Could Dentists Help Stop Systemic Diseases?

There’s a continual battle in our mouths among microscopic bacteria, viruses, and fungi. Unfortunately, most patients are unaware they’re vulnerable to pathogenic microbes until it’s too late.

There’s a simple way to know ahead of time. Some dentists advocate for saliva tests of the oral microbiome that might help prevent some 57 non-oral diseases that are now associated with periodontal disease. But most dentists don’t offer it. Neither do medical doctors. Insurance doesn’t cover it. And many professionals aren’t convinced the test matters much.

This is one example that critics say sows discord among dental and medical professionals who could be collaborating for oral-systemic disease prevention and treatment. At least one organization—the American Academy of Oral and Systemic Health (AAOSH)—is trying to raise awareness and unite the two fields for the benefit of patient health.

Missing From Mainstream

A shift in the oral microbiome and the host’s inflammatory response are the primary contributors to gum disease, according to a 2010 review in Periodontology 2000. A common cause of tooth loss, periodontitis is a biofilm-associated inflammatory disease of the gum tissue that can be successfully treated, the research article said, by addressing the underlying microbial and immunological causes.

But oral microbiome testing isn’t a standard of care. Mainstream acceptance has been slow, in spite of what advocates say is overwhelming evidence of its role in oral and systemic diseases.

Some saliva tests not only show the makeup of the entire oral microbiome, but also examine the host response and detect oral cancer biomarkers. They can also pick up biomarkers for other cancers that have a unique oral microbiota signature. A study published this year in Cancers declared a link between colorectal cancer and the oral microbiome.

“Saliva gives as much information as blood. By taking salivary samples, in the very near future your dentist every six months could be looking at exactly what the body is producing,” Dr. Mark Connon, a retired dentist, told The Epoch Times. “The issue is that insurance companies are not reimbursing for it.”

The reason, he said, is that medical insurance says it should be a dental screening test, and dental insurance providers insist it’s a medical test. As president of AAOSH, Dr. Connon is leading the organization’s charge to redefine oral health to cease infighting to help doctors and dentists more easily collaborate on patient care.

Flawed Approach?

Oral microbiome testing seems far-fetched when many Americans aren’t even getting necessary treatment for cavities and gum disease, which are both prevalent and preventable. That’s because dental insurance coverage itself isn’t widespread.

Only half of American adults ages 18 to 64 have private health coverage, according to the U.S. Centers for Disease Control. Among that group, 22 percent didn’t see a dentist in the past year.

Oral disease pathology, however, appears to cross both disciplines, especially when it comes to diseases affected by the microbiome and systemic inflammation. A 2016 review article in the Journal of Clinical Periodontology reported links between periodontal disease and diseases such as diabetes, cardiovascular disease, preterm birth, rheumatoid arthritis, and liver diseases.

Medicine largely ignores what’s happening inside the mouth, with the exception of trauma or focusing on one pathogenic invader. Dentistry tends to be more functional and aesthetic, as one Journal of the American Dental Association (JADA) editorial pointed out.

“Effective and efficient chewing, enjoyment of food, pleasing appearance, self-confidence, and freedom from pain and infection are just a few of the benefits of good oral health,” the authors, one of whom is Dr. Bruce L. Pihlstrom, wrote. “Good oral health alone justifies preventing oral disease and maintaining oral health.”

A Different Perspective

The article, published in 2018, warned against promoting oral health care strictly for its relationship to systemic health. Possible causal mechanisms were acknowledged, but Dr. Pihlstrom wrote that there is “no definitive evidence that treating oral disease will have any clinically meaningful effect on the prevention, treatment, or outcomes of any systemic disease.”

The Epoch Times contacted JADA to ask whether it has updated its position on oral-systemic health.

The Australian Dental Journal agreed with the JADA article, referring to what it called poorly designed studies investigating trivial associations that raise false hopes among those with systemic conditions.

“We are a proud profession and we do not need to resort to gimmicks to promote our profession,” Editor P. Mark Bartold wrote in the journal. “More recently, we have seen a change in focus towards understanding how oral infection and inflammation are bad and must be controlled in order to maintain high quality oral health. Surely this is a very noble goal and does not need to be embellished by sensationalist claims that are probably not true?”

Rarely does anyone dismiss that there is an oral-systemic connection, even if they don’t agree on how to contextualize it. The American Dental Association notes the common risk factors between many diseases of the body and the mouth and a strong association between oral-systemic diseases, but it stops short of a causal relationship. Rather, it lists conditions that can affect oral health, including Alzheimer’s disease, chronic kidney disease, sleep disorders, and diabetes.

Redefining Oral Health

AAOSH states that the mouth affects the whole body through breathing and airway issues, as well as the microbiome. “We are this crazy group of people that think health care should be integrated. We actually believe it’s one body, that you can’t just take it apart and treat things separately,” Dr. Connon said sarcastically.

Founded in 2010, AAOSH is ramping up efforts to educate in dental and medical schools, promote functional dentistry, and grow its membership.

“It’s ridiculous how we treat oral health differently than systemic health. That schism is causing a lot of damage, a lot of death and suffering. It’s so sad,” functional dentist Dr. Mark Burhenne told The Epoch Times.

Dental groups often follow business models that base income projections on insurance plans and offer only services that are guaranteed reimbursements, such as filling cavities, X-rays, and cleanings.

“That’s a horrible model, because it never has any reason to address the root cause,” Dr. Burhenne said.

Functional Dentistry

Lack of coverage hasn’t stopped functional dentists who often operate on cash models. They not only conduct oral microbiome testing, but also adopt a whole-body approach to treatment. Their goal is to bring the body’s entire microbiome into balance while lowering inflammation—and they encourage colleagues to join them.

“We are missing the mark not only to help patients get optimal oral health but to help their whole body health,” Dr. Staci Whitman, pediatric dentist, told The Epoch Times. “We do need a mindset shift to change our practice models ultimately to help our patients achieve optimal health.”

The oral cavity is the body’s second-largest diverse community of microbes behind the gut, and everything that ends up in the gut must pass through the mouth.

“All the studies of the oral microbiome, whether good or bad, are linked to health disease throughout the body because the mouth is a gateway,” Dr. Connon said. “The new axis of disease is the oral microbiome sets up the gut microbiome.”

Neglecting to educate patients about the prevention of gum disease and cavities is ignoring the elephant in the room, according to Dr. Whitman, who said the root cause is often related to food—what, when, and how we eat.

Avoiding ultra-processed foods, eating more slowly and mindfully, and eating less frequently are as important as daily brushing and flossing, she said. Dr. Whitman also gathers information about her patients’ metabolic health, inflammatory markers, blood sugar, vitamin D levels, and oral microbiomes.

“We really want to look bigger picture, the whole body, the whole patient, not just the mouth and teeth,” she said. “We’re really trying to get patients back to optimal health, to prevent issues from happening again and teach patients and motivate them with coaching and emotional support.”

Education and Collaboration

Dr. Connor, who’s a professor at Northwestern University Feinberg School of Medicine, said the oral-systemic health movement is growing. AAOSH offers continuing education training on the latest research online and at annual conferences.

Some are personally trying to bridge the professional gap. Dr. Craig Backs, internist and founder of the Cure Center for Chronic Disease, developed an app for his patients and invites their dentists to access it, too. The app is used to set and monitor health goals related to lowering risk factors, upload test results, and stay mutually motivated.

Dr. Burhenne has compiled an online listing of functional dentists who have integrative or functional training. He said lack of patient knowledge and insurance coverage are barriers for the growth of oral-systemic care.

“Educate yourself as a patient. Don’t trust your dentist. They’re good people, but they’ve been indoctrinated. They have a certain way of dealing with your health issues. They wait until you have bleeding gums,” he said. “A functional dentist will treat you in your prodromal phase, in other words before you get bleeding gums or cavities … so you never get the disease.”

SIDEBAR: Bleeding Gums Are Not Normal

Bleeding gums aren’t only a sign of inflammation but also an opportunity for problematic bacteria to become a hitchhiker on red blood cells.

This is the mechanism of action linking the oral microbiome to systemic disease, Dr. Ellie Campbell, an integrative primary care specialist, told The Epoch Times. Gum tissue is vascular, and oral microbes can invade the body.

“Normal brushing or flossing should never cause bleeding,” she said. “The problem is too many dentists tolerate it. They look at your gums and they say, ‘You have good gums. You don’t have deep pockets or active bleeding.’ But they didn’t do the bacteria test. Whole bacteria get in the bloodstream, and they can travel anywhere.”

Bleeding gums should automatically warrant oral microbiome tests, Campbell said. Although everyone has some bad bacteria in their mouths, a healthy community of commensal microbes will prevent them from becoming pathogenic, or disease-causing.

In a disease state, pathogenic species begin to stick to the mucosa, where they breach the barrier of the commensals and cause infection. The makeup of the microbial community can also perform anti-inflammatory functions, or—if out of balance—contribute to inflammation, according to a 2021 article in Periodontology 2000.

But much of what’s happening in the oral microbiome is quiet. Campbell said a normal pathogenic level is 5 percent, but by the time there are disease symptoms, it’s risen to about 48 percent.

“That’s part of the sneaky thing. Somewhere along the continuum, you had an escalating number of bad bacteria but no symptoms yet. That’s where we can intervene,” she said. “It’s a simple spit test that’s under $100.”