In earlier BLOGs we have talked about brushing and flossing with braces and aligners. We also reviewed the proper techniques for brushing and flossing either with or without braces or aligners. Our recommendations have been general, and any specific individual concerns should be discussed with your dental healthcare provider. This advice is especially true and even more important as we present some thoughts on how our oral health relates to our overall physical health. Because the interactions, physiologic relationships, and individualized responses are extremely varied and complex, you must consult with your personal physician about any individual treatment recommendations or changes in medical or pharmacologic routine. These systems are so complex that nothing can be taken for granted.
It should be obvious that if one area or system in the body is suffering in its contribution, the other systems will have a harder time meeting their obligations. Fortunately for us, our bodies can function to an adequate level even when the individual systems are performing at a less-than-optimal level. For example, if we have high blood pressure or suffer from heart problems, our kidneys may not be able to function as proficiently as they would if heart performance were optimal, but they function to a level that is sufficient to support life. If we want to get the most out of life, we need all our physical systems to function and interact optimally.
A single system can affect the whole in a positive or a negative way. If a vital system is functioning at peak performance, this helps improve the performance of all the other systems. This rising tide lifts all the boats. This is true of the relationship between our oral health and our general physical health. Because the head and neck are extremely complicated, oral health is not as simple as just keeping the teeth clean by brushing and flossing, although this is a critical aspect. We will discuss some of the prevalent general interactions and stay away from complicated interactions and those that are not well understood. We will discuss these in general terms and not in depth.
A good place to start is with periodontal disease and how it relates to cardiovascular disease, as well as the relationship between diabetes and periodontal disease. Periodontal disease has been linked to both cardiovascular diseases and diabetes mellitus.
Let’s define periodontal disease or periodontitis, since it is the oral disease, we are considering in our link to general health. Periodontal disease, commonly called gum disease, is an inflammatory disease of the gums and other tissues that support the teeth. It is caused by the excess and long-standing accumulation of bacterial plaque on the teeth, which initially manifests as gingivitis. In periodontitis the bacterial plaque invades the underlying jaw bones, infecting them, ultimately leading to tooth loss.
Diabetes is a chronic disease where the blood sugar (glucose) levels are elevated and has two classifications or types: Type 1 and Type 2. In Type 1 diabetes the body does not produce insulin, while in Type 2 the body either produces insufficient amounts of insulin or is incapable of using the insulin produced efficiently enough to be productive. Signs and symptoms of diabetes include high levels of blood glucose, frequent urination, excessive thirst, weight loss, increased hunger, blurred vision, and numbness or tingling in the hands and feet. If diabetes is not well managed it can lead to some serious complications and problems, including heart disease, kidney failure, nerve damage and neuropathy, and eye problems including blindness.
There is a bidirectional link between periodontal disease and diabetes. This means that a person with periodontal disease is at greater risk for developing diabetes, and a person with diabetes is at a higher risk of developing periodontal disease. Both diseases potentiate each other. Since periodontal disease is strongly associated with a chronic lack of oral hygiene and poor brushing and flossing habits, there is a significant link between good oral hygiene and a lower risk of diabetes. Diet affects both dental plaque accumulation and diabetes. A good, healthy diet will help control diabetes in addition to reducing the risk of periodontitis. Treatments for diabetes include monitoring blood glucose levels and taking appropriate actions; appropriate diet, regular dental check-ups and care, and maintaining excellent oral hygiene.
Now, let’s see how periodontal disease is related to cardiovascular disease. Cardiovascular disease is a catch-all for a host of diseases and problems associated with the heart and circulatory system. It refers to a group of conditions affecting the heart and blood vessels. Cardiovascular disease encompasses a wide range of disorders like coronary artery disease, peripheral artery disease, heart attack, and stroke, and can also include congenital heart defects. Cardiovascular disease is a killer, literally. It is the leading cause of death and disability worldwide. This is a sad statement on society worldwide because we could eliminate much of this death and morbidity through changes towards a more favorable and healthier lifestyle. Cardiovascular disease is primarily caused by smoking, an unhealthy diet, and a lack of physical activity, and is associated with high blood pressure and periodontal disease.
Periodontal disease is associated with an increased risk of cardiovascular disease, meaning if you have poor oral hygiene habits and poor oral health, you are at a greater risk for developing cardiovascular disease. Because periodontal disease results in an inflammatory response to the plaque infection of the gums and jaw bones, this localized oral inflammatory response can trigger a more general systemic inflammatory response which may lead to atherosclerosis (coronary artery disease and peripheral artery disease; the arteries narrow due to fatty plaque build-up). The bacteria from periodontal disease invade the blood stream through the gums and jaw bones blood supply and trigger this systemic inflammatory response or cause an infection.
The association between cardiovascular disease and periodontal disease is evident, but not as clear as other causal relations. What is known is that those who have periodontal disease are at a higher risk for suffering a heart attack, stroke, or another cardiovascular event. Even if your gums are healthy, other shared risk factors like smoking, a lack of dental care, poor oral health, poor diet, and poor oral hygiene all individually increase the risk of cardiovascular disease and the associated cardiovascular incidents. It should also be noted that tooth loss is associated with poor outcomes in stable coronary heart disease, and people with periodontal disease are more likely to present with high blood pressure or hypertension.
As noted above, a poor diet complicates relationships and worsens the prognosis for periodontal disease, cardiovascular disease, and diabetes. A poor diet also worsens the body’s ability to fight off infections and other communicable diseases because it lacks the nutrients it needs to defend itself. Even with a very good diet, if a person is missing several teeth or has a severe malocclusion (a bad bite) that prevents them from being able to chew their food properly, this can have a profoundly unfavorable effect on their ability to prepare the food for digestion and can have the same physical effect as a poor diet. If one is unable to chew their food, it is more difficult for the body to unlock the needed nutrients. Even with a good diet it is difficult to achieve the benefits. With a poor diet, this compounds the adverse effects of that compromised diet. Having strong, healthy teeth, a good bite, and straight teeth that are easy to clean and function well, can have a profound positive affect on our health.
Another area where there is a profound correlation between oral health and our general health and well-being is mental health and the effect our psychological strength and resilience has on our physical health. Our outlook on life, our healthcare, those who provide our healthcare, and our confidence in the success of the proposed procedures and remedies has a significant impact on the outcomes and success of those treatments. If we have a good relationship with our healthcare providers and a high level of confidence in the treatments, they propose we are more likely to experience a favorable outcome and better results.
How does this relate to oral health and its impact on our overall health and well-being? If we have a good oral hygiene routine, proper dental care, healthy teeth and gums, a strong healthy bite, and nice straight teeth, we should be experiencing good oral health and have beautiful smile aesthetics. With this in place, we should have a healthy positive self-image and good self-esteem. This should give us the confidence to live a good life, full of accomplishment and positive contributions to our family and society. If we are making positive contributions to the lives of others, we should have a sense of satisfaction and be in a good healthy mental state. Our smile has a lot to do with our self-image. If our teeth are clean and healthy, and we have a smile that radiates our positivity, we should enjoy a good mental state of health and well-being.
If we are not happy with our smile or suffer from a poor self-image, this will adversely affect our self-esteem and mental health. It may also limit our desire and ability to have a positive impact on others. The great thing about our bodies and our minds is that we have the capacity to change and heal. We can make changes in our lifestyle, our attitude, our diet, and our self-image. If we smoke, have an unhealthy diet, poor oral hygiene and care, poor smile aesthetics, or periodontal disease, we can make changes to address these undesirable parts of our life. Small incremental favorable changes made consistently will culminate in massive positive progress over a period.
It doesn’t take as long as one might think to see the results of small consistent improvements. This is exactly how your orthodontic treatment works; small incremental favorable changes over time move you towards the goal of enjoying the amazing smile you envision for yourself. Establish a good oral hygiene pattern, see your dentist regularly, make good, healthy lifestyle choices, and pursue orthodontic treatment to maximize your smile aesthetics and make your teeth easier to clean. This will give you better oral health, improved self-image and self-esteem, and better physical health and well-being. It’s not that hard, but it does take commitment and effort. In the end, the investment you make to improve your health and well-being will pay dividends you can enjoy throughout life. It’s well worth the effort made!