Oral Health and Overall Health: Their Impact on Each Other

October 16, 2024

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In the latest episode of the Let’s Talk Oral Health podcast for professionals, Professor Maria Clotilde Carra (Prof. of Periodontology at University Paris Cité) dives into the oral-systemic link as a key pillar for preventing periodontal and peri-implant diseases. Tune in to the podcast or explore the key takeaways in the digest below.

Oral health and general health are one health

The patient’s risk factors and comorbidities must be considered, for a holistic approach of health

Risk factors

A risk factor is a behavior, a condition that increases the risk of developing a disease. Non-communicable diseases like diabetes and periodontal diseases are chronic diseases resulting from a combination of genetic, physiological, environmental and behavioral factors. They share a lot of risk factors. For example, smoking is a modifiable, behavioral risk factor that increases the risk of cardiovascular diseases, respiratory diseases, metabolic diseases, and oral diseases.

Comorbidities

Comorbidity means two or more conditions that coexist in the same patient. These diseases may be directly linked or be the consequences of the exposure to common risk factors. When comorbidity exists, the disease burden for the patient increases, and so does the treatment complexity.

Consequently, oral health and overall health being conflated, the patient must be considered from a global perspective, taking the risk factors and the other potential systemic diseases into consideration to address the periodontal and peri-implant diseases with preventative measures and treatments.

Primordial and primary prevention

Since risk factors have a major role in the aetiology of periodontal diseases and peri-implant diseases, risk factor control represents the main preventative strategy.

Primordial prevention

It is a form of prevention that promotes healthy behaviors, to prevent the exposure to risk factors. It targets the general healthy population and comes before everything, prior to disease development. In cardiovascular health, research identified at least 7 metrics that define the ideal cardiovascular health (no smoking, BMI, physical activity, blood pressure...).

For oral health, the key targets for primordial prevention are not known yet but if it for sure includes advising good oral hygiene habits and regular visits to the dentist, it can also include promotion of healthy behaviors in general, such as regular physical exercise, balanced diet, healthy behaviors and lifestyle (no addictions, good sleep, etc).

Primary prevention

Primary prevention refers to risk factors identification and control per se. It targets patients who have not yet developed the disease but are at risk because they are exposed to some risk factors. Primary prevention implies behavioral change in patients, which is not an easy task. As an example, it is well established that smoking is a risk factor for several systemic diseases but also periodontitis and peri-implant diseases. Still, quitting smoking remains difficult for patients.

Another example of primary prevention of periodontal and peri-implant diseases would be glycemic control in diabetic patients. As a history of periodontitis can expose to a four-time higher risk of peri-implant diseases and implant failures, uncontrolled glycemia also increases the risk of peri-implantitis and implant failure.

Global risk factor assessment

The difficulty to control the risk factors partially explains why the prevalence of periodontitis is not decreasing, and actually, even rising. The average standardized prevalence of severe periodontitis was estimated at 11.2% in 2010 and at 13.5% in 2019, making periodontitis the 7th most prevalent non communicable chronic disease worldwide. Moreover, this prevalence is expected to rise with the growing and aging population.

Periodontitis being a chronic multifactorial disease, its list of risk factors is lengthy and it has a high chance of recurrence. As such, the global risk factor assessment of a patient is essential for a targeted management. Dentists should not forget that the patient is not just a mouth, and they need to inform them about the link between oral health and general health. Patients need to understand the burden of a chronic disease, its impact on daily functioning, esthetics, and quality of life and why prevention works. Implementing preventative strategies at population level and raising awareness in patients may help to promote health as a whole.

Obesity is a typical example of a non-communicable chronic disease that is a highly prevalent risk factor in industrialized countries and of the link between oral health and overall health. It is estimated that 35% of the population is overweight or obese.

Obesity impacts oral health

Obesity has multiple consequences on general health, including risk of diabetes, obstructive sleep apnea, hypertension, cardiovascular diseases, and on oral health. There is a linear relationship between the BMI and the risk of periodontal diseases, with an increased risk of periodontitis for obese patients compared to normal weight patients. The impact of obesity seems even stronger in the age range 18-34 years and in European countries. Also, obesity increases the risk of tooth loss or of being edentulous.

Periodontal diseases impact obesity

In the case of obesity, a bidirectional relationship may also be advocated. Literature shows that individuals with any tooth loss had 1.41-time higher odds of obesity, while edentates had even higher odds. Indeed, once obesity has developed, comorbidity often installs as well, including insulin resistance and diabetes, hypertension, metabolic syndrome and in general, a low-grade systemic inflammation is present.

This predisposes to periodontitis development or worsening, which, if left untreated, may lead to tooth loss. Lost or inadequately replaced teeth then have dramatic consequences on masticatory functional capacity, meaning that patients may have to change their nutritional habits, entering a vicious cycle of inflammation and weight gain.

Nutrition and oral health

A healthy diet helps to protect against malnutrition in all its forms and against non-communicable diseases, including diabetes, obesity, heart disease, stroke, cancer, and oral diseases. WHO recommends that the energy intake (in terms of calories) is balanced with the energy expenditure. This may vary from an individual to another and according to age, but the total fat should not exceed 30% of the total energy intake. The intake of free sugars and salt should also be limited.

It has been showed that patients with periodontitis tend to consume more carbohydrates, less dairy products, and may present some vitamin deficiency (like vitamin D) more often than individuals without oral diseases. These epidemiological data suggest that, nutrition and oral health being linked, a Dietary and Nutraceutical Approach as an adjunct to periodontal therapy is necessary to improve oral and periodontal health.

Sleep and periodontal health

Sleep is an emerging risk factor for oral and periodontal health. Sleep has a cardinal role for health, with multiple functions ranging from development, memory consolidation, to immunity and inflammation regulation. Whenever sleep is disrupted on a chronic basis, several consequences on general health are observed.

There is a non-linear U-shaped relationship between sleep duration and periodontitis and tooth loss: individuals who do not sleep enough (<5-6 hours/night) or sleep too much (> 8 hours/night) are at increased risk of periodontitis and tooth loss. Patients suffering from obstructive sleep apnea (OSA) have higher odds of periodontitis compared to non-OSA patients.

Although there is no direct evidence that improving sleep quality or treating sleep disorders improves oral health, it appears clear that promoting a good sleep hygiene could be a preventative strategy not only for systemic health but also for oral and periodontal health.

Key insights

Risk assessment is cardinal for both personalized prevention and treatment. It must be repeated over time, as exposure to risk factors can vary with time, age, occurrence of comorbidities and behavior change. Prevention and treatment must be adapted according to this evolving risk profile.

Dentists have a crucial role in screening for other systemic diseases and counseling but a multidisciplinary approach with other health professionals is mandatory, to care for patients in a holistic way, especially for those with chronic diseases with life-long cares, recall visits and motivation needs.

Expand your knowledge on a 360º approach to periodontal and peri-implant disease prevention by listening to the other episodes in the Let’s Talk Oral Health podcast for experts. Don’t miss our discussions on the oral microbiome and behavioral change in patients.

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