicine shares his opinion on the latest research in the Oral Systemic Connection.

What is the Oral Systemic Connection?

Dr. Rubinov: The oral-systemic connection is basically a link between the health of one’s mouth and overall health of the body. An important study in 1954 in the Post-Graduate Medical Journal found a link between oral germs such as those that lead to gum disease can actually enter someone’s bloodstream and spread rapidly throughout the body. That study paved the way for further research linking oral health to systemic health. A major breakthrough occurred in 2008 when both the Journal of American Medical Association (JAMA) and the Journal of the American Dental Association (JADA) published an article in the same month linking the oral and the systemic micro environments. This spread can lead to chronic inflammation which can lead to cardiovascular disease, diabetes and some forms of cancer. Bad oral hygiene and health has also been linked to rheumatoid arthritis and pregnancy complications and most recently to Alzheimer’s disease and early onset dementia.

What impact could this research have on Dental Care?

Dr. Rubinov: This can revolutionize the way that providers respond to periodontal disease which has been shown to lead to arterial disease and has also been shown to have a genetic correlation. Rather than only focusing on the severity of symptoms like how deep the infection is or the amount that the gums bleed,  dentists now know to measure Oral Pathogens through DNA analysis and create patient specific protocol for treatment and prevention of recurrent infection. According to the American Dental Association, Periodontal and systemic diseases share many common risk factors, including nicotine consumption as well as a poor diet and sedentary lifestyle.

While the idea that oral bacteria may contribute to disease in other parts of the body has been discussed since at least the late 19th century, for the last several decades a number of systemic diseases have been associated with oral health, particularly cardiovascular diseases and diabetes. There are two mechanisms which have been hypothesized to explain the observed associations. Firstly, chronic inflammation in the oral cavity may increase levels of inflammatory markers in the bloodstream affecting immune response, or adding to the body’s general burden of disease. Secondly, the oral cavity may act as a reservoir for pathogenic bacteria that can enter the bloodstream and affect distant-site or systemic pathologies (systemic endotoxemia or bacteremia).

Is there Causality?

Dr. Rubinov: While significant associations between oral health status and a number of systemic diseases have been established, the current evidence of these relationships is largely based on observational (i.e., case-control, cohort, and cross-sectional) studies. Associations based on observational studies do not imply causation and may be biased by confounding factors, because “any association could potentially be due to another factor that influences both conditions.” There may very well be unknown genetic and environmental factors that can hinder disease progression from local areas of the mouth to other areas of the body in some people and it would be very difficult to create a study where participants are allowed to walk around with active, severe periodontal disease long term just to witness direct causality. That being said, I think it’s safe to say that there is a link if you encounter 5,000 people with severe oral inflammation and active gum disease and a vast majority also have concomitant cardiovascular disease and chronic systemic inflammation.

Even though many studies that do control for other potential factors have found links between periodontal/systemic diseases, proving direct causality is still very difficult because such clinical trials as those mentioned above have yet to be conducted. The best advice from Dr. Rubinov for longevity is to make sure the mouth as a whole and not just the teeth themselves are kept clean and checked periodically, especially after the age of 40, when inflammatory and cardiovascular disease starts to pose a higher threat.