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Inside Dentistry
April 2023
Volume 19, Issue 4

Oral and Systemic Disease

Helping patients understand the relationship between dental treatment and overall health

Ana Paz, DDS, MS

Doctors have known for years that oral health is directly related to the state of disease in the rest of the body. There is sufficient scientific literature proving that this correlation exists. However, nowadays, more and more patients are hearing about the connection between systemic disease and oral disease. Dental treatment to control oral disease is finally being recognized as something vital to the body.

The bacteria that cause oral disease are not limited to the oral cavity; they can circulate throughout the body. Therefore, the entire body can be affected by the inflammatory processes that occur in the oral cavity, leaving patients with fever, pain, or fatigue. Of course, it is possible to have an ongoing oral infection and an inflammatory response without any systemic symptoms; however, if the cause of the inflammation is not treated, it can get worse, and damage—to the organs, blood vessels, heart, and even joints and nerves—can occur. Periodontal disease is a primary cause of oral inflammation; however, there are other causes, such as inflammation due to impacted teeth and neuralgia-inducing cavitational osteonecrosis (NICO) lesions, which are maxillary or mandibular bone infections resulting from dental injuries, root canals, or poorly performed extractions.

Treatment for the various causes of oral inflammation can include scaling and root planing, surgical interventions by a dentist, and more. Patients need to understand that when bacteria are removed from the teeth, gingiva, and bone, infection and inflammation can be reduced or eliminated. With a reduced bacterial load, the body's immune system can promote an overall healing process. The presence of essential vitamins and minerals makes this healing and maintenance process faster and more effective. As an adjunct to treatment, patients should be instructed to take nutritional supplements, particularly to ensure that they receive adequate doses of vitamin D and vitamin C. Vitamin D is a hormone that is essential in regulating the inflammatory process and in fighting and preventing infections. In addition, it plays a very important role in bone remodeling. Vitamin C has a crucial role in strengthening the immune system as well, but it is also the precursor of collagen, the base component of gingiva and bone.

Regarding NICO, it is a disease characterized by lesions in the mandibular and/or maxillary bone, which may or may not be detectable radiologically through a cone-beam computed tomography scan. The patient may exhibit symptoms, but NICO can present as an asymptomatic lesion. With these infections, the bacteria present not only pass the blood barrier and enter the circulatory system but also easily reach the brain, which may result in degenerative and nervous diseases. Oftentimes, these infections are silent and end up compromising the immune system, which is focused on eliminating them without success. This may lead to problems such as migraines, chronic fatigue, and even atopic dermatitis (ie, eczema) or hair loss.

After a clinical and radiologic diagnosis of NICO is established, patients should be informed that the solution consists of a simple surgical intervention in which the infection is eliminated with a rigorous protocol of disinfection involving laser and ozone therapy. In these cases, it is also advisable to place platelet-rich fibrin into the surgical site to improve healing and to complement the procedure by having the patient take supplements, such as vitamin C, vitamin D3, vitamin K2, and magnesium, to improve the process of bone regeneration.

Prior to surgical intervention for NICO, it is recommended to have patients undergo clinical analysis to be able to demonstrate to them that improvements were made after the intervention. Asking for inflammatory indicators, such as LDL and HDL cholesterol, triglycerides, ferritin, C-reactive protein, interleukin 6, and tumor necrosis factor, establishes the initial inflammatory state that is found so that patients can see how the values have decreased and improved when they are tested again after treatment. In addition, monitoring vitamin D3 values is essential to optimizing the bone recovery and remodeling process.

Although it is important to remind patients that taking care of their oral health and undergoing necessary dental treatment can lower their risk of general health problems, they should also be reminded that it is necessary to eliminate other associated factors, such as being overweight, smoking, poor diet, lack of exercise, and any unnecessary medications that may be having adverse effects. All of these factors have an impact. If patients maintain healthy mouths, take appropriate supplements, and eliminate other factors associated with systemic inflammation, they can live healthier lives.

About the Author

Ana Paz, DDS, MS, is an oral surgeon and the head of scientific research and development at the White Clinic in Lisbon, Portugal.

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