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The Oral-Systemic Link: Monsters in Your Mouth

November 10, 2016 By John Wilson

Jamie Toop, DDS, with Rebecca Sorci

After presenting about the link between oral and systemic health at a recent meeting in Chicago, a woman thanked me for my presentation. She told me that her husband died 2 years prior from infective endocarditis following a root canal. He was a healthy football player in his 20s. When he was sick, everyone said infective endocarditis was not possible in someone like him. She thanked me for spreading the word on how oral bacteria can lead to systemic disease and bodily harm.

Educating our patients and other health care professionals about the systemic effects of oral bacteria can help lead to greater overall wellness in others, decreased medical bills, and extended years of life. To assist in the mission of educating others, this article explores available data on the oral-systemic link. These studies provide evidence to support the correlation between diseases of the oral cavity and chronic systemic diseases. While this correlation does not necessarily imply causation, it is hard to dispute the oral-systemic connection.

The Leading Causes of Death

According to the most recent data released from the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States. In 2010, the United States spent $108.9 billion on coronary disease alone,1 which is higher than any other condition. The second highest total US health care spend in 2010 was on oral health conditions ($102 billion), which demonstrates the impact of both heart and oral health on the health care system.

Following heart disease, chronic lower respiratory diseases, stoke, accidents, Alzheimer’s disease, and diabetes are the leading causes of death in the United States.2 With the exception of accidents, each of these causes of death can be linked to proteins, enzymes, and bacteria in the oral cavity in some way. Thus, six of the seven leading causes of death in the United States represent chronic diseases that have been associated with conditions in the oral cavity. The CDC also reported that chronic diseases account for $3 of every $4 spent on US health care. If improvements in oral health can have any benefit in reducing chronic disease, there would be a major impact in both the financial and human costs of these conditions.

Heart Disease

Inflammation in the mouth may be correlated to inflammation in the body. Studies have shown that patients with periodontal disease are up to 35% more likely to develop coronary artery disease than patients with healthy gums.3

In 2010, the British Medical Journal reported that patients who brush less than twice a day are at a higher risk of suffering a cardiac episode than those who brush more than twice a day.4 Poor oral hygiene is associated with higher levels of cardiovascular disease risk and low-grade inflammation, which is measured by increased levels of C-reactive protein (a protein found in the blood that rises in response to inflammation).

A recent study in mice was able to show that chronic oral infection directly accelerates atherosclerotic vascular disease.5 The results of this study provide evidence of a causal relationship between periodontal disease and cardiovascular disease. Periodontal treatment can also reduce systemic inflammation. A recent study in a random population-based sample of men and women demonstrated that improvement in periodontal health is associated with less progression in atherosclerotic vascular disease.6Studies have also shown a reduction of C-reactive protein and improvement of heart and blood vesicle function following periodontal treatment with the dentist.7

Cancer

Correlations have also been shown between pancreatic cancer and the condition of the oral cavity. In 2014, researchers at San Diego State University found that patients with pancreatic cancer have significantly higher levels of leptotrichia and campylobacter bacteria in their saliva.8 They believe this is because both the pancreas and saliva produce amylase. A test currently in development may be able to detect early changes in saliva. This test is easily conducted in the dental office and would provide the ability to detect pancreatic cancer sooner than any other method to date.

According to the American Cancer Society, the overall 5-year survival rate for all stages of pancreatic cancer combined is only 6% because it is difficult to detect, and the disease is typically already in the untreatable late stages when diagnosed.9 It’s also notable that men are at higher risk of the associations between periodontal disease and cancer than women. Men with periodontal disease are 30% more likely to develop cancers of the blood.10 They also have an increased risk for prostate cancer. Recent data has shown that men with both periodontal disease and prostate cancer have higher levels of prostate-specific antigen secretion, an enzyme that is only normally secreted in very small amounts in healthy men.10

Lower Respiratory Disease

The third leading cause of death in America is chronic lower respiratory disease. Bacteria originating in the oral cavity can cause lung infections.11 Bacteria, such as Porphyromonas gingivalis, Fusobacterium, and Aggregatibacter actinomycetemcomitans, can be aspirated into the lower airways and cause pneumonia, which can present in chronic forms.12

Although smoking is believed to be the leading cause of lower respiratory infections such as chronic obstructive pulmonary disease, periodontal disease may be a contributing factor that can worsen the condition. Since individuals with respiratory infections are known to have compromised immune systems, it is easier for the bacteria and inflammation to spread from the oral cavity to the lungs.

The greater the periodontal disease, the greater loss of lung function is observed.13 This happens by way of aspiration. As oral bacteria are inhaled into the respiratory epithelium, an infection occurs when the bacteria multiply and begin to destroy tissue if the host is unable to clear them.14

Stroke and Transient Ischemic Attack

The incidence of cerebral ischemia, or the condition where blood flow through the brain is insufficient, is typically greater in patients with periodontal disease. Those with severe periodontal disease are 4.5 times more likely to suffer an ischemic stroke than those with healthy gums.15 The greater the periodontal disease, the greater the risk is for cerebral ischemia.

Some of these leading causes of death are interrelated systemic diseases. Stroke and heart disease have many of the same risk factors, including high blood pressure and high levels of low-density lipoprotein cholesterol, smoking, diabetes, and obesity. Those with coronary heart disease have more than twice the risk of stroke than those who do not.16 Periodontal disease may be another contributing risk factor.

Alzheimer’s Disease

A case study of Alzheimer’s disease in Japan found that the loss of more than half of adult teeth by age 50 to 60 years may correlate with a 2.6-fold increased risk of Alzheimer’s disease.17 For participants in this study, the most common cause of tooth loss was periodontal disease occurring 20 to 30 years prior to the onset of dementia. Another study of 144 participants having few or no teeth showed that the risk of dementia increased 4.3-fold.18

Alzheimer’s is a non-reversible condition with no cure. People with dementia and Alzheimer’s tend to decline in their oral hygiene.19 This creates a vicious cycle of periodontal disease, which leads to dementia, declines in oral hygiene, and worsened periodontal disease.20

Diabetes

The seventh leading cause of death in America is diabetes. Studies have shown that diabetic patients with severe periodontal disease are at a 3.2-fold increased risk of diabetic nephropathy and ischemic heart disease.20 Studies also demonstrated improvements in glycemic control resulting from the use of non-surgical periodontal treatment. Advanced periodontal treatment can also reduce health complications for patients with type II diabetes, which can reduce annual health care costs by approximately 40%.21 The integration of advanced periodontal treatment into diabetes management can reduce the costs and complications of individuals with elevated A1C.

Evidence of a Correlative Relationship

Researchers at the University of Indiana are studying the oral-systemic link in a different way. Instead of determining the systemic impact of periodontal disease, their focus is to “harness a controlled model of oral infection,” which they call the “Experimental Gingivitis Model.” This model permits investigator control of induced infection and resolution of gingivitis, and determines a range of systemic microbial and host outcomes. These researchers are the first to demonstrate that a systemic inflammatory response under the conditions of a 21-day model and the accumulation of dental plaque in systemically healthy young adults results in endotoxemia, a known driver of atherogenesis.

In a groundbreaking study by United Concordia, 1.7 million insurance records were reviewed from 2005 to 2009.21 Members who completed treatment for gum disease plus follow-up visits were compared to those who did not. The annual medical cost savings per patient was $5,681 for members with cerebral vascular disease (stroke), $1,090 for members with coronary artery disease, $2,840 for members with diabetes ($1,477 for diabetes outpatient drug costs alone), and $2,433 for women who were pregnant (decrease in preterm birth rate). Those who had persistent oral inflammation and systemic disease, and did not treat their periodontal disease had a greater amount of medical costs. Those who did treat their gum disease saw a decrease in health care costs.

This study also found a correlation with the reduction in hospitalizations. There was a significant savings in annual medical costs and a significant reduction in annual hospitalizations in those who underwent treatment for periodontal disease versus those who did not. The annual hospitalizations were reduced by 21.2% for members with strokes, 28.6% for members with heart diseases, and 39.4% for members with diabetes. The researchers present oral health as the “key missing piece to overall health.” Periodontal therapies, including scaling and root planing, regular visits to the dentist, and impeccable oral hygiene instruction should be strongly encouraged, and are necessary to provide more complete care and overall wellness for our patients.19

Filed Under: blog

Through Nature and Evolution

December 8, 2015 By John Wilson

Through Nature and Evolution, your teeth have endured the test of time. In fact, teeth are designed so well that they have remained unchanged for over 400,000 years. Your teeth are naturally designed to last a lifetime, and with proper care and attention this can be a reality. When your teeth become damaged or decayed, it is logical for restorations to mimic the function, strength, and beauty of natural teeth.
Dr Wilson practices Biomimetic Dentistry – the art and science of restoring damaged teeth with restorations that mimic natural teeth in appearance, function, and strength. Biomimetic dentistry is conservative- by only replacing what is damaged, and strong- by replicating nature’s original design.

WHAT IS BIOMIMETIC DENTISTRY?

Translated literally, biomimetic dentistry means to copy what is life-like. Nature has provided the most successful and ideal properties to our natural teeth. When restoring damaged, broken, and decayed teeth, the goal is to return the tooth to its original strength, function, and esthetics. Biomimetic dentistry accomplishes all of this in a conservative, strong, and attractive approach.

bio-mimetic

BIOMIMETIC DENTISTRY IS BASED ON ADVANCED ADHESIVE DENTISTRY

All too frequently, fillings are treated as a temporary solution because of the belief that the fillings will eventually fail and need to be replaced with crowns or onlay restorations to be a more permanent restoration. As adhesive dentistry has evolved, our materials and techniques have been refined allowing us to achieve a predictable long lasting adhesive bond. These advanced techniques are the cornerstone of Biomimetic Dentistry.
With the Biomimetic approach, a filling is a final restoration when it is indicated (small or medium amount of damaged tooth structure). The restoration is carefully placed in increments to maximize the adhesive bond to your tooth. This prevents excessive shrinkage and gaps from causing premature failures. Techniques such as this, along with a sound understanding of advanced adhesive methods is what separates Biomimetic Dentistry from the traditional approach to dentistry.

BIOMIMETIC DENTISTRY IS TOOTH CONSERVING DENTISTRY

Once significant damage has been done to a tooth, a crown is the restoration of choice in traditional dentistry. Teeth become structurally compromised when a large amount of the tooth is missing or damaged. Traditionally, crowns were indicated to restore strength to these structurally compromised teeth. However, crowns result in over 70% reduction of your original tooth structure. The problem is a majority of structurally compromised teeth will require even more reduction of healthy tooth structure in order to fit the crown which is supposed to strengthen the tooth.
This approach is fraught with problems. Crown preparations can lead to sensitivity, root canals, and fractures. A tooth with a crown behaves differently than a natural tooth and the stresses on the crown are more damaging to the remaining tooth structure. With Biomimetic dentistry, only the damage and decay is removed, and your final restoration is bonded to the healthy natural tooth structure. The final restoration is often referred to as an inlay or onlay restoration. There is no extra removal of healthy structures to fit a crown and the result is a conservative and strong final restoration.

BIOMIMETIC DENTISTRY PREVENTS UNNECESSARY ROOT CANALS

In many instances, root canals can be completely avoided with these principles. Most Biomimetic Dentists report over 90% reduction in the number of root canals their patients receive. Removing excessive amounts of healthy tooth structure for a crown can inevitably result in sensitivity and irritation to the vital tooth which will require root canal treatment. By limiting removal of healthy tooth structure, Biomimetic Dentistry significantly reduces the necessity for root canal treatments. This is paramount to long term success and retention of your natural teeth.

Filed Under: blog

Sports Dentistry Facts

January 29, 2014 By John Wilson

Facts from the National Youth Sports Foundation for Safety

  • Dental injuries are the most common type of orofacial injury sustained during participation in sports; the majority of these dental injuries are preventable.
  • An athlete is 60 times more likely to sustain damage to the teeth when not wearing a protective mouthguard.
  • The cost of a fractured tooth is many times greater than the cost of a dentist diagnosed and designed professionally made mouthguard.
  • Every athlete involved in contact sport has about a 10% chance per season of an orofacial injury, or a 33-56% chance during an athletic career.
  • The cost to replant a tooth and the follow-up dental treatment is about $5000.
  • Victims of knocked out teeth who do not have a tooth properly preserved or replanted may face lifetime dental costs of $15,000-$20,000/tooth, hours in the dental chair, and the possible development of other dental problems such as periodontal disease.
  • It is estimated that faceguards and mouthguards prevent approximately 200,000 injuries each year in high school and college football.
  • The stock mouthguard which is bought at sports stores without any individual fitting, provide only a low level of protection, if any. If the wearer is rendered unconscious, there is a risk the mouthguard may lodge in the throat potentially causing an airway obstruction.

http://www.sportsdentistry.com/

Filed Under: articles

Dr. John Wilson and Dr. Jannah Wilson Father–Daughter Dynamic Duo

February 8, 2013 By John Wilson

When listening to Dr. John Wilson, you are startled by the humble and self-effacing nature of this popular Vancouver Island dentist. With his patients he uses a “you’re the doctor, i’m the technician” approach to his dental practice. He doesn’t consider himself ‘special’ or ‘above anyone else’; as a consequence, he has developed sincere compassion for his many loyal patients. He believes that this philosophy is sometimes lacking in a small number of the younger dentists of today who see their dental career more from an investment perspective.

Dr. Wilson’s advice to young dentists is “become the best dentist in the world” and all else will follow. He urges them to spend the time necessary to master their dental craft, take the courses to improve delivery and learn how to communicate effectively with staff and patients. He encourages dentists to practice in small town environments where he feels the rewards are greater, both professionally and personally. However, he qualifies this belief in saying that the small town should be close enough to a ‘big city’ to allow for the benefits a large cosmopolitan centre can offer.

John possesses a ‘green’ side that is prevalent in many west coast Canadians. He is currently planning to build a cob house to improve his lifestyle and lessen his impact on his natural surroundings. Modern cob houses still use ancient building techniques and materials like bricks made of mud, sand and straw and harnessing natural energy sources such as passive solar heating. To these older wisdoms are added the latest in today’s technological thinking; the result is an environmentally friendly accommodation and living style. While these homes might not appeal to all, they are highly efficient, cost effective, sustainable and low maintenance ‘green’.

Growing up in Gananoque, Ontario, the son of steel worker, he had two choices: work in the steel mill or go to university. He is thankful he was born and raised in Canada and praises his parents for a ‘normal’ upbringing that allowed him freedom and choice. He has tried, with his wife Sylvia, to provide a similar upbringing for his own children.

One of John’s children, Jannah, is a surgical resident entering her final year of residency. Like her father, she works hard – very hard at her chosen profession. A typical week at the Ottawa Hospital involves a minimum of sixty hours and sometimes, the hours served are twice that amount. Jannah loves the pace of hospital life. She enjoys thinking on her feet, calling on her manual and mental skills to solve the never-ending problems of providing quality medical care for her patients.

Prior to medical school, Jannah worked in Methadone clinics on the east side of Vancouver. She taught a Youth at Risk programme for troubled teens.  She considered and explored careers in both sociology and law enforcement. She thought about a career in physiotherapy and worked as a fitness trainer at a rehab hospital. What drives this energetic young professional? She freely admits she is an adrenalin junky looking for a challenge and the high she gets from her work on a day-to-day basis. She learned perseverance (a word she uses often) from both her sister and her father. Her sister overcame a hearing disorder from birth through sheer determination and hard work. Jannah grew up looking up to and out for her older sister. Her father asked his children to strive harder at whatever they did and he himself lived the credo he encouraged in his children.

father-daughter

The possibility of following in her father’s pathway as a dentist was never rejected. While her father never encouraged any one career, including dentistry, he did ask Jannah to think hard and long before becoming a doctor. The endless, demanding hours that a career in medicine entails were his central concern. Ten years down the road, Jannah hopes to have worked as a locum in hospital settings in at least three provinces. Educated in French Immersion classes, she wants to perfect her fluency in French and become truly bi-lingual. She loves the natural setting and lifestyle of British Columbia and hopes to practice in the northern regions of that picturesque province. As a child growing up in Timmins, Ontario, she acquired a soft spot for Ontario, especially its cottage country. For now, Jannah looks forward to another year of perfecting her surgical skills and procedures. Her perseverance and patience coupled with her desire to problem-solve and volunteer as an international aid worker keeps her humble and balanced.

Dr. John Wilson credits his wife and family for his being grounded, open and caring. Jannah concurs with her father. The unconditional love provided by her mother, her interactions with her siblings and the respect for others that her parents instilled, usually derived from dinner table discussions, was crucial to her development. Her sister’s early hearing struggles taught her about human vulnerability. She laughingly related that her ‘brat’ brother taught her that patience was indeed a virtue. Both John and Jannah fondly recall family dinner chats, when everyone related the events of their day. It became a time of sharing feelings, debating ideas and reflecting on everyday issues both big and small. John and Jannah understand the need for a personal life and vacation time. They are active and physically fit, enjoying skiing, sailing and hiking. Jannah loves sports, travel and is happy riding her motorcycle whenever possible. John, in his spare time, is content to be busy planning and building a cob house. Both live life to the fullest.

Bottom Line: This article relates the lifestyle and interests of two health care professionals who just happen to be father and daughter.

Article originally published in Profitable Practice Magazine – Dental Edition – Fall 2012

Follow-up article Profitable Practice – WestCoastLifestyle

Filed Under: articles

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The Oral-Systemic Link: Monsters in Your Mouth

Jamie Toop, DDS, with Rebecca Sorci After presenting about the link between oral and systemic health at a recent meeting in Chicago, a woman thanked me for my presentation. She told me that her husband died 2 years prior from infective endocarditis following a root canal. He was a healthy football player in his 20s. […]

Through Nature and Evolution

The art and science of restoring damaged teeth with restorations that mimic natural teeth in appearance, function, and strength. Biomimetic dentistry is conservative- by only replacing what is damaged, and strong- by replicating nature’s original design.

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