It's a Small, Small, Extra Small World

We may think we're in charge, but actually, it's the the bacteria, fungi, parasites and viruses that run our lives.  Look at the problems that both the Ebola virus and Enterovirus D68 have caused and are causing here in the USA, as well as the rest of the world.  This microscopic world is fascinating and so powerful.  

This is an example of disease bacteria in the mouth (a video I took a few years ago.)


As a dental hygienist, I want to be sure my patients have a healthy oral flora of bacteria, etc...  Why should this really matter?  Because it affects our entire body health.  We call this the oral-systemic connection and it's a fairly new concept in the dental world.  When there is an infection in our mouth, whether it is tooth decay or gum disease, the bacteria, fungi, parasites and viruses travel throughout our bodies, infecting other parts of us!  The infection does NOT stay just in the mouth or just on that one tooth.  
Two weeks ago, I traveled to St. Louis, Missouri to attend the American Association of Oral Systemic Health Scientific Session.  At the AAOSH meeting, we heard from all manner of health care providers, not just dentists.  They spoke about different ways the bacteria and other pathogens from the mouth infect the body.  Today's post will review some of those connections.  (AAOSH has a great website and does have a list of dental professionals that think about dentistry in terms of "total body health".)  I'm proud to say I am an AAOSH member!

First, please remember that the pathogens that infect teeth are contagious. If you have a cavity, it can travel to the next tooth and the next one.  Gum disease is contagious too!  Kissing, sharing utensils, food, drinks-- it's all about saliva to saliva contact.  The mouth is a perfect incubator for the pathogens.  It's warm, moist, plenty of food (carbohydrates), dark, and best of all, undisturbed!  At any one time there may be 20 billion bacteria in your mouth, and they procreate rapidly.  You swallow up to 100 billion daily!  If allowed, these pathogen take over and infect both the teeth and the gums.  They live happily on your cheeks, tongue, roof of mouth, even your tonsil areas.  Your immune system can control this bacterial load ... to a point.  You have to help yourself out help, though.  If not, the bacteria take over control of your mouth, your body and ultimately, your health. 

So, how do these microbes invade your body? There are three routes:
     1. Respiratory system
     2. Digestive system
     3. Blood system 

Respiratory System: Pneumonia can be caused by oral pathogens that we inhale into our lungs!  This is especially a problem for those in the hospital or in nursing care, assisted living or nursing homes.  Aspiration pneumonia (as opposed to, say, viral pneumonia) is the leading cause of death in nursing homes!  The lack of simple toothbrushing or proper cleaning of dentures can cause such devastation!  Advocate for oral care for your elders, please!

Digestive System: Swallowing oral pathogens can lead to stomach ulcers, stomach cancer,  non-hodgkins lymphoma, GERD, and there is a possible link to pancreatic cancer.  The bacteria Helicobactor pylori is the common culprit in all these diseases.  It is found in the mouth, and is often initially contracted in childhood.  This is a good example of why an OralDNA swab (see below) can be so helpful: This guy could be hiding out for years, waiting for a break in your immune system and putting you at risk for these diseases, while a simple antibiotic could finish him off. 

Blood System: First, if your gums are healthy, you don't harbor disease bacteria.  Even if you came in contact with some, the blood system wouldn't be a viable route for them, because your gums, like your skin, protect your bloodstream from pathogens.  If, on the other hand, your gums bleed, you have an open highway for bacteria to enter your bloodstream. I've said it before, but if your finger bled every time you washed your hands, you'd be concerned, right??  Same should go for your mouth. Once you have introduced bacteria into your blood system, you have a bacteremia. Sometimes your immune system can take care of it, no problem. Sometimes... 

Bacteremia can have several consequences. The immune response to the bacteria can cause sepsis and septic shock, which has a relatively high mortality rate. Bacteria can also use the blood to spread to other parts of the body (which is called hematogenous spread), causing infections away from the original site of infection. Examples include endocarditis or osteomyelitis. Treatment is with antibiotics, and prevention with antibiotic prophylaxis can be given in situations where problems are to be expected.

(Wikipedia was just so concise.)

Toothbrush bristle with plaque

Whether this infection happens during your professional dental cleaning, probing, normal toothbrushing or even a tooth extraction, it can occur.  These pathogens invade your body by hitching a ride in your blood system.  And, just like a roulette ball, where it ends up is anyone's guess! 


Here's a list of systemic diseases that are connected with both gum disease and tooth decay: 
Heart Disease                                                 Colorectal Cancer
Stroke                                                             Dementia
Atherosclerosis                                               Kidney Disease
Low Birth Weight Baby/Preterm Baby          Brain Abscess 
Still Birth                                                        Obesity
Rheumatoid Arthritis                                      Diabetes

My guess is this list will continue to grow as more research is done looking into inflammation and its effect on the entire body.  AAOSH is dedicated to helping you learn about the oral-systemic connection.  

What's a person to do to avoid causing these health issues?  Prevention is key.  The bottom line is DO NOT wait until you have bleeding gums or infected teeth.  Do not wait for moderate disease signs and symptoms to appear.  Work with your health care providers (both dental and medical) to promote a shift from pathological microbes to healthy microbes.  In my office, we use a chair-side phase contrast microscope to get a quick peek into the microbial world that is living under your gumline. Further exploration with OralDNA is used to get an even better picture of the degree of quantity and quality of the pathogens residing in your oral cavity. Then, if need be, we attack it and work hard to help our patients to change it to a healthy oral flora.  There is healthy bacteria, we just need to encourage it to grow and replace the "bad guys".   For more information on oral hygiene tools and healthy tips check out my other posts, especially Stop Flossing or Conquering Cavities in Kids.  You can have a healthy mouth and a healthy body!  Join me on this journey and learn how!  

And this is what a healthy slide looks like!



While the microbial world is powerful, we can indeed take charge of it, stay healthy and be well!
Questions or comments are welcome! 
Keep Smiling!!
Barbara

P.S.  All my blog posts are now on a Queen of Dental Hygiene Pintrest board!