Bad oral health can have a significant negative impact on people’s quality of life. It can also affect other diseases that they may be suffering. But whether oral ill-health causes general health problems depends on what disease you’re talking about.
People with untreated oral and dental diseases can experience severe pain, loss of sleep, inability to eat certain foods, time off work or school and embarrassment about their appearance.
These diseases can accelerate the progress and severity of other illnesses, which makes it even more important that we do all we can to ensure everyone has access to affordable dental care.
The oral disease most frequently associated with medical conditions is chronic periodontal disease, which is the result of inflammation of the tissues surrounding the tooth affecting the gum, the ligaments and the bone. It’s caused by a bacterial infection and other factors, such as smoking.
In its most severe forms, periodontal disease can cause loss of the bone that supports the tooth, resulting in the tooth becoming loose. It can even cause tooth loss.
The strength of the relationship between periodontal disease and general health varies with the medical condition under investigation. The strongest evidence for such a link is between periodontal disease and diabetes.
Periodontal disease and diabetes
Epidemiological studies have confirmed that patients with diabetes (both type 1 and type 2) are more susceptible to periodontal disease. The extent of the risk relates to the duration and control of their diabetes – periodontal disease is likely to increase markedly when diabetes is poorly controlled.
Diabetes, in turn, leads to more rapid and severe progression of destructive periodontitis, increasing the risk of greater severity at least twofold. It essentially doubles the rate of periodontal disease progression.
Essentially, research suggests the relationship between periodontal disease and diabetes goes both ways – not only do people with diabetes have more severe periodontal disease, but periodontal disease may make it more difficult for people who have diabetes to control the condition.
Periodontitis and heart disease
The relationship between cardiovascular disease and periodontal disease has been more difficult to elucidate. Many studies found an association, but others have not. A recent review and meta-analysis of seven studies for the US Preventive Services Task Force found that the presence of periodontal disease was a weak but independent risk factor for heart disease.
So the important question of whether periodontal disease causes heart disease has yet to be determined.
This issue was recently addressed in a statement by the American Heart Association. The statement said there’s good evidence that periodontal disease and stroke, heart disease and peripheral vascular disease occur in the same people but that there’s no evidence periodontal disease causes these problems or that treating periodontal disease prevents them.
A 2008 meta-analysis concluded periodontitis had an effect on general health but issues of both the criteria for periodontal disease and confounding (diseases having the same risk factors as periodontal disease) need to be resolved.
The association between pregnant women with periodontal disease and adverse pregnancy outcomes has been demonstrated in a number of studies. But results from a number of randomised controlled trials of periodontal treatment during pregnancy have not been successful in improving pregnancy outcomes.
Other diseases where chronic infection may be an important factor have also been associated with periodontal disease. They include rheumatoid arthritis, stroke, chronic kidney disease and obesity.
Causation and correlation
In all these health problems, issues of confounding (many of the risk factors for periodontal disease are the same as those for other diseases) or co-morbidity (diseases sharing underlying risk factors or occurring in people with similar susceptibility) need to be clarified before causation can be determined.
Well-designed, large-scale longitudinal studies are required to determine whether causal links exist, the strengths of these links and whether treatment can reduce risks.
Meanwhile, oral diseases are a significant burden for many people particularly those who have difficulty gaining access to dental care because of financial constraints, location or disability.
Even though the nature of the relationship between oral health and general health remains to be clarified, the burden of bad oral health is significant for many Australians. It results in pain, discomfort, and loss of self-esteem as well as time lost from school and work. This makes it a major health issue in its own right, and one that requires attention and action from governments.