Systemic Inflammation and Oral Health

Inflammation is a natural process of innate biochemical defense mechanisms that helps the body heal from trauma, injury, infection, and illness. The body’s response is to increase the production of white blood cells, immune cells, and substances called cytokines and chemokines (inflammatory mediators that coordinate the process). Most people are aware of the inflammation that occurs around a cut, wound, or athletic injury. This is called acute or short term inflammation. Classic signs may include redness, pain, heat, and swelling; this type of inflammation is well understood and ends when healing occurs. The other type of inflammation, chronic or systemic inflammation is less well recognized or understood.

Systemic inflammation contributes to chronic diseases

Systemic inflammation is seldom diagnosed on traditional medical or dental examinations; it often remains silent or painless as a continuous low-level physiologic background response that lasts for weeks, months, or years; long periods of inflammation can be harmful and results in the activation of both the inflammatory and immunologic pathways that cause detrimental effects on: blood vessels walls, the intestinal lining in the gut, organ systems, and joints.  Systemic inflammation contributes to many ongoing health problems, including the chronic diseases that account for up to 75 percent of US healthcare costs, conditions such as:  cardiovascular disease, heart attack, stroke, diabetes, digestive disease, rheumatoid arthritis, hypertension, fatty liver disease, high cholesterol, and cancer.

An unhealthy lifestyle drives inflammation

Systemic inflammation is largely driven by preventable (modifiable) lifestyle risk factors – poor diet, inactivity, obesity, stress, bad sleep, poor oral health.  However, for some people, non-modifiable risks also contribute; those with family histories of complex diseases can have an increased genetic risk for amplified systemic inflammation due to exaggerated pro-inflammatory responses.

Poor oral health can affect whole body health

Prolonged oral infections are one of the root causes of systemic inflammation.   Disease causing oral organisms gain entrance into the bloodstream via the wounds of periodontal disease and gingivitis, or from the infections of abscessed teeth, where they become metastatically transported thru the vasculature to organ systems; they may also enter the respiratory tract by aspiration or inhalation, or the digestive tract via ingestion. Oral pathogens, their toxins and by-products, initiate inflammatory and immunological responses orally and systemically, causing an elevation of serum pro-inflammatory chemicals, elevation in serum lipids, immunological injury, adverse organ inflammatory states, and the intravascular inflammation that promotes arterial plaque formation (atherosclerosis). Some organisms may cause blood infections such as, bacteremia, septicemia, or endotoxemia; others may directly invade organs or damage the delicate lining of blood vessel walls. This oral inflammatory burden produces risk factors and disease processes that increase the costs of healthcare.  Associated systemic risks can range from an increased probability of micro-vessel dementia, retinopathy, thrombosis, impaired kidney function, pregnancy complications, insulin resistance, rheumatoid arthritis, bacterial pneumonia, digestive cancers, or the vascular events linked to heart attacks and strokes.

Wellness and disease prevention costs less than sickness

It is impossible to have good medical health with poor oral health.  Improving dental health is tied to reducing risk factors for many potentially fatal medical health conditions.  Research demonstrates reductions in medical costs in people who have proper dental care – from an average annual savings of almost $2,000 overall, to nearly $4,000 for people with rheumatoid arthritis, to up to $14,000 for people with kidney disease.  Proper oral care represents one of the simplest and lowest cost methods for controlling both inflammation and its related healthcare costs; medical healthcare costs decrease significantly with good oral health.

Oral Pathogen Significance to Systemic Health

PORTAL OF ENTRY:

– Prolonged entrance of oral pathogens can occur via the gingival-sulcular wounds of periodontal disease, chronic gingivitis, or from endodontic abscesses with metastatic spread via the bloodstream through the vasculature
– Entrance into the respiratory tract can occur via aspiration / inhalation
– Entrance into the digestive tract via ingestion

DETERMINANTS:

– Pathogenicity or virulence of bio-burden
– Genetic risk of the host for systemic inflammation
– Host immune status and immunological response
– Relative abundance of pathogens above threshold
– Environmental influences (e.g.: medications, toxins)
– Life-style factors (e.g.: smoking, nutrition)
– Systemic changes or disease (e.g.: pregnancy, puberty, salivary flow, diabetes, etc.)

ORAL PATHOGEN SYSTEMIC INFLUENCES:

1. increase in chronic inflammatory pathways, pro-inflammatory mediatorsincrease in bacteremias, endotoxemias
2. increase in bacteremias, endotoxemias, immunological injury
3. increase in atherogenesis, thrombosis
4. increase in lipogenesis
5. increase in osteoclast activity, decreased bone density
6. increase in endothelial dysfunction
7. increase in organ system inflammatory states
8. increase in insulin resistance, hyperglycemia, diabetes risk
9. increase death rate in type 2 diabetics with periodontal disease from 3.7% in non-periodontal diabetic patients to 28.4% for diabetics with severe periodontal disease
10. increase in nutritional deficiencies
11. increase in systolic and diastolic blood pressures, hypertension risk
12. increase in sub-acute bacterial endocarditis risk
13. increase in cardiovascular disease risk
14. increase in heart attack risk 2x
15. increase in ischemic stroke risk 3x
16. increase in chronic kidney disease risk, dialysis risks, glomerulonephritis
17. increase in organ transplant/stem cell infection/rejection risk
18. increase in infection risks for suppressed immune systems, chemo / radiation therapy, HIV+ status, ESRD
19. increase in artificial joint surgery infection / rejection risk
20. increase in rheumatoid arthritis risk
21. increase in pre-term low birth weight births 7x
22. increase in respiratory infections, bacterial pneumonia, chronic obstructive pulmonary disease
23. increase in Alzheimer’s risk, microvascular dementia risk 4x
24. increase in erectile dysfunction risk
25. increase in tongue cancer, throat cancer, tonsillar cancer, esophageal cancer risk
26. increase in colon cancer risk
27. increase in cancers in men 14%
28. increase in kidney cancers in men 49% vs. women
29. increase in pancreatic cancers in men 59% vs. women
30. increase in blood cancers in men 30% vs. women
31. increase in CRP levels, LP-PLA2 levels, hbA1c levels
32. increase in plasma fibrinogen levels
33. periodontal disease + diabetes family history + hypertension + high cholesterol = 27-53% chance of undiagnosed diabetes
34. increase in health care related costs

Oral Organisms Associated with Systemic Disease