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The Importance of Oral-Systemic Dentistry

Posted Jun 09 2010 8:21pm

The following is a guest post by Melinda Robertson. If you are interested in guest posting for Dental Heroes, please sign up here .

As dental professionals we’ve known for some time that there is an ‘oral-systemic’ connection. Unless we’ve graduated in the last 10 years, we weren’t taught about it in school and, sadly, often know little more than our patients.

Dentistry has changed dramatically since I graduated in ‘84. Over the years we went from believing disease was caused by calculus, then too much plaque, then specific plaque and today realize it’s a combination of specific plaque organisms under the influence-specific environment and host.

Oral diseases are bacterial disease – bacteria group together to form plaque. In combination with their by-products these bacteria cause decalcification and caries, left untreated leading to root canals or tooth loss. Bacterial plaque populations as they grow, change in composition, tipping the balance form good to bad, leading to gingivitis, periodontitis, halitosis. As if this isn’t bad enough we now know they have serious systemic consequences.

Bacterial populations that get out of balance initiate an immune response that results in an increased permeability of the tissues and bacteria and their by-products can then travel through out our system. Most are familiar with the association between bacteria and heart problems/valve replacements/joint replacements and the need for pre-medication prior to procedures that may result in an increased likelihood of bacteria getting into the blood stream via the sulcus(1). Remember the last time you gave blood? A recent visit to the dentist will now screen you out of being a donor – because you may be carrying oral bacteria in your blood and the costs to run additional tests on all the samples is just too costly. It’s easier to exclude these people(2).

Oral bacteria and periodontal disease has been associated with an increased instance of stroke and other coronary conditions, especially in persons with known high cholesterol(3).

Most clinicians will also be familiar with the association between low birth weight babies and premature births (4). Bacterial plaque from the oral cavity can travel to the placenta. In research earlier this year the journal of Obstetrics & Gynecology reported the first confirmed instance of oral bacteria responsible for stillbirth.

Research involving institutionalized elderly has identified a connection between oral bacteria and increased respiratory infections (5).

Periodontal patients have shown to exhibit an increased instance of a variety of cancers (6,7).

An out of balance oral bacterial population can also result in premature death (8)!

We need to take a more medical approach to diagnosis, prevention and treatment. This means looking at the problem not just treating the consequences (disease). We need to deal with the bacterial origin.

This is done with simple microbial screening. A BANA test is a quick, easy, affordable way to show clients/patients that ‘bad’ bacteria are present in the mouth and can be confirmed and further diagnosed with a simple microbial slide. In most instances you would perform your normal protocols, retest and if the slide results are still showing bacterial imbalance, a topical antibacterial is likely indicated.

With objective, microbiology results you can custom treat the bacterial infection with appropriate topical medication, metronidazole is often most appropriate. (Systemic medications would require a much larger dosage and the medication is delivered to every cell in the body, when in fact it’s only needed in one specific area – topicals are much more efficient and effective) The Novora system offers a rinse, topical cream and subgingival gel of varying concentrations, each geared for a different situation.

Other instances may call for antifungals, different antibiotics or other products designed to re-balance the once harmonious bacterial ecosystem. These might include chlorohexidine, chlorinedioxide, oral probiotics etc.

Because bacterial infections are transmissible – by close contact like kissing, tasting each others food – retesting is important to prevent future flare-ups of infection or the risk of transmitting the infection to a love one – infant or aging parent perhaps – who may not be as resistant to the negative effects of these bacteria.

To learn more about oral-systemic dentistry and a more medical approach to treatment visit or and please do follow us on twitter .

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4. Han YW, et al., Term Stillbirth Caused by Oral Fusobacterium nucleatum Obstetrics & Gynecology: 2010;115(2):442-445.

5. Scannapieco FA, Mylotte JM Relationships between periodontal disease and bacterial pneumonia J Periodontology 1996 Oct;67(10 Suppl):1114-22. [abstract]

6. Michaud DS, et al.Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study Lancet Oncol 2008; 9(6): 550-58. [abstract]

7. Cesar A Migliorati C, Periodontal diseases and cancer Lancet Oncol 2008; 9(6):510-512

8. J Periodontal Res. 2007 Aug;42(4):361-6.

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