Blood in the sink: How the relationship between oral and systemic health is gaining momentum – and what dental professionals need to know, part II

May 3, 2013

Recently, I spoke with Charles “Chip” Whitney, MD, about the relationship between oral and systemic health (see part I), and what dentists and doctors need to know in order to better serve their patients. See our Q&A below.

How can dentists, hygienists, and physicians work together more closely in the usual setting?
It’s not so much working together, it’s more of working with their patients in concert. Currently, I refer to GI specialists, cardiologists, orthopedic surgeons, and other specialists, but we as physicians hardly refer to dentists. I think if we could understand the significance of disease in the mouth – that it leads to disease in the body – dentists could look for things going on and they could say to their patients, “Look, this periodontal disease might signify that you have a glucose problem. You might want to talk to your physician.” It’s more about interrelating our specialties. We need each other. I can’t do everything a dentist does and a dentist can't do everything I do, so people need both of us.

INFOGRAPHIC: Oral health and overall health: Clearing the air about dental care

What are some of the early signs of disease that dentists can spot, and how can they work with physicians to reverse the damage in its early stages?
The dentists ought to look at their perio patients. Perio can lead to vascular disease and diabetes, and I’ve heard many dentists and hygienists say that they can’t control a patient’s periodontal disease if their diabetes isn’t controlled. Their perio could be influencing their blood pressure and their diabetes. They can’t take care of their mouth without taking care of their diabetes.

“The bad bacteria that are bad for the gums are the same
bad bacteria that will cause heart attacks or strokes.”

Dentists should also look at the history and participate in the patient’s education. Others are getting more proactive in screening for blood pressure, measuring their hemoglobin A1c (HbA1c), checking their glucose levels. Most people see their dentist a few times a year but rarely see their physician.

The link between periodontitis and cardiovascular disease: A brief overview
Oral-systemic associations: 2013

A lot of dentists are implementing more wellness programs into their practice. Some dentists have implemented the same that I’ve got in my practice. For example, I implemented a program for weight loss where everyone gets a health coach, and dentists can implement it too. It’s very hands-on. Others offer online learning for their patients where their patients can learn healthy lifestyles. Again, not practicing medicine, but helping them help their system as well as their mouth.

What do dentists need to know, from the physician’s standpoint?
If there was one message I could get to the dentist, it would be don’t accept any blood in the sink. A lot of dentists understand that if there’s blood from brushing, flossing, or cleaning, there’s a connection between their mouth and bloodstream. Even if it’s not profound periodontal inflammation, there’s inflammation, and it means high-risk bacteria could be getting into the blood stream. That’s a huge red flag. I’ve seen a lot of people that have had early plaque in their arteries and the result appears to come from the high-risk bacteria that’s present in their mouth. There is absolutely a connection between that and the rest of the body. The bad bacteria that are bad for the gums are the same bad bacteria that will cause heart attacks or strokes. Oral DNA Labs has a saliva test marketed primarily to dentists that I myself use in my practice that lists 11 different bacteria present in the mouth: high-risk, middle-risk, and low-risk. In studies published 10 years ago, they removed carotid arteries during surgery, did a DNA analysis of the plaque, and found evidence of the bacteria in the mouth that was the same as the bacteria in the arteries. Five years ago, they found that Aa and Pg bacteria gave a person a two- to five-fold increase in heart attacks and strokes.

Why isn’t the relationship between oral and systemic health more popular, and why don’t dentists see their value in the patient’s overall health?
I didn’t know about all of the connections between the mouth and the rest of the body until about a year and a half ago. In all of my medical education and residency, I remember one lecture total about the mouth. Physicians start with the tonsils and move on and dentists have everything in front of the tonsils. Until about 10 years ago, there was not thought to be a significant connection between oral and systemic disease.

“If there was one message I could get to the dentist,
it would be don’t accept any blood in the sink.”

Every physician has been trained to react to diseases that already exist. I recently read a review article on Parkinson’s disease. The entire article was focused on diagnosing and treating and there wasn’t one word on prevention and how the children of these patients can lessen their chance of getting it. We’re focused on reacting to the disease rather than identifying the problem early and helping patients create their health. Most dentists have been trained to treat the tooth and gum problem after it begins, and dentists, like physicians, are set in their ways. The need for prevention hasn’t been emphasized as much.

There’s a subset of people that I work with that I use the Carotid Intima-Media Thickness (CIMT) Ultrasound that looks for early cardiovascular disease. I’ve had patients that have had early disease, but they didn’t have the usual problems – heart disease, high blood pressure – they were exercising, they were thin, they seemed healthy. I’ve also had patients whose blood inflammatory markers were high. The only variable changed was to improve their oral health regimen and inflammatory markers plummeted. Newer testing in cardiovascular prevention shows that elevated inflammatory markers (LpPla2) means an increased risk in heart attacks and strokes. I’ve watched patients lower that LpPla2 by just taking care of their mouths and no other variable.

How do patients respond when you approach health concerns this way? Are they responsive?
Mine are because I’m objectively showing them the problem in their results and explain that high risk oral bacteria are likely the cause. They find it very easy to implement a regimen where they’re doing more home oral care. In the lay press, there’s been more public education about the connection between oral disease and systemic disease, especially since last year when an American Heart Association study was published. There are so many things that are more difficult to implement like exercise and weight loss. So if we’re really going to help our country’s health by treating the core mechanisms of the disease, we really can’t ignore the mouth.

Lauren Burns is the editor of Proofs magazine and the email newsletters RDH Graduate and Proofs. She is currently based out of New York City. Follow her on Twitter: @ellekeid.