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How can we promote better oral hygiene and thereby reduce the risk of chronic diseases?

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Brett M.
Brett M. Dec 24, 2020
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Oral health for total health is not just a phrase, it should be a lifestyle. The number of health conditions that are related to oral hygiene is extensive . The tight link between oral health and these detrimental health disorders raises the importance of practicing good oral hygiene to prevent the development of oral diseases such as periodontitis.

Periodontitis

Periodontitis is a term used to define a broad spectrum of diseases characterized by inflammation that affect the periodontium: a set of structures that provide support for your teeth, including the cementum, gingiva, alveolar bone, and periodontal ligaments . When severe (or aggressive), periodontitis can cause bone destruction and rapid attachment loss.

Typically, periodontitis is diagnosed by the presence of inflammation upon probing, radiographic bone loss, and increased probing depth, which is essentially a non-radiographic method of determining bone loss .

Chronic periodontitis

Over time, periodontitis can progress into chronic periodontitis, which is mainly characterized by a dysbiosis of the oral microbiome and activation of innate and adaptive inflammatory mediators . There is evidence that external environmental stressors, such as smoking, can increase the risk of chronic periodontitis . However, there may be underlying genetic factors that can increase one's vulnerability to developing this oral disease, such as through regulation of DNA methylation via epigenetic mechanisms . These mechanisms have been linked to inflammatory mediators that are present in periodontitis and provide a possible target to intervene as an approach to mitigate the long-term health effects of this disease. Finally, there are also indications that imbalances in anti- and pro-inflammatory cytokines as well as lipid mediators, growth factors, and even chemokines may play a role in perpetuating the inflammation observed in periodontitis.

Linking periodontitis to other health conditions

Importantly, there is evidence that chronic periodontitis is linked to the development of diabetes, cancer, maternal complications (e.g., premature birth, low birth weight), oral cancers, squamous cell carcinomas, and chronic obstructive pulmonary disease (COPD), though large-scale studies are needed to confirm the latter .

How can we promote good oral hygiene to prevent these complications?

It is apparent that oral health plays an important role in an individual's total health, but how can we emphasize the importance of maintaining good oral hygiene? It is suggested that about 55% of Americans maintain a healthy oral hygiene schedule by brushing teeth twice a day, whereas an astounding 31% of Americans fail to do so . This fact is incredibly important to consider given the substantial evidence that brushing teeth is one of the key methods to prevent against periodontal disease . It is obvious that education about the importance of preventing periodontitis is lacking and may be a necessity to preserve total health, especially since a variety of these long-term health complications can be detrimental to one's lifespan and quality of life.

Two approaches that I have come across as a method to improve oral hygiene as it relates to disease are by introducing prebiotics (i.e., natural enzymes, proteins) into toothpaste that can facilitate the oral cavity's natural microbiome in the fight against inflammatory diseases . As well, there is the development of anti-inflammatory/anti-microbial toothpaste that has been shown to significantly reduce gingivitis, plaque development, and biofilm vitality . It would be interesting to see how effective these oral health methods and strategies are at reducing the risk of developing chronic diseases.

[1]Hoare A, Soto C, Rojas-Celis V, Bravo D. Chronic Inflammation as a Link between Periodontitis and Carcinogenesis. Mediators Inflamm. 2019 Mar 27;2019:1029857. doi: 10.1155/2019/1029857. PMID: 31049022; PMCID: PMC6458883.

[2]Uppoor AS, Lohi HS, Nayak D. Periodontitis and Alzheimer's disease: oral systemic link still on the rise? Gerodontology. 2013 Sep;30(3):239-42. doi: 10.1111/j.1741-2358.2012.00660.x. Epub 2012 Mar 28. PMID: 22458804.

[3]Li C, Lv Z, Shi Z, Zhu Y, Wu Y, Li L, Iheozor-Ejiofor Z. Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis. Cochrane Database Syst Rev. 2017 Nov 7;11(11):CD009197. doi: 10.1002/14651858.CD009197.pub3. Update in: Cochrane Database Syst Rev. 2019 Dec 31;12:CD009197. PMID: 29112241; PMCID: PMC6486158.

[4] Cardoso, R. (2017). Chronic periodontitis, inflammatory cytokines, and interrelationship with other chronic diseases. Postgraduate Medicine, 130(1), 98–104. https://doi.org/10.1080/00325481.2018.1396876

[5] AAP, American Academy of Periodontology Task Force. American academy of periodontology task force report on the update to the 1999 classification of periodontal diseases and conditions. J Periodontol. 2015;86(7): 835–838. DOI:10.1902/ jop.2015.157001

[6]Yucel-Lindberg T, Båge T. Inflammatory mediators in the pathogenesis of periodontitis. Expert Rev Mol Med. 2013;15:e7.

[7]Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015;15:30–44.

[8]Luo Y, Peng X, Duan D, Liu C, Xu X, Zhou X. Epigenetic Regulations in the Pathogenesis of Periodontitis. Curr Stem Cell Res Ther. 2018;13(2):144-150. doi: 10.2174/1574888X12666170718161740. PMID: 28721820.

[9] Garlet GP. Destructive and protective roles of cytokines in periodontitis: a re-appraisal from host defense and tissue destruction viewpoints. J Dent Res. 2010;89(12):1349–1363.

[10]Liu YC, Lerner UH, Teng YT. Cytokine responses against periodontal infection: protective and destructive roles. Periodontol 2000. 2010;52:163–206.

[11]Bosma-Den Boer MM, Van Wetten ML, Pruimboom L. Chronic inflammatory diseases are stimulated by current lifestyle: how diet, stress levels and medication prevent our body from recovering. Nutr Metab (Lond). 2012;9:32.

[12]Van Dyke TE, Van Winkelhoff AJ. Infection and inflammatory mechanisms. J Clin Periodontol. 2013;40:S1–7.

[13]https://fortsondentistry.com/blog/crazy-dental-statistics/#:~:text=How%20often%20do%20we%20brush,far%20too%20long%20between%20brushing.

[14]https://www.perio.org/consumer/prevent-gum-disease#:~:text=Brushing%20after%20meals%20helps%20remove,toothbrush%20can%27t%20quite%20reach.

[15]https://www.zendium.co.uk/

[16]Arweiler NB, Pergola G, Kuenz J, Hellwig E, Sculean A, Auschill TM. Clinical and antibacterial effect of an anti-inflammatory toothpaste formulation with Scutellaria baicalensis extract on experimental gingivitis. Clin Oral Investig. 2011 Dec;15(6):909-13. doi: 10.1007/s00784-010-0471-1. Epub 2010 Oct 9. PMID: 20936314.

oral healthperiodontitisoral hygieneantimicrobial
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Creative contributions

Multimedia Educational skits for young children and newsletters to their parents at elementary school/kindergarten

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salemandreus
salemandreus Apr 03, 2021
Given milk teeth fall out and new teeth start pushing through around 5- 6 years old it's crucial to teach children (and their parents) about oral hygiene early. Decay can set in quickly with neglect. One example I knew was a kid in kindergarten with all his milk teeth, already incredibly visibly damaged (ate sweets, didn't brush).
Given milk teeth come through at 6-12 months a lot of damage can be done in roughly 4-5 years. (This is not just a factor of milk teeth being weaker - by comparison, I have a friend who had only milk teeth as an adult, which lasted him until about age 30.) My family were meticulous about dental care and I never had a filling or any dental problems as a result (age 33 now) - early interventions make a difference.
A toothpaste company taught my school a song and dance on brushing in third grade, which I STILL remember and can recite - it's possible to instill those teachings young and have them be remembered! Simultaneously sending newsletters to parents to raise awareness with free dentist-recommended toothbrushes can reinforce the message, especially with cute cartoon characters on the toothbrush. Including mirror-attachable toothbrush timers reminds kids to brush for longer than 5 seconds, which helps even if they lack technique/motor skills. Quizzing kids after those presentations reinforces the memory. For a third reinforcement, another teaching in a different form a week later (eg a game or art lesson drawing healthy and unhealthy teeth) can further cement the message through the known benefits of dual-coding or multimedia learning.
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Spook Louw
Spook Louw3 years ago
I agree with targeting the children, generally, they tend to have the most unhealthy eating habits and they are the one portion of the population that spend a portion of their day being supervised and receiving instructions. Telling adults to take care of their bodies will only be effective if they care, while children are at school they are at least expected to follow instructions. So by making students brush their teeth after every lunch and giving them fluoridated water we can impact a significant part of the population.

Hopefully, these habits will follow them home and they might even get their families to join in, or at the very least they will continue taking care of their teeth when they leave school, eliminating the problem generation by generation.
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A sip of fluoride-containing water after every meal

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Shubhankar Kulkarni
Shubhankar Kulkarni Jan 08, 2021
Drinking fluoride-containing water is one of the easiest ways to help prevent cavities. As an example, in 2011, the Canadian city of Calgary stopped adding fluoride to water. In a study, researchers compared school kids in Calgary with kids in the same age group in Edmonton, another Canadian city that uses fluoridated water since 1967. The researchers found that children in Calgary had more tooth decay than children in Edmonton.

The unwanted sugar left behind on the teeth harbors cavity-causing bacteria that eat sugar and produce acid that wears away enamel (the outer shell of your teeth). Drinks like soda have added acids, which also erode the enamel. Water cleans your mouth by washing away leftover foods and residues. It also dilutes the acids produced by the bacteria in the mouth. Saliva contains calcium, phosphate, and fluoride and it is the mouth’s first defense against tooth decay. Therefore, a dry mouth increases the risk of tooth decay.

Gargling immediately after a meal with fluoride-containing water is the best thing to do. If gargling is not possible, drinking a sip of fluoride-containing water can also help. As mentioned in the session text, oral diseases may aggravate other inflammatory diseases in the body. Maintaining oral hygiene simply by drinking fluoride-containing water is the easiest thing to do.

[1]McLaren, L, Patterson, S, Thawer, S, Faris, P, McNeil, D, Potestio, M, Shwart, L. Measuring the short‐term impact of fluoridation cessation on dental caries in Grade 2 children using tooth surface indices. Community Dent Oral Epidemiol 2016; 44: 274– 282. © 2016 The Authors. Community Dentistry and Oral Epidemiology Published by John Wiley & Sons Ltd.

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Martina Pesce
Martina Pesce3 years ago
Very much relevant problem, thank you for bringing it up!
I think this sip of fluoride-containing water is a great idea, but it needs somehow to be integrated into people's culture and habits. Maybe a way to help this could be to oblige restaurants and bars (and every other shop which serves you something that would require you to brush your teeth afterward) to provide you a glass of fluoride-water.
No big trouble, no big cost, no trouble of people complaining about the conspiracy of too much fluoride in public water.
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Shubhankar Kulkarni
Shubhankar Kulkarni3 years ago
Martina Pesce Great idea. I was thinking fluoride can be added at the source. The water purification plants can add fluoride and then release the water. That way, every household and public place will receive fluoride-containing water. This is what the cities in the studies I mentioned in the contribution did.
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Brett M.
Brett M.3 years ago
I definitely agree, fluoridated water is an essential part of the process. I know this has been a standard for water treatment plants throughout North America - fluoride is added to drinking water as a preventative measure against cavities. I'm wondering if that study quantified the amount of water consumed? If equal amounts, perhaps one of the issues we face in promoting oral hygiene is getting people to drink enough water. In fact, only 22% of a sample population were found to drink adequate amounts of water (the recommended 8-10 glasses per day; https://nypost.com/2020/09/03/most-adults-dont-drink-enough-water-every-day-do-you/). So, great point, maybe if people would just simply drink more water that has been fluoridated (which is commonplace in Western civilizations) aka typical drinking water, we would see a significant increase in oral hygiene status... Thanks for your contribution!
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Install power floss at public places

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Shubhankar Kulkarni
Shubhankar Kulkarni Jan 20, 2021
Power floss is a dental water jet that propels water to clean your teeth. It is usually portable but it can be installed in public places (especially in restaurants and near eateries). I imagine the design to be a cross between the drinking fountain and the power floss.
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General comments

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salemandreus
salemandreus3 years ago
Depending where you live dental visits can also be expensive which may be a reason they are neglected in the first place (although they become far more so if neglected).

Given the myriad of other health issues from neglecting it it would seem to be in the interests of insurers to try to provide preventative care wherever possible if it reduces the likelihood of further (and long-term) complications arising. Perhaps an investigation as to why this is often not the case given it seems counterintuitive and financially unviable for insurers to neglect this is also important here - insurance companies can generally be relied on to incentivise healthy living and are heavily incentivised to find ways to minimise the risk of large claims paid out. It could be that despite the health risks insurers are still not willing to cover dentists, or perhaps people do not know their options regarding preventative dental care or the importance of it (or else it is only being taught later in life).
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salemandreus
salemandreus3 years ago
It’s commonly cited that one should see a dentist every 6 months, though more like 3-4 months if one has dental problems and once a year is considered ok if one does not.

My family made a point of doing dental check-ups frequently and I thus learned at a young age from dentists how to improve my brushing techniques.

Given children start losing their milk teeth around age 6, learning about dental care and proper brushing technique should definitely start at a young age, before the development of adult teeth begins so that these practices become firmly entrenched.

As a child I never feared dentists as I did not have tooth problems so the experience was always non-invasive.

On the other hand, many people only visit the dentist when it is unavoidable, probably due to this common fear (which then makes the experience confirm those fears). I recall a colleague being incredibly surprised that I was going to the dentist "just" for a check-up and another colleague mentioning they recently had a very painful visit to the dentist having last visited a dentist ten years ago and were hoping to not go again for another ten years - thus in my anecdotal experience to a cultural awareness of preventative care still needs to be normalised.
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