The Mouth as a Portal: Oral-Systemic Inflammation

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Our mouths are a gateway to the rest of the body, and the health of our gums and oral mucosa directly impacts our systemic well-being. This is a topic that I’m particularly passionate about, and this connection is crucial for health and disease.

Periodontal disease isn’t just a localized problem; when impacting most of the dentition it equates to 72cm2 of tissue bleeding (it is similar to the surface area of two palms of our hands bleeding). Periodontal inflammation usually presents as a chronic condition that gives no pain and can have far-reaching effects on the entire body. 

In addition, the bacteria and their by-products, along with inflammatory mediators producing the immune response to them, don’t just stay in the mouth. They can enter the bloodstream and travel to other organs and tissues, acting as a portal for systemic issues. There are millions of live immune cells in our saliva that go in and out of our oral tissue. Thus, these carriers bring information from the mouth elsewhere. They act as messengers locally and systemically.

This is why examining and managing oral inflammation frequently is so important. Early detection is key, not only for preserving teeth but also for improving a patient’s overall health.

The Systemic Effects of Periodontal Inflammation

For a long time, the connection between periodontal diseases and systemic health was debated. But now, thanks to extensive research, including from my laboratory, the link is clear. Here are some of the key areas where oral inflammation has been shown to play a role:

  • Cardiovascular Diseases - The same bacteria found in periodontal pockets have been identified in the plaque of clogged arteries. Chronic inflammation from the gums can contribute to the hardening and narrowing of arteries, increasing the risk of heart attacks and strokes.
  • Diabetes - This relationship is a two-way street. Especially with type 2 diabetes, not only does diabetes increase the risk and severity of periodontal disease, but severe periodontitis can also make it harder for the body to control blood sugar levels. Strong evidence shows that treating gum disease can actually help improve glycemic control.
  • Respiratory Diseases - The inhalation of oral bacteria can lead to respiratory infections like pneumonia, especially in patients with pre-existing lung conditions.
  • Pregnancy Complications - There’s a growing body of evidence suggesting a link between periodontitis and an increased risk of premature birth and low birth weight.
  • Brain Complications – Surprisingly, a bacteria from the mouth – porphyromonas gingivalis or P.G. – has been found in the brain of patients with multiple sclerosis.
  • Gut Complication – Fusobacterium Nucleatum – a common bug in all of our mouths – when found in the gut, has been associated with Colon Rectal Cancers (CRC).

More than ever, we have evidence-based research to demonstrate the strong link between oral and systemic health, validating the role of our specialty in preventing and treating diseases.

In terms of mechanism, it is well accepted that there are two major pathways. One direct pathway is the direct invasion of microbes from the mouth going into the vessels and invading other organs. The second and indirect pathway, relates to the local and systemic activation of inflammatory cytokines that control cell behavior and impact the entire resolution process (termination of inflammation).

Figure 1: The Mouth as a Portal – Oral-Systemic Inflammation. This infographic we created with AI (hey why not) illustrates how the mouth, when affected by chronic inflammation (such as periodontal disease, represented by the swirling red energy), acts as a portal for inflammatory mediators and bacteria to enter the bloodstream and impact various systemic organs. Arrows indicate the pathways of inflammation leading to potential health issues in the heart (cardiovascular disease), brain (cognitive decline), lungs (respiratory infections), and kidneys (renal dysfunction). The red jagged lines and ‘N’ symbols represent inflammatory signals spreading from the oral cavity to these vital organs.

 

Finally, understanding these connections empowers us to provide more comprehensive care for our patients. By focusing on both local oral health and the broader systemic implications, we can help our patients live healthier lives. Read more information about inflammation activation and resolution here.

There are new insights on how to control inflammation more precisely within the oral cavity. I am looking forward to reporting the new research in the near future.

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