Oral Health - What is changing?
Before, the clinical activity of the oral cavity was mainly limited to dental treatments, or used as a means to observe the oropharynx and digestive system. However, increasingly the scientific community seems to be more interested in studying the relationship between the pathophysiology of some diseases with systemic involvement and the oral cavity itself.
Recent studies reinforce the association between diseases of the oral cavity and systemic diseases. To commemorate World Oral Health Day, I decided to address some of these relationships, in order to warn about the change that must take place in the way we see and care for our oral cavity.
Diabetes mellitus (DM) is an excellent example to start with. Adults with poorly controlled DM (HbA1C> 9%) are 2.9 times more likely to have periodontal disease. If they are smokers, this risk is 6 times higher. Increasingly, the scientific community believes that this mechanism is bidirectional: DM is a risk factor for periodontal disease and periodontal disease is a risk factor for DM. This group of patients has a higher prevalence of some lesions of the oral cavity, such as geographical tongue, stomatitis, angular cheilitis and oral thrush.
This relationship also appears to exist in patients with hypertension. Some of the drugs used to treat hypertension can cause dry mouth, gum hyperplasia and/or lichenoid reactions. Some recent studies seem to suggest that periodontitis itself may be associated with the failure to treat hypertension. Atherosclerosis and vascular diseases also seem to be associated with periodontal disease. We must not forget the importance of antibiotic prophylaxis in the prevention of bacterial endocarditis in patients at risk.
Whereas, a while ago, osteonecrosis of the jaws was only associated with bisphosphonates, today there are other drugs associated with osteonecrosis of the jaws that deserve our attention.
Oral cancer, the sixth most common in the human body, often associated with the excessive consumption of alcohol and tobacco, is now increasingly associated with the human papilloma virus (HPV), changing the paradigm with more and more cases of affected young patients. Portugal has one of the highest oral cancer incidence and mortality rates in Europe, with around 15 cases per 100 thousand inhabitants. Increasingly, self-examination of the oral cavity should be a common practice, allowing suspicious lesions to be identified at an early stage of the disease.
The oral cavity microbiome has about 700 known microorganisms. This microbiome is greatly influenced by our diet and oral hygiene habits. It is directly related to some autoimmune, cardiovascular, metabolic and digestive system pathologies. With advances in human genome sequencing techniques, we can predict that in the future there will be biomarkers based on the microbiome that can help us to early diagnose some of these diseases. Thus, I reinforce the importance of research in the field of oral health, in a different light, interacting it with systemic pathology and with the impact of the oral microbiome, which has the advantage of being easily accessible to clinicians and researchers.
David Ângelo
Assistant Professor - Faculty of Medicine of Lisbon University
European Society of Temporomandibular Joint Surgeons
Clinical Director - Instituto Português da Face
