Changing conceptions about oral health and systemic health

Changing conceptions about oral health and systemic health

by Matías Santos López

Oral Health and Systemic Health

Oral diseases are a major public health problem worldwide; however, they have not been given the attention they deserve. The World Health Organization (WHO), in the Global Oral Health Status Report of 2022, estimated that 3.5 billion people suffer from oral diseases in the world, the main ones being dental caries, periodontal disease, tooth loss and oral cancer.

Poor oral health impacts various essential functions for an individual, such as eating, breathing, aesthetics, self-esteem, the ability to communicate and function socially, as well as the quality of life in general. In addition to the discomfort of pain, it carries a significant economic burden.

The historical approach has been to separate oral health from systemic health and consider them two specialties that manage unrelated conditions. In simple words, the person goes to the doctor and goes to the dentist without any communication between these two professionals about their health, as if they were two different patients.

However, for years the evidence has demonstrated the association between oral diseases and systemic diseases, especially chronic non-communicable diseases, such as malnutrition, obesity, cardiovascular pathologies, hypertension, diabetes and cognitive impairment. By combining the damage of oral diseases and chronic diseases in populations with progressive aging, a vicious circle is generated that accelerates the progression of the three situations, and which finally translates into a deterioration of health at a greater speed, a lower quality of life, and finally a higher mortality rate.

But why is this? Various authors agree that oral diseases and systemic diseases share risk factors, such as unhealthy diet, tobacco use, and alcohol consumption, among others… but we will return to this topic later.

5×5 Agenda for Non-Communicable Diseases

In the last 20 years, non-communicable diseases have been the leading cause of death in most countries, causing 200 million premature deaths in people between 30 and 70 years old. Many of these deaths could have been prevented or delayed.

Currently, the WHO states in its “5×5 Agenda for Non-communicable Diseases” that cardiovascular diseases, cancer, diabetes, respiratory diseases and mental pathologies can be prevented or delayed by reducing their main risk factors, such as tobacco use and alcohol consumption, unhealthy eating, physical inactivity and air pollution.

With this, it is clear that oral and systemic non-communicable diseases share part of their risk factors, in addition to having a bidirectional interaction where both are negatively enhanced. But why are they not included in the 5×5 Agenda?

Image credit: NCD Alliance. 2020. The Need for a Person-Centred, Inclusive NCD Agenda. The Need for a Person-Centred, Inclusive NCD Agenda | NCD Alliance

6×6 agenda?

Professor Habib Benzian (New York University College of Dentistry, New York, USA) has raised the need to include oral diseases as a pathology and sugar consumption as a risk factor in this agenda. This is based on the fact that oral diseases fit the definition of a non-communicable disease since they are chronic, non-infectious and have a progression that affects the entire life course. Furthermore, they have a high prevalence and are potentially avoidable. And for its part, sugar consumption is the main risk factor for the development of cavities, contributing to the development of obesity, diabetes, and cardiovascular pathologies.

An interesting precedent is the inclusion of mental health and air pollution on the agenda. By expanding the list of diseases on the agenda, a more integrative approach to environmental health and systemic health was achieved.

Why couldn’t a more integrative approach between oral and systemic health be achieved in the same way, if both are related to chronic non-communicable diseases, share risk factors and have a bidirectional relationship supported by evidence? Its inclusion would lead to a more holistic understanding of health, understanding that there are relationships that cannot be studied separately and require a collaborative effort to achieve results.

Matías Santos López is a dentist from the Finis Terrae University, an epidemiologist (c) from the University of Los Andes and currently works at the Chilean Ministry of Health. His degree work focuses on the relationship between chronic multimorbidity and oral health in the Chilean population.

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