This month I would like to address a topic we may not always discuss: oral health and its relationship to systemic health. It has been 40 years since a relationship was observed between atherosclerosis and alveolar bone loss (in the tooth sockets). At the time, little was known about the nature of the relationship, but now this is an area of increasing interest among researchers and clinicians. Let’s take a closer look.
Systemic conditions associated with poor oral health include diabetes, cardiovascular disease, bacteremia/endocarditis, pneumonia, gastritis, rheumatic arthritis, cancer, liver and kidney disease and dementia. A person with poor oral health may exhibit tooth loss, gingivitis (swollen bleeding gums), halitosis (bad breath) and periodontitis (bone loss in the tooth socket). Beyond a lack of oral hygiene, culprits contributing to poor oral health include genetic factors, xerostomia (dry mouth), bruxism (jaw clenching), diet (excessive sugar consumption), gut dysbiosis and smoking.
What is the mechanism by which the relationship between oral hygiene and systemic health exists?
In general, inflammation that is allowed to fester (advances from acute to chronic) doesn’t remain contained, regardless of where it occurs. Meaning the oral inflammatory mediators and pathogenic bacteria can translocate systemically via the damaged periodontium to damage other organs and systems.
In addition, the same inflammatory burden and bacteria may be absorbed extra-orally via inhalation or ingestion. This is the case when bacteria associated with gingivitis or periodontitis is aspirated leading to pneumonia, a common nosocomial infection. If ingested, it may lead to endocarditis or gastritis. In some cases, specific oral bacteria have been linked to specific diseases, such as atherosclerosis. With diabetes, a bi-directional relationship exists. Periodontal disease is a complication of poorly managed blood sugar and acute inflammation (such as that in gingivitis and periodontitis) reduces the uptake of glucose and reduces the efficiency of insulin. Thus, diabetes can cause periodontal disease and periodontal disease can exacerbate diabetes.
A final consideration is the relationship between the gut microbiome (GMB) and overall health. Dysbiosis in the GMB is a culprit in numerous conditions and disease states, because the digestive system initiates with the oral cavity.
There is much we are still learning about the relationship between oral health and systemic conditions/diseases. We do know that maintaining oral health includes:
It has been said that the oral cavity is the mirror reflection to one’s overall health.
A Scary Look at Data Misrepresentation in Nutritional Science
As consumers of information, we are barraged daily with conflicting information, nowhere is this more evident than in nutrition research where the information seems to change from week to week. Why is this the case?
We can start with how people eat: are the people in the fake headline above just eating ice cream? Likely they are eating the usual ice cream companions like cones, sprinkles, whipped cream and hot fudge. People follow patterns of eating behavior. It is virtually impossible to take a reductionist view of what people eat and limit it to a single food or nutrient.
Then, we can look at how the data is collected. Most often, nutrition research asks people to recall what they ate over a given period of time in the past. Do you recall how much ice cream you ate last summer? Last month? Last week? Was it soft serve or hard? What flavor was it? Was it dairy or dairy-free? Did you add toppings? Was it served in a cup or a cone? What type of cone? …Just how accurate do you think the information collected is?
Next, we can examine the participants in the study. How many participants are needed before one can make the observation in our fake headline? 3? 30? 300? What were the demographics of the participants? Was it a diverse group of people (age, ethnicity, socioeconomic status, geographical location, etc.)? If all the participants in our fake headline were 80-year-old Caucasian females living in the Bronx, then it would be nonsensical to the extrapolate trends from this data to anyone other than 80-year-old Caucasian females living in the Bronx.
Then, ask yourself, is observation causation? The answer is no. That is a fundamental issue with study design. Much nutrition research is observational. We observe “associations” between variables, but we cannot control unforeseen variables. Let’s take our fake headline: What if the participants in the study ate their ice cream on a sugar cone? How do we know the shark bite wasn't due to the cone and not the ice cream at all? By not measuring the sugar cone as a variable we have made a false association between ice cream and shark attacks.
In addition, it is rare in nutrition research to see a “gold standard” randomized control trial (RCT) in nutrition whereby people are randomly assigned to an intervention and a control group. In our fake headline, one group would eat ice cream, one group would not (the control group) but they would both go swimming at the beach. Then we would be able to draw comparisons between the two groups about a shark attack.
Sometimes the research comes up flat and nothing of interest is found. These negative results are important! They add to the body of knowledge on a subject. However, negative results aren’t highly sought after and are rarely published. This is referred to as publication bias. What if 10 previous studies found no association between eating ice cream and shark attacks, but because this was a positive result it was the only one published? The body of knowledge suffers as does the information disseminated to the public.
It is sad but true, that much research is funded by industries. The nut industry funds much of the research on nuts. The cacao industry funds much of the research on chocolate, and so on. Again, positive findings are more likely to be published, negative findings are repressed. Unfortunately, these positive findings are then used by the government to make nutrition guidelines and recommendations.
Researchers are human, they have egos and pride. The careers of scientists are built on their hypotheses, and, like industries, they have a vested interest in positive findings. Disappointingly, research is replete with insidious behavior meant to protect and promote careers.
Finally, there is the media; their job is to promote ratings. They are not obligated to properly vet the research (study design, participants, funding, etc.). Additionally, the media fails to properly explain the implication behind the headline (i.e. what does this mean to you?)
Where does this leave us, the consumers of information who want to make smart nutrition choices? Do we throw the baby out with the bathwater? Throw our hands up and eat Oreos for breakfast? Pringles for lunch? Not exactly. However, we do have a responsibility to take a look behind the headlines before making dietary decisions that impact our health. Sometimes that may mean getting the original research and using the above to decide if the study is valid for us.
Feel free to email Concierge Choice Physicians (firstname.lastname@example.org) with your questions or even send a headline or study to us, and we will be happy to answer your questions.
After a few years of a very uncertain travel market and amid subsequent changes to the industry, many of us are resuming regular travel and taking much needed vacations. But before you hit the roads and skies for travel, be sure to prepare yourself and pack your bags for medical scenarios.
Importantly, make sure to refill all your prescriptions ahead of your trip at least one week in advance of your departure and always bring at least a few extra days’ worth of medication with you. With the state of the travel industry, there is a high probability of your return not going quite as planned. You should always pack your medications in your carry-on—not in your checked suitcase—just in case your luggage is lost.
The Pack Smart Guide from the CDC offers a checklist to help you prepare for a healthy trip, including prescriptions, medical supplies, over-the-counter medicines, supplies to prevent illness or injury, first-aid kits and important documents. Many items in this list would be especially helpful if you are heading off the grid or traveling to an exotic location where medical supplies are not conveniently available at a local drugstore.
Also, keep in mind, we do not offer travel vaccines and would need to refer you to a travel health specialist or local pharmacy, so, please plan ahead. The CDC offers a complete list of destinations with travel health notices, recommended vaccines and precautions to consider for your specific destination.
Finally, make sure to enter your concierge physician contact details into your phone—including cell number and email—and remember to pack your membership card so that you can reach us with any medical concerns during your trip. We can potentially offer a telemedicine visit, call in a prescription or, based on your destination, help to arrange a visit with a local Concierge Choice Physicians provider if needed.
As always, feel free to reach us with any questions. Safe travels!
End-of-life care planning is important while we’re still healthy, and the pandemic has made it clear that illness and disability are not reserved for the elderly. Do your loved ones know your thoughts and wishes should a situation arise? According to the National Institute on Aging, 1 in 3 people guessed incorrectly when asked how their loved one would want their end-of-life care handled. It can be an uncomfortable subject to discuss and, in some families, maybe even a taboo subject. However, advance care planning empowers our loved ones when it comes time to handle our end-of-life care and decisions and helps make sure that our preferences and arrangements are known and honored.
One primary aspect of advance care planning includes legally designating a person to make healthcare decisions for you if you are unable to communicate these decisions yourself. This designated person is known as a healthcare proxy (or durable power of attorney healthcare agent, surrogate, representative, attorney-in-fact, or patient advocate). A healthcare proxy decides the types of medical care, procedures, treatments, or services you receive, as well as who provides that care and where. If not otherwise predetermined in advance care directives, they may also make decisions about autopsy, tissue and organ donation, and what happens to your body after death.
The American Bar Association has a helpful guide for selecting a healthcare proxy.
Your appointed healthcare proxy will have access to your medical records. If you are a Medicare recipient, Medicare will need to know about this individual which can be communicated by completing their Authorized Representatives form.
It is important to note a separate document is required to assign a person to handle your finances. Your healthcare proxy can only make medical decisions for you. Contact your lawyer for more information on a power of attorney for your finances.
I encourage a discussion about assigning a healthcare proxy and opening the conversation of advance care planning—including a Living Will—at your next visit. For Medicare patients, this is a covered service under Medicare Part B during your Annual Wellness Visit. For non-Medicare patients, feel free to call my office to schedule an appointment.
Three years ago, we were met with a global health crisis that resulted in many of us putting our other health concerns on pause, and we want to be sure you have all shifted your focus back to your overall health and wellness.
Have you kept up with your yearly physical? Is it time to do a full review of your medicine and treatment regimens? Have you gained or lost significant weight? How are your stress levels, sleep patterns, fitness programs and anxiety?
Your annual comprehensive examination could be the foundation of your good health. Diseases and conditions such as hypertension, cancer, and anemia can be asymptomatic, for example, but a thorough history, physical examination, laboratory testing, and an in-depth discussion may prove revealing and lifesaving. We can also take advantage of this time together to create a plan to help you meet your wellness goals.
Let’s partner toward your best health. Please contact our office to schedule your annual exam. And as always, we are available should you have any concerns or questions.