Dental infections may have detrimental consequences

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Amardeep Bains and Mohammed Ahmed Rashid's opinion piece on the inextricable relationship between poor oral health and cardiovascular diseases has not only omitted key facts implicated in the causation of dental and cardiovascular diseases but also contained the erroneous assumption that ‘periodontal disease occurs as the result of untreated dental caries’. ¹

It is a significant moment that the journal has decided to trigger a debate on such an important issue at a time when poor dental status has been statistically linked with cardiovascular mortality and morbidity, already many years ago. Most importantly, coronary heart disease remains the single greatest cause of mortality in Western countries. Scientists at Helsinki University Central Hospital have long established the correlation between retaining healthy teeth and wellbeing, life expectancy and individual longevity. ² Scholars have also recognised that periodontal diseases, periapical diseases and coronary heart diseases may share a common pathogenic pathway. ³ Bacterial communities that colonise tooth surfaces are among the most complex that exist in nature. The understanding of the complex interaction between biofilm communities and the human host remains pivotal in our search for explanations of the development and pathogenesis of several systemic diseases not only those with infectious nature. Acute oral infections have been shown to be correlated with increased serum inflammatory markers such as C-reactive protein which trigger systemic reactions that could be used as predictors of mortality and indicators of prognoses of diseases. ² Another valid point worth mentioning is that individuals with fewer teeth, looser teeth or unstable dentures have poorer masticatory ability and nutrient intake, parameters that are usually associated with increased mortality among elderly populations. ⁴

Oral infections can play a prominent role in the development and pathogenesis of many systemic diseases not only in ill or immune-compromised individuals but in healthy ones as well. New data have also been presented to indicate the possibility of an association between poor oral health and oral cancer and malignancies in other organs, and highlighted the need for the inclusion of carcinogenesis in the oral infection-systemic health paradigm. ⁵ Further research is warranted to elucidate whether improving oral hygiene or the modification of biofilm composition by specific chemicals in oral hygiene products, among other measures would result in the reduction of the level of mortality from cancer and cardiovascular diseases among other systemic diseases. ⁶ Studies between oral and dental diseases and other forms of cancer are best studied in countries where reliable nation-based cancer registries are available.

What is most important in this discussion, however, is the fact that dental diseases, caries and periodontal diseases, are fully preventable simply by healthy behaviour, if the individual so wishes and the society encourages.