Oral healthcare: From the mouth to overall good health

REGULAR exercise, a balanced and nutritious diet, enough rest and sleep are the key things we say we need to achieve and maintain good health. But are these really all that is necessary or could we be missing something?

Oral health, that aspect of overall hygiene and well-being that is easily taken for granted by people who wrongfully think that brushing three or more times a day and twice a year of visit to the dentist are enough, is a crucial part of the health equation as well. It has been thought of as having no relation at all to one’s overall health, but this notion is now increasingly being challenged as we pursue that mecca of good health toward a longer, fuller life.   

Indeed, poor oral health may be a risk factor for systemic diseases. A bleeding or dry mouth can be an indicator of systemic disease or exacerbate the effects of an existing disease such as diabetes and heart disease. People often make the mistake of ignoring the connection between oral health and overall health when in fact the mouth is an open door for many microbial infections to enter the bloodstream.  

According to Liliana Rozo, D.D.S., assistant professor at the University of Louisville School of Dentistry and a certified pediatric dentist by the American Academy of Pediatric Dentistry (AAPD), parents should make oral health care a priority if they want their children to stay healthy.

The common problem of tooth decay amongst children is not limited to causing pain and inability to chew food well. It can affect a child’s disposition, especially when it distracts from play and learning, and causes embarrassment about discoloured or damaged teeth. It may even have a detrimental effect on a child’s performance in school and quality of or success in life.  

Even amongst athletes, who generally pursue active and healthy lifestyles, poor oral health is known to affect general health and performance. Some 18% of athletes surveyed by the University College London (UCL) during the London 2012 Olympic Games said their oral health had a negative impact on their performance. More than 45% admitted not visiting the dentist in the past year. In a consensus statement published in the British Journal of Sports Medicine, UCL-led health experts and sporting bodies hope to address these concerns by calling for action to remedy poor oral health amongst athletes. Experts hope for the integration of oral health into the broader culture of sports healthcare and health promotion, saying that simple steps such as better brushing and flossing could achieve the same marginal performance gains as expensive physical therapies.

Teething problems

The human mouth contains a balanced mix of microbes. A disruption in this balance can cause oral diseases. 

Amongst children, dental caries, more commonly as tooth decay, is the single most common chronic disease. It is also an infectious disease. Mothers with cavities can transmit caries-producing oral bacteria to their babies or children when they share spoons or stick pacifiers in their own mouths.

Meanwhile, another oral infection is oral candidiasis. Also known as oral thrush, this infection is 

common in patients with HIV/AIDS, compromising their quality of life despite the intervention of antiretroviral therapy or drugs. 

A new study looks into this disease further by comparing the bacteria and fungi present in the mouths of healthy individuals and those of HIV patients. Mahmoud Ghannoum of the Case Western Reserve University in Cleveland, USA, and his colleagues used high-throughput gene sequencing in cataloguing the core oral bacteriome--the bacteria commonly present in the mouth--and the core oral mycobiome, or the fungi commonly present. The researchers found little difference in the bacteria between healthy individuals and HIV patients, but noted consistent differences in the oral fungi.

Both groups had a family of fungi called Candida, but the HIV patients had them in higher levels. Another family of fungi, Pichia, was observed in both groups, and the level was greater amongst healthy individuals. 

The findings prompted the researchers to surmise that these two groups of fungi were hostile toward each other. In a related study where they grew Pichia alone in a liquid medium and then removed the fungus, they observed that the “Pichia spent medium” or PSM suppressed the growth of Candida and other disease-causing fungi. Using a mouse model of oral candidiasis, the researchers presented that mice treated with PSM showed much less severe symptoms than the untreated ones. 

The researchers noted the wide implications of their findings on the discovery of new antifungal agents. They hope this recent endeavour will pave the way for new therapeutic approaches for the management of fungal infections.  

Sinking the teeth into achieving better health

Nutrition remains at the core of oral health, and ultimately overall good health. A new practice paper published by the Academy of Nutrition and Dietetics calls for better collaboration amongst 

registered dietitian nutritionists, dietetic technicians, and registered and oral healthcare professionals toward better health promotion, disease prevention, and intervention.

The practice paper, titled “Oral Health and Nutrition,” states that nutrition assessment is crucial to identify dietary intake and nutritional factors affecting a person’s oral health. Because of this, healthcare professionals must emphasise the value of food choices in ensuring optimal oral health. Specifically, food and nutrition practitioners should educate patients and clients on important aspects of nutritional health that lead to oral health. 

These practices include the consumption of fresh fruits, vegetables, and dairy foods such as milk, cheese, and yoghurt without added sugar to lower an individual’s risk of cavities, whilst taking in fewer foods or drinks high in acid and sugar to reduce chances of dental erosion and cavities.  High-acid foods comprise fruit juices, pickled foods, sour candies, citrus fruits, and wine. Sugar-sweetened beverages, meanwhile, include soft drinks, sports drinks, energy drinks, and fruit drinks. Registered dietitian nutritionists can provide better guidance about healthy food choices and regular oral healthcare to help in the improvement of nutritional and oral health.

The practice paper, which has been published on the website of the Academy of Nutrition and Dietetics, supports the Academy’s position paper on oral health and nutrition, which was published in the Journal of the Academy of Nutrition and Dietetics in May 2013. The Academy posits that nutrition is an integral component of oral health.

Efforts to boost nutritional health should be complemented by stricter oral care. Parents must bring their baby to the dentist as soon as the child’s first tooth erupts, according to the AAPD. A pediatric dentist can help parents learn more about their child’s dental and oral health milestones, and can teach them about teething, proper oral hygiene habits, normal tooth development, and trauma prevention. Regular visits can also include nutritional counselling for better oral health.

Amongst Olympic athletes, a dental checkup within 12 months of a competition is a requisite. The previous survey found out, however, that almost half of the athletes in London 2012 had not visited their dentists. 

As a consequence of this finding, health experts are urging national sport funders and policy organisations to lead steps in guaranteeing a regular assessment of oral health, particularly during pre-season, to provide a period for customising prevention plans and early treatment of any disease.

The consensus statement from health experts and sporting bodies that came out of the April 2014 Oral Health and Performance in Sport collaboration led by Professor Ian Needleman of the UCL Eastman Dental Institute and Dr Mike Loosemore of the Institute of Sport Exercise and Health (ISEH) paved the way for a conference at UCL. This became a venue for experts in oral health and sports medicine on one hand and sporting associations and elite athletes on the other to discuss and reach a consensus on ways to boost oral health in sport.

According to Professor Needleman, ways on improving performance have always been a priority amongst professional athletes and their teams in their efforts to make all the difference in elite sports. These activities receive a lot of time and money, when improving oral health and preventing problems are simple steps that can ensure marginal gains without requiring additional time or costs. He added that daily practices involving better brushing techniques and using toothpastes with greater fluoride content could help prevent the toothache and associated sleeping and training difficulties experienced by athletes.  

“Oral health could be an easy win for athletes, as the oral conditions that can affect performance are all easily preventable,” says Professor Needleman. 

Athletes face intense dietary and training pressures, all of which could increase the risk of oral health problems. For one, the amount of energy athletes need for training often requires them to maintain high-carbohydrate diets and use sugary, acidic energy drinks. These may lead to decay and erosion in their teeth. Meanwhile, dehydration and drying of the mouth could raise the dangers of developing oral health problems as the saliva helps to protect teeth from decay and erosion. 

Without trivialising the importance of energy drinks for athletes, Professor Needleman noted that it is important to know the potential negative effects of taking energy drinks on oral health so athletes and their teams can take measures to mitigate the consequences. For instance, water or hypotonic drinks could be a better alternative to energy drinks for simple hydration requirements. Instead of rinsing their mouths after brushing, athletes could just spit. For those engaged in sports that require a lot of energy drinks, high fluoride toothpastes and mouth rinses should be seriously considered as better options for oral health.