Good oral health is essential for good general health: the oral–systemic connection

Abstract

Oral diseases continue to be a major public health problem worldwide, and comments such as ‘You cannot have good general health without good oral health’ and ‘The mouth is part of the body’, while all cliches, are gaining an increasing momentum with the realisation that oral and systemic health are connected. Several epidemiological studies have indeed linked poor oral health with cardiovascular diseases, poor glycaemic control in diabetics, and low-birth-weight preterm babies, together with a number of other diseases, including rheumatoid arthritis and osteoporosis. Oral disease is also recognised as a significant problem in medically or immunologically compromised patients suffering from a range of chronic conditions. This publication, based on a symposium held during the recent 25th ECCMID in Munich, includes a series of papers which address specifically these issues; the possible mechanisms by which oral infection and inflammation can contribute to cardiovascular disease are covered, as are the oral conditions associated with medically compromised patients. The role of antimicrobial agents such as chlorhexidine and triclosan in the prevention and control of oral disease, especially periodontal disease, is also presented. A large number of clinical studies have established the clinical efficacy of these agents in the control of gingivitis and dental plaque and, more recently, chronic periodontitis in susceptible individuals. The importance of the role of infection and inflammation in the initiation and progression of atherosclerosis is now widely accepted. Chronic inflammatory periodontal diseases are found worldwide and are among the most prevalent chronic infections in humans. There have now been over 50 studies investigating the relationship between periodontal disease and cardiovascular disease, with the majority showing a significant, albeit modest, association even after adjusting for confounders. However, any such relationship must be biologically feasible and the paper by Seymour et al. (this publication) reviews possible pathogenic mechanisms, with particular attention being paid to the role of molecular mimicry between the bacterial heat-shock protein GroEL and the human heat-shock protein 60 (hHSP60). The importance of oral health in patients with chronic conditions is further taken up by Migliorati and Madrid (this publication), who show, in a series of elegant case studies, that oral diseases in medically compromised patients carry a significant morbidity and that care of the mouth should be an integral part of overall medical care. They note that improvements in longevity have resulted in populations with special needs, such as the immunosuppressed, the residents of longterm-care facilities, and those with chronic conditions such as cancer and HIV ⁄AIDS. Migliorati and Madrid make a strong case that optimal care for these populations should involve collaborative efforts between medical and dental professionals and that this should constitute a central theme for the training of future healthcare professionals worldwide. Good oral hygiene is essential for good oral health, and in this context the routine control of dental plaque is fundamental. Yet, the widespread prevalence of oral diseases indicates the inability of most people to achieve a level of plaque control consistent with oral health. Approaches aimed at improving oral hygiene have included the addition of antibacterial agents to oral care products. While chlorhexidine is the reference standard, it does have significant Corresponding author and reprint requests: G. J. Seymour, Faculty of Dentistry, University of Otago, 310 Great King Street, PO Box 647, Dunedin 9054, New Zealand E-mail: gregory.seymour@otago.ac.nz