Beyond the Enamel: Oral Health's Connection to Well-being

Tara Haelle

September 04, 2019

During a routine check-up, Uche Odiatu, DDS, a dentist in private practice in Toronto, noticed that his patient had a scalloped tongue. Observing that she also carried extra weight and had a short neck, he asked her how she slept.

"Poorly," she said. "How could you tell?"

Odiatu explained that her mouth told a story that went beyond oral health. "By looking at your mouth, I can sort of get an idea that you might not sleep very well," he said.

And a lifetime of poor sleep is associated with dementia, high blood pressure, difficulties with blood sugar management, and other health issues, he told her during her twice-yearly check-up.

"Most people don't realize that the body heals during nighttime," Odiatu told Medscape Medical News. "Our immune systems are on standby during the day and then go into high-gear in the night. Poor sleepers are poor healers, and poor sleep can affect your brain, your body, and your overall health."

His patient was surprised to hear her dentist telling her information she might have expected from a primary care doctor, but for Odiatu and other dentists and dental hygienists, such conversations are part of their role in promoting overall health that goes beyond just teeth and gums.

Odiatu will speak about the inextricable link between oral health and overall health during his multiple presentations at the upcoming World Dental Congress 2019. He will also lead a session on how attendees can transform their own health in multiple "zen body" morning sessions.

"It gives participants a chance to have an appreciation for the body, not just thinking of it as a carcass that drags you through the day, but as a miraculous machine with a computer inside — the brain. If we start treating it better, we can enjoy more of life and have a more flexible body, more flexible mind, and more flexible life," Odiatu said.

"Many people come to my workshops for their patients and realize their voice has more authority and authenticity if they're living it."

The idea that dentists can, while remaining within their scope, offer insight into the overall health of their patients is "not necessarily new," but it's getting noticed more, said Matt Messina, DDS, a consumer advisor for the American Dental Association.

What happens in the mouth doesn't stay in the mouth.

"Teeth are connected to people. When we go back to the early 1920s, when medical and dental schools separated, somehow the mouth got separated from the rest of the body," Messina told Medscape Medical News. After that, people began to believe that the two are not interrelated, but that's not true, he said.

"What happens in the mouth doesn't stay in the mouth," Messina added. "Since we're talking to patients about their overall health, we have a role to play in advising patients to get enough sleep and eat a healthy diet" in addition to usual oral health habits, like brushing, flossing, and regularly seeing their dentist.

A key element to that overall health is diet, which is the central theme of Odiatu's session on patients' gut health. Over the past decade, research into the microbiome has exploded, revealing how broadly the bacterial composition of people's guts affects body systems and a wide range of health conditions.

"One way to look at it is that the microbiome could impact your health as much as your genes do," Odiatu said. "The number one way to change your microbiome is to change the way you eat. The mouth–body connection is not just about bacteria in the mouth."

The Eating Apparatus

That's why it is important for dentists and dental hygienists to understand the link between the microbiome and overall health, and to discuss it with their patients, he explained.

"Dentists and hygienists are in front of the eating apparatus, so we are in charge of how well people chew, consume, and, as an end result, digest and absorb nutrients," he said.

"Our microbiome depends on what we eat, so if someone has fewer teeth, dry mouth, allergy, joint pain, or any chewing or masticatory problems, their microbiome can be affected. You see the impact that dentists and hygienists can have on the overall health of patients above and beyond just straight, white, pain-free teeth."

Dentists and hygienists get a lot of education hours in nutrition, said Odiatu, noting that they often have more time to spend with patients. Hygienists spend up to an hour with each patient, and dentists can spend from 20 minutes to 2 hours.

Dentists do not treat the whole body, but they should be noticing what's going on with it, Odiatu said.

When he notices evidence of stress in patients — whether in their mouths (such as scalloped tongue or teeth grinding) or in general — he might recommend massage therapy.

If he sees a jaw or posture problem, he might refer the patient to a physical therapist. If he sees evidence of sleep problems, he advises patients to see a medical doctor or get a sleep study done, letting them know about the link between sleep apnea and stroke (Sleep Med Disord. 2018;2:120-125), for example.

Messina said he agrees, and added that a major goal throughout his career has been to put the mouth "back in the rest of the body" in terms of how people think about their oral and overall health.

"If you have periodontal disease, that's going to have an effect on your systematic health," he said, noting the link between periodontal disease and cardiovascular disease, diabetes, and even dementia. "The lynchpin is inflammation. As we increase the amount of inflammation in the body, bad things happen."

Dentists and hygienists are often the first to observe that inflammation, when bacteria under the gums cause an inflammatory response. And it is not uncommon for dentists to be the first to notice unusual gum tissue that ultimately leads to a leukemia diagnosis, Messina said. Although he does not treat oral cancer, he does treat the oral sequelae that results from cancer treatments.

"I live in the link between oral and systemic disease every day," he said, which is why he advises patients on the importance of the human papillomavirus (HPV) vaccine. That topic will be addressed at the meeting in a presentation by Alessandro Villa, DDS, PhD, from Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston.

It all comes back to the idea of giving patients information that pertains to their whole body's functioning, said Odiatu.

"We have an ability to help patients enjoy optimal health. I look at the whole body, from head to toe, not just the enamel."

Odiatu is a consultant for Philips Sonicare and Hyperbiotics, which manufactures probiotics. Messina has disclosed no relevant financial relationships.

World Dental Congress (WDC) 2019. To be presented September 5 and 6, 2019.

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