Oral health is a leading health indicator

Healthy People 2020 identified oral health as one of the 10 leading health indicators, along with other indicators such as access to health, nutrition, cancer, HIV and heart disease. Good oral health not only enables you to functionally perform as a human being (i.e. speaking, smiling, smelling, eating), it is also important for communication, human relationships and financial prosperity. Poor dental health has serious consequences, including painful, disabling, and costly health conditions.

This is especially the case for those who have the biggest obstacles in getting access to dental care – rural and lower income households. According to the ADA’s Health Policy Institute surveys of the U.S. population, one in five low income adults say their mouth and teeth are in poor condition – and one in three of them say the condition of their mouth and teeth affects their ability to interview for a job.

Many of the determinants that impact our oral health, such as diet and hygiene are controllable with the right habits.  Tooth decay (cavities) is the most common chronic childhood disease, yet it is preventable through healthy diet choices and good hygiene habits. However, without these healthy choices and habits, plaque buildup eventually leads to cavities, gingivitis or severe gum disease that puts teeth and gums at risk – and even other parts of your body. 

The connection between Alzheimer’s and dental health

A growing body of research has identified a connection between oral health and chronic diseases such as Alzheimer’s, diabetes and other serious conditions affecting millions of people. Recent research at the UIC College of Dentistry is helping to unveil some of the mystery behind the onset of Alzheimer’s Disease to pave the way for new treatments and bridge the “gap” that has traditionally separated the medical and dental professions. The goal is to use these findings to lowering the risk of diseases such as Alzheimer’s Disease and diabetes, especially as you age.

Alzheimer’s Disease (AD) is a devastating neurodegenerative disease that affects 1 in 10 adults over the age of 65. It leads to dementia, memory loss, and a steady decline in a person’s ability to function independently. The two major forms of AD are familial (early onset) AD which constitutes less than 5% of AD cases and sporadic (late onset) AD which constitutes over 95% of all AD. Early onset AD results primarily from mutation of genes that are involved in the formation of amyloid or senile plaques.  Sporadic AD has a relatively late onset (60-65 years of age) but its etiology and molecular mechanisms are largely unknown.

Dr. Keiko Watanabe is a Professor of Periodontics and researcher at the UIC College of Dentistry. Her research focuses on the connection between oral and systemic health, a research area that is critical in overall patient care.

In a recent study, Dr. Watanabe and colleague Dr. Vladimir Ilievski found that mice that were orally exposed to periodontal disease (gum disease) bacteria developed neuroinflammation, neurodegeneration, and senile plaque formation that were similar to AD in humans. Control animals did not show this pathology. Furthermore, they identified the presence of a periodontal pathogen/product within the neurons in the brains of experimental mice.

Another important finding is that the mice used in their experiments were young wild-type animals. Historically, transgenic mice were used to study AD since wild-type young mice are not thought to develop senile plaque. This suggests that chronic oral bacterial infection or the presence of bacteria/product in the brain may influence the development of senile plaque and hence chronic bacterial infection may be a risk factor for the Sporadic form of AD. 

The results were surprising even to Dr. Watanabe and serve as a breakthrough in our understanding of Alzheimer’s. “We did not expect that the periodontal pathogen would have this much influence on the brain, or that the effects would so thoroughly resemble Alzheimer’s Disease,” Watanabe said.

Dr. Watanabe’s research has established a clear animal model correlation between periodontitis and AD that serves as a basis to explore exciting new clinical research areas and therapeutic targets. The use of mice also presents clarity in the findings because animal models don’t have the confounding factors that can affect human studies, such as varying diets, obesity and exercise levels.

“These things are all controlled using the animal system…To me, it’s the clearest model system,” she explained.

Studying the brain to fight periodontitis

The effects of periodontitis are far reaching, and we have only touched the surface of our understanding.  Dr. Watanabe has also previously discovered that periodontitis can even affect the brain’s metabolism along with the liver and heart.

“We did a metabolomic analysis of mouse brain tissues, that shows a change in metabolism — the metabolites in the brain – that results from oral exposure to a periodontal pathogen. The metabolomic analysis shows there’s a decrease in glucose availability, which is significant since the brain needs glucose for energy.”

What this means for those suffering from Alzheimer’s remains to be seen until further research clarifies the connection between the illness and periodontitis in humans. However, other researchers have found periodontal pathogens in post-mortem human brains.

Links between periodontal (gum) disease and pre-diabetes

Dr. Watanabe has also linked exposure to periodontal bacteria and the development of pre-diabetes in mice.

Prediabetes is a pre-diagnosis of diabetes, and is an indication that you could develop type 2 diabetes. Prediabetes occurs when blood glucose level (blood sugar level) is higher than normal, but it is not high enough to be considered diabetes.

Periodontitis, or gum disease, also has potentially serious health ramifications. About half of all American adults 30 and older – nearly 65 million of them – suffer from periodontitis. While gum disease is common, it is also preventable.

Dr. Watanabe and her team examined how periodontitis affected pancreatic and liver cells in a way that could lead to prediabetes/diabetes. “The periodontal pathogen that we introduced into the mouth of the mice or a product from this pathogen influences the pancreatic alpha and the beta cells, and also the liver’s Kupffer cells,” Watanabe said. “And those two organs are very critical in the development of prediabetes/diabetes and maintaining health.”

Dr. Watanabe’s research team demonstrated that mice with prolonged exposure to periodontal bacteria also developed insulin resistance and glucose intolerance – major signs of prediabetes.  They have also shown that rats with a mutation that makes them prone to obesity develop diabetes and its onset was accelerated in the presence of periodontitis.

The changing landscape of dental care

Despite the scientific knowledge we now have, there remains a well-recognized “gap” between the medical and dental professions, and the delivery of care across them. The oral health workforce has historically been concentrated in private practice settings where dentists lead teams comprised of dental hygienists, assistants, lab technicians and office personnel. The majority of these practices continue to operate independently of most primary health practices and health systems.

Progress at the system level remains a challenge. Separate insurance systems, incompatible electronic health records, and a lack of education continue to be major obstacles in the coordination of care provide by dentists, physicians and other providers.

However, the landscape of dental care delivery is still changing. The private practice model is shifting to more integrated models, such as seen in dental service organizations (DSOs) and community based health centers (FQHCs). There are several community based initiatives in the US to expand access to dental care, especially among the most vulnerable. Some of the more notable programs include Give Kids a Smile, Missions for Mercy, and school-based dental sealant programs. Many are making great strides in integrating oral health with primary care or providing dental services in everyday settings such as schools.

Interprofessional education (IPE)

Interprofessional education (IPE) programs are also helping to close the gap. IPE creates learning environments where students from different fields can interact and learn in ways that prepare them for the seamless teamwork of collaborative practice necessary for coordinated care delivery. It is this collaboration and coordination of care that is a hallmark of the future vision for patient care experiences. Coordinated care benefits providers and payers through operational efficiencies and cost savings. Patients appreciate the ease of navigating options to get the affordable care they need from the best providers.

At University of Illinois at Chicago for instance, the Interprofessional Education (IPE) & Collaborative Practice focuses on developing collaborative competence across the continuum of health profession education including pre-professional students, students in health professions programs and practicing professionals.

Recently, the Institute for Healthcare Improvement (IHI) opened a school student chapter at UIC. This is an interprofessional student organization focused on developing the skills, competencies, teamwork and leadership of UIC health professions students to tackle the quality and safety issues that impact our patients, health professions, and healthcare systems.

And continuing research on the connections between oral and systemic diseases help to shed light on the importance of understanding the connections between oral health and well being. Results from Dr. Watanabe’s research suggest the importance of at-home dental care, regular check-ups, and heightened oral health awareness for everyone, especially those with a family history of potentially associated illnesses, such as Alzheimer’s and pre-diabetes / diabetes.

Good oral hygiene doesn’t only make you more kissable—it also may make you more fertile. According to emerging research, dental health may impact how long it takes a woman to conceive. In men, gum disease and tooth decay have been linked to poor semen and sperm health. The possible connection between dental health and fertility applies to both men and women.

During pregnancy, poor oral health is associated with an increased risk of gestational diabetes, preeclampsia, preterm labor, and having low birth weight baby. Ensuring your teeth and gums are healthy isn’t only important for your fertility—it may also be important for your not-yet-conceived child.

How might dental hygiene impact fertility and a future pregnancy? And, most importantly, what should you be doing to make sure it doesn’t negatively affect it?

Periodontal Disease, Gingivitis, and Your Health 

Most of the research on fertility and dental health is focused on periodontal disease. Swollen, red, and tender gums are possible signs of periodontal disease. Your dental hygienist is looking for evidence of this when they probe your gums. This process involves taking a dental tool known as a periodontal probe—a thin, long metal pick with a blunted end and measurement indicators—and gently pressing the instrument into the pockets (or spaces) of tissue that exist between the gum and tooth.1

Deeper pocket measurements indicate possible periodontal disease. Periodontal disease is chronic inflammation of the gums, supporting tissues, and jawbone. Left untreated, tooth loss and irreversible jawbone deterioration can occur. Between 1 in 10 people experience severe periodontal disease.

You may also have heard of gingivitis. Over half of adults in the United States have gingivitis.2 Gingivitis is a milder form of gum disease, which involves inflammation of the gums but doesn’t lead to a bone loss like periodontal disease. However, gingivitis can progress to periodontal disease. Poor oral hygiene can cause gingivitis.

Periodontal disease is associated with a number of health conditions, including heart disease, diabetes, respiratory diseases, and stroke.2 Women with polycystic ovarian syndrome (PCOS) and endometriosis and men with erectile dysfunction are more likely to be diagnosed with periodontal disease than the general population. 

Dental Health and Male Fertility

Several studies have found that men with poor oral health—whether from excessive and untreated cavities or periodontal disease—are more likely to face male factor infertility, especially when compared to men with normal sperm health.3

Low sperm count, poor sperm motility (that’s how the sperm swim), abnormal sperm morphology (that’s the shape of sperm), and evidence of bacterial infection in the semen are associated with various dental and oral health problems. While erectile dysfunction isn’t a common sign of male infertility (most men with infertility have few to none visible symptoms), those who do experience erectile dysfunction are more likely to have gum disease.3

A handful of studies has found that the treatment of cavities and dental infections did result in improved semen health. However, this is an area that needs more research, and not all studies found a direct improvement after dental treatment.

What does poor oral health have to do with your sperm? There are a few theories.

First, cavities, tooth infections, and gum disease all involve high levels of bacterial growth in the mouth. (Bacteria grow inside cavities and are also responsible for gum disease.) Elevated levels of bacteria in the mouth may lead to increased levels of bacteria in other areas of the body.

Bacteriospermia is when a bacterial infection (or evidence of infection) is found in semen. In a semen analysis, an abnormally high white blood cell count would indicate possible bacteriospermia. Studies have found that poor oral health is associated with an increased risk of bacteriospermia.3 Some research has found that treating cavities and oral infection has lead to a reduction or elimination of bacteriospermia.

Secondly, when your body is fighting an infection (and tooth decay is an infection), your body’s immunological response may go into overdrive. The infection and immunological response may be concentrated in the mouth, but this can still result in increased inflammation throughout the body. This in turn may lead to the immune system attacking healthy, non-threaten cells—like developing sperm cells.

Thirdly, it’s possible that risk factors for poor oral health are also risk factors for infertility. For example, let’s consider smoking. Smokers are at an increased risk of developing periodontal disease and smoking may negatively impact infertility.

Two Extra Months to Conceive in Women With Periodontal Disease

The majority of the research on dental health and fertility has been done in men. However, scientists are beginning to look at how female fertility may be impacted by oral health.

In a study of 3,737 pregnant women in Australia, researchers examined whether periodontal disease was associated with more difficulty conceiving.4 Of the women surveyed, they only included those who had planned pregnancies. They also excluded women who conceived with fertility treatments. (Therefore, we can’t determine how periodontal disease would impact women with diagnosed infertility from this study.)

Women with periodontal disease took an average of 7.1 months to get pregnant. However, women without periodontal disease spent on average 5 months trying to get pregnant. Periodontal disease increased the time of conception by two months.

It’s important to point out that this statistically significant increase in time-to-conception only was found in non-Caucasian women. In Caucasian women, there was also an increase in time to conception, but it was not considered to be statistically significant.

Why might this be? Ethnicity is a known risk factor for periodontal disease, along with other genetic factors. It is possible that non-Caucasian women have immune systems that are more susceptible to periodontal disease, and are also more likely to deal with the related health consequences of gum disease.

Periodontal Disease and Reduced Fertility

This is an area that needs much more research before any conclusions can be made. Does periodontal disease cause other health problems? Or do the health problems cause the periodontal disease? Or is something else responsible for both? We just don’t know.

However, there are theories. One possible connection between poor oral health and female fertility is the immunological connection. (Similar to the theory for male fertility problems and periodontal disease.) Periodontal disease may cause the immune system to be overly reactive. Or, it may be that an overly-reactive immune system may increase the risk of developing periodontal disease.

Reproductive immunology studies the possible connection between the body’s immune system and how it reacts to embryo implantation and development. Women with over-reactive immune systems have been found to be at an increased risk of infertility, miscarriage, and embryo implantation failure during IVF treatment.5 Common causes of female infertility—specifically endometriosis and polycystic ovarian syndrome—are also associated with an increased risk of periodontal disease.

According to a study of just over 4,000 women, those with self-reported endometriosis were 57% more likely to have gingivitis or periodontal disease when compared to women without endometriosis.6 Researchers theorize that immune dysregulation may be the connection.

In a small study, researchers found that women with PCOS were more likely to have gingivitis when compared to women without PCOS.7 What’s especially interesting about this study is they did not include women who were smokers, diabetics, or obese.

This indicated that something about PCOS itself­—and not related risk factors—causes in increased risk of gum disease.

What to Do to Improve Your Dental Health (and Maybe Your Fertility)

Whether infertility is a risk factor for periodontal disease or periodontal disease is a risk factor for infertility, it’s worth your time and energy to take care of your dental health. This is especially true given the research showing that treatment of cavities and gum disease may improve male fertility and pregnancy outcomes.

Your risk of developing periodontal disease depends on a variety of factors, including genetics, general health habits, the presence of other diseases, and oral hygiene. You don’t really have control over your genetics, but you do have control over your health habits and oral hygiene practices.

Here’s what you can do to reduce your risk of gum disease, improve your dental health, and (possibly) improve your fertility.

Get regular dental cleanings. When you’re already struggling to get to all your fertility testing and treatment appointments, it can be tempting to cancel or postpone your dental cleanings. Don’t do it.

Regular dental cleanings are key to maintaining healthy gums and oral health. Regular check-ups are also the only way to catch cavities before they become serious. By the time you’re experiencing pain, the tooth infection is well developed.

How often do you need to be at the dentist? At least once every six months, and more frequently (every three months) if you have periodontal disease.

Ask your dentist or dental hygienist for a comprehensive review of your gum health. Honestly, this is something your dental team should be doing already. However, some offices schedule appointments so close together that a comprehensive review of your dental health isn’t possible. Make sure your dental hygienist knows this is something you care about. 

Get those cavities fixed. It’s not enough to just get your teeth cleaned. If your dentist finds evidence of tooth decay, don’t delay in getting things taken care of.  

Brush your teeth twice a day. This may seem basic, but not everyone makes sure it happens. Every morning after you wake up and before you go to bed, give your teeth and gums a good brushing.

Floss! Regular flossing is vital to healthy gums. “You can brush every day, twice a day, and still have very inflamed gums and develop gingivitis or periodontal disease if you don’t floss,” explains Jason Olson, registered dental hygienist.

Flossing isn’t always enough, however. This is especially true for those who have already developed gum disease. You may benefit from using a water pick or interdental brushes. Talk to your dental hygienist about the best way for you to clean your teeth. Also, ask for them to demonstrate proper flossing technique. Most people don’t floss effectively.  

Rinse with water after you eat. You don’t need to brush after every meal, but rinsing helps. “Rinsing with water after you eat—or after you drink something that isn’t water—will reduce gum inflammation and your risk for cavities,” explains Olson.

If your dentist recommends more frequent cleanings, schedule them. Those with periodontal disease require more frequent visits to the dentist. Instead of every six months, cleanings every three months are recommended.

If you have deep pocketing of your gum tissue, it’s not possible for you to keep your teeth clean at home. Bacteria build up inside those deep pockets, and that’s what leads to the jawbone deterioration and tooth loss from periodontal disease.   

Schedule fertility treatments at least a few weeks after deep dental cleanings. Preliminary research has found that deep dental cleanings—specifically cleanings intended to treat periodontal disease—can cause a temporary increase in immunological activity. Researchers worry this may negatively impact fertility treatment success.

This is all still theory. However, if you can, try to have a three or more week buffer between your cleanings and your fertility treatment cycle.

If you smoke, make a commitment to quit. Smoking both increases your risk of developing periodontal disease and harms fertility. This is true for both men and women. 

Talk to your doctor about dental X-rays during the two-week-wait. You know you’re not supposed to have X-rays when you’re pregnant. But does that apply during the two-week-wait (the days between ovulation and your expected period)? Most OB/GYNs say dental X-rays during this time are safe. Still, talk to your doctor if you’re concerned. 

The benefits of good dental hygiene go beyond bright smiles. Making sure you’re brushing properly, flossing daily, and keeping up with dental appointments preserves your overall health.

Dental problems such as gum disease and tooth decay can contribute to a number of health conditions, including heart disease and pneumonia.

This article provides a quick overview of the conditions associated with poor oral health, those that can make your dental health worse, as well as what you can do to maintain your smile.

Did you know that your oral health offers clues about your overall health — or that problems in your mouth can affect the rest of your body? Protect yourself by learning more about the connection between your oral health and overall health.

For me, it’s been one of the more surprising observations in recent years: study after study has shown that people who have poor oral health (such as gum disease or tooth loss) have higher rates of cardiovascular problems such as heart attack or stroke than people with good oral health.