Links between oral & general health
The Mouth-Body Connection
Oral health is essential to general health and well-being at every stage of life. A healthy mouth enables not only nutrition of the physical body, but also enhances social interaction and promotes self-esteem and feelings of well-being. The mouth serves as a “window” to the rest of the body, providing signals of general health disorders. For example, mouth lesions may be the first signs of HIV infection, aphthous ulcers are occasionally a manifestation of Coeliac disease or Crohn’s disease, pale and bleeding gums can be a marker for blood disorders, bone loss in the lower jaw can be an early indicator of skeletal osteoporosis, and changes in tooth appearance can indicate bulimia or anorexia. The presence of many compounds (e.g., alcohol, nicotine, opiates, drugs, hormones, environmental toxins, antibodies) in the body can also be detected in the saliva.
Oral conditions have an impact on overall health and disease. Bacteria from the mouth can cause infection in other parts of the body when the immune system has been compromised by disease or medical treatments (e.g., infective endocarditis). Systemic conditions and their treatment are also known to impact on oral health (e.g., reduced saliva flow, altered balance of oral microorganisms).
Periodontal disease has been associated with a number of systemic conditions. Though the biological interactions between oral conditions such as periodontal disease and other medical conditions are still not fully understood, it is clear that major chronic diseases – namely cancer and heart disease – share common risk factors with oral disease. Recognition that oral health and general health are interlinked is essential for determining appropriate oral health care programmes and strategies at both individual and community care levels. That the mouth and body are integral to each other underscores the importance of the integration of oral health into holistic general health policies and of the adoption of a collaborative “Common Risk Factor Approach” for oral health promotion.
The Common Risk Factor Approach
Traditionally, oral health promotion has focused on the care of the teeth and gums, in isolation from other health programmes.
The Common Risk Factor Approach (CRFA) to health promotion takes a broader perspective and targets risk factors common to many chronic conditions and their underlying social determinants
The key concept of this approach is that concerted action against common health risks and their underlying social determinants will achieve improvements in a range of chronic health conditions more effectively and efficiently than isolated, disease-specific approaches. Adoption of a common risk factor approach is more resource-efficient than a targeted disease-specific approach because:
- most chronic diseases have multiple risk factors
- one risk factor can impact on several diseases
- some risk factors cluster in groups of people
- risk factors can interact – in some instances synergistically – with each other.
The common risk factor approach provides a rationale for developing multi-sectoral healthy alliances between health professionals, statutory, voluntary and commercial bodies and the general public. It recognises that engendering lasting changes in individual “lifestyle” behaviours requires supportive social, economic and political environments.
Common Risk Factors for Oral Health
Oral disease is the most widespread chronic disease, despite being highly preventable. The common risk factors that oral disease shares with other chronic diseases/conditions are:
– Risk factor for dental caries, coronary heart disease, stroke, diabetes, cancers, obesity
- Tobacco smoking/chewing
– Risk factor for oral and other cancers, periodontal disease, coronary heart disease, stroke, respiratory diseases, diabetes
- Alcohol consumption
– Risk factor for oral and other cancers, cardiovascular disease, liver cirrhosis, trauma
– Risk factor for periodontal disease and other bacterial and inflammatory conditions
– Risk factor for trauma, including dental trauma.
- Control & Stress
– Risk factors for periodontal disease and cardiovascular disease
- Socio-economic status
– Independent risk factor as well as underlying determinant of other risk factors.
Diet is a risk factor for dental caries, coronary heart disease, stroke, diabetes, cancers and obesity.
Diet – the foods and drinks we consume to nourish our body – and our eating habits have an important influence on our health and well being. A good diet provides the body with the appropriate quantity and quality of nutrients it requires to sustain health. Deficiency diseases such as anaemia and osteoporosis result from the inadequate intake of essential specific nutrients (undernutrition). Overeating or excessive intake of nutrients (overnutrition) leads to obesity, a recognised major health risk factor. Obesity is a serious problem in Ireland: in 2007, 25% of adults (24% of men; 26% of women) were obese; in 2002, 23% of boys and 28% of girls were either overweight or obese. Being overweight and obese increases the risk of coronary heart disease, stroke and Type 2 diabetes.
Dietary guidelines in Ireland are based on the Food Pyramid published by the Health Promotion Unit (www.healthpromotion.ie) of the Department of Health. The Food Pyramid is designed to help people to eat a balanced diet combining several different types of food in the right amounts. The “top shelf” of the pyramid represents foods high in fat, sugar and salt which are not essential for health and which should be used sparingly (maximum 1 daily serving); the “bottom shelf” represents foods high in carbohydrates (e.g., breads, cereals and potatoes) which should comprise the bulk of our diet (i.e., 6+ daily servings). A survey of dietary habits of the Irish population (SLÁN 2007) found that only 14% of all adults surveyed (13% of men; 16 % of women) complied with the “top shelf” recommendation to use foods high in fat, sugar and salt sparingly.
The top shelf of the Food Pyramid is of particular relevance to oral health as high consumption of foods/drinks containing added sugars is a direct cause of dental caries. The oral health message to restrict consumption of foods/drinks containing added sugars to mealtimes complements the healthy heart message to reduce consumption of foods high in oils and fats.
Studies aslo show that eating more fruits and vegetables can have a protective influence against cancers and systemic inflammatory (including periodontal) diseases.