As a first year at Harvard, we take all our classes with the medical students. We learn every component of the physical exam and practice those skills on patients during our weekly “Practice of Medicine” class. In fact, we don’t take our first purely dental class until the beginning of second year.
But what does dentistry have to do with systemic health? Good question!
Dentists do more than fill and whiten teeth, place implants or do extractions. They are at the forefront of oral health. What they do in terms of prevention and treatment affects systemic health in a multitude of ways. For this reason, knowledge in medicine is a foundation for the practice of dentistry.
Periodontitis is a chronic inflammatory condition caused by bacteria that can attack gum tissue and the bone supporting the teeth. In severe cases, it can lead to tooth loss. Periodontitis has been in the spotlight recently with research underway to understand its effects on pregnancy. Women who suffer from periodontal disease are at higher risk for premature births and low birth weight. The Center for Disease Control and Prevention states that low birth weight, especially when a baby is less than 5.5 pounds or born more than three weeks early, is a major risk factor for developing intellectual disabilities and delayed motor skills. Pre-term babies are also at higher risk for digestive, respiratory, hearing and vision problems. Both the American Academy of Periodontology and the American College of Obstetricians and Gynecologists recommend pregnant women maintain good periodontal health.
Apart from the effects on pregnancy, oral bacteria in the bloodstream also trigger the production of prostaglandins. These chemicals can induce many different systemic effects including inflammation and increased levels of C-reactive protein. Disseminated bacteria can even attach to damaged parts of the heart, leading to endocarditis, a life-threatening infection of the endocardium. Check out a recent blog post from a dental student who acquired infective endocarditis here.
According to research done by the Harvard School of Public Health, men with a history of periodontal disease have elevated risks of developing pancreatic cancer. Periodontitis has even been linked to elevated RA factor, an indicator of rheumatoid arthritis. Furthermore, there seems to be a connection between periodontitis and osteoporosis, preeclampsia, diabetes and the development of other infections.
If your patients have swollen, inflamed gums, make sure you thoroughly evaluate if they are developing periodontitis. This is especially important for pregnant patients or those who may become pregnant. Work with your patients now to develop better oral hygiene and help them avoid other systemic health complications later on.
~ Deepti Shroff, Harvard ’19