The eyes are a window to the soul, but the mouth can tell just as much about a person’s health—and about the diseases that determine how we age.
To better understand those relationships, scientists are studying how problems that start in the mouth may contribute to chronic inflammation elsewhere in the body. Specifically, they are investigating how bacteria from diseased gums and the immune response they trigger may contribute to conditions including heart disease, diabetes, cognitive decline, arthritis, respiratory disease, and chronic liver disease.
The emerging science presents a challenge to health care, given the traditional divide between medicine and dentistry – these fields have long been divided by separate training, records, and insurance systems. “Dentists have not traditionally been trained to think about the health of the whole body in relation to the mouth, and doctors have not been trained to view dental health as the first step to overall wellness,” says Dr. Jessica Lederhausen, author of “Oral,” a book exploring the role of dentistry and lifestyle on oral health.
but that’s changing. Dental schools, which have taught how diseases like diabetes affect the mouth, are also placing more emphasis on how oral disease can affect the rest of the body. Medical-education leaders have called on medical schools to better integrate oral health into physician training.
At Harvard School of Dental Medicine, the Initiative to Integrate Oral Health and Medicine is researching how oral-health policy and health-system design can better support “whole-person care,” according to its director, Dr. Lisa Simon, who is both a dentist and physician.
“We envision a future where a heart doctor asks patients if they’re seeing their dentist regularly, and if they know that their periodontal disease could mean their heart condition is much worse,” says Wenyuan Shi, lead oral-microbiology researcher at the ADA Forsyth Institute, the research arm of the American Dental Association.
Experts say that with better coordination, including shared medical and dental records, primary care doctors can refer patients at high risk of diabetes or heart disease to a dentist or periodontist for evaluation and treatment of gum disease. Meanwhile, more dentists can identify the symptoms of uncontrolled diabetes and coordinate care with the patient’s physician.
longevity link
The increasing understanding of the mouth-body connection is also leading to new diagnostic tools, prevention strategies, and treatments. And it is intensifying calls to provide more comprehensive coverage for preventive dental procedures, especially for older adults who are most at risk.
According to the Centers for Disease Control and Prevention, about half of all adults age 30 and older have periodontitis, a more serious gum disease in which the bone around the teeth is destroyed. But federal data also show that prevalence increases with age, with nearly 60% of people 65 or older having some level of the disease — just as people become more vulnerable to conditions that can dramatically impact a healthy life span. In turn, conditions such as diabetes can make gum disease more severe or difficult to treat.
one 2023 Review The study, published in the journal Biogerontology, concluded that oral health plays a key role in reaching “extraordinary longevity” due to its link to inflammation. And Research A study of adults aged 65 and older found that oral disease – including periodontal disease, tooth decay and tooth loss – remains a major source of years lived with disability, suggesting that oral health may shape not only the length but also the quality of later life.
fillet connection
At the center of current research is the oral microbiome, the community of hundreds of bacteria, fungi and other microbes that live in the mouth. Most are part of a healthy ecosystem, but a small group can thrive beneath the gums, causing gum inflammation and leading to diseases such as gingivitis and periodontitis. Over time, severe gum disease can destroy the tissue and bone that hold teeth in place.
A major challenge is dental plaque, a protective structure known as a biofilm that helps bacteria stick to teeth and makes them more resistant to removal by saliva, mouth rinses and some antimicrobial agents. When plaque accumulates, it can harden into tartar and cause chronic inflammation in the gums.
Periodontists often manage patients through deep cleaning and scaling and sometimes laser. The procedures remove plaque beneath the gums and disrupt the bacterial biofilm that contributes to gingivitis.
But plaque can shed bacteria or bacterial products into the bloodstream, says Dr. George Hajishengalis, a professor specializing in microbiology and immunology at the University of Pennsylvania Dental School. Most of the time, the immune system clears them quickly. With periodontitis, inflamed gums can weaken the body’s normal barriers, and normal activities like chewing, brushing or flossing can allow small amounts of bacteria or bacterial products to repeatedly enter the bloodstream, potentially exacerbating inflammation elsewhere in the body.
Research by Hajishengalis and another Penn professor, immunologist John Lambris, led to the development of an experimental drug injected into gum tissue aimed at silencing the immune response. In an early trial in people with gum disease, the drug was reported to reduce gum inflammation for several months. While researchers say it will not replace traditional dental cleanings, it can be used in conjunction with such cleanings to keep the inflammation of gum disease at bay.
Aminadas Pharmaceuticals, a company founded by Lambris and spun off from Penn, is planning larger trials, Lambris says.
Another company, Dentaric, is developing a therapeutic vaccine designed to help patients who already have gum disease. Earlier this year, the FDA approved the vaccine for Phase II clinical trials in the US
“The goal is not to replace existing dental care, but to work alongside it by helping the body address one of the major biological drivers of disease progression,” says CEO Sean McLaughlin.
A dose of prevention
A growing number of startups are entering the oral-health space, developing new approaches to prevent and manage the disease, such as reducing harmful bacteria in the mouth while preserving helpful bacteria, and controlling biofilms before permanent damage occurs.
Dr. Anna Basile Giglio, a New York periodontist and president of the American Academy of Periodontology, says some of the most promising future treatments for gum disease are aimed at controlling the body’s inflammatory response rather than simply removing plaque or killing bacteria.
One approach would be to block the destructive enzymes that break down gum tissue; Second, it will help the body naturally turn off inflammation after it’s done its job; And a third will slow the loss of gum tissue and bone that hold teeth firmly in place.
a fresh report The Journal of Periodontology predicts that technologies such as AI, diagnostic saliva testing, and sensor-based monitoring will allow more early detection and personalized treatment. For example, sensors can be placed in the oral cavity for real-time monitoring, continuously tracking changes in the oral environment and monitoring things like markers of inflammation. Sensors can also connect with apps or wearable technology to provide feedback to users.
Oral-health experts are also turning to AI to analyze the growing amount of data coming out of patients’ mouths. A group of Ada Forsyth researchers is using AI in a five-year federally funded project to develop smart dental-filling materials and help them read dental X-rays and other digital images for signs of cavities, gingivitis and gum disease. By 2025, machine-learning models have already shown promise in analyzing radiographs Review.
Better care, shared records
Dr. Frank A., professor at the University at Buffalo School of Dental Medicine. According to Scannapieco, lack of dental care insurance is a major challenge for people age 65 and older. A Study A study they co-authored, published in 2023, found that a preventive dental visit in the year before hospitalization was associated with a 10% lower risk of a type of pneumonia that affects hospitalized patients, while periodontal therapy within six months was associated with a 30% lower risk.
and a review Research They co-authored a study concluding that adding dental benefits to the Medicare program for the diagnosis, prevention, and control of oral diseases could improve health and potentially reduce medical costs.
Meanwhile, efforts are being made to overcome a behind-the-scenes hurdle between doctors and dentists: the records system. Often, the two types of caregivers use different digital systems to store important patients’ information, and those systems may not talk to each other.
One effort comes from PDS Health, a Henderson, Nev.-based company that provides business and administrative support services to more than 1,200 dental and primary care practices nationwide, including the widely used Epic electronic health record system. Chief executive Stephen V. Thorne IV says it has helped dental and medical providers collaborate around a shared patient record, and allows patients to view their oral and medical information through a single patient portal.
Since 2020, more than 303 million patient records have been exchanged between medical and dental providers, and PDS is working with dental schools, including the University of Michigan, to expand the use of Epic records in dental education. The university health system and its medical school already use Epic, and a dental-school spokesperson says the ability to view entire health records will enable its students and faculty to get a fuller picture of patients’ unique health care needs.
Efforts toward better oral health are not limited to dentists and doctors’ offices. The nearly $40 billion-a-year global oral-care industry is fueling new products, like app-connected smart toothbrushes and more natural toothpaste ingredients.
And some companies are promoting brushing and flossing to young consumers as part of a broader health routine, “like skin care,” says Stephen Habif, chief technology officer and head of research and development at oral-care giant Colgate-Palmolive. “We’re trying to create an experience for the consumer, so they’re doing the right thing, but not looking at it as a workaround.”
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