Home Issues2023 OSH Issue The Oral-Systemic Link

The Oral-Systemic Link


by Mike Milligan

The Oral-Systemic Link has many components, yet they are all interconnected. Let’s keep it simple. I like to think of three main categories of the Oral-Systemic Link:

  1. Blood-Borne Oral Pathogens/Inflammation
  2. Airway/Breathing/Sleep
  3. Lifestyle


BACTERIA AND THEIR TOXINS from the mouth can DIRECTLY infect other areas of the body by travelling through the cardiovascular system; and more importantly they can INDIRECTLY cause problems by creating an inflammatory/immune response. These bacteria come from both:

  • Periodontal infections
  • Apical infections

The health problems related to these oral bacteria and their toxins have been shown to include:

  • Heart Attack and Stroke and other cardiovascular disease. Once oral bacteria and their toxins enter the body, they may cause inflammation which weakens the arterial wall allowing soft fat deposits to move from within the arterial wall into the lumen, thrombus formation clogging blood flow, and embolus formation. These conditions may be responsible for heart attacks, strokes, and other dangerous health conditions. Brad Bale, MD, and Amy Doneen, DNP in their landmark article “High Risk Periodontal Pathogens Contribute to the Pathogenesis of Atherosclerosis,” show that periodontal disease is CAUSAL of arteriosclerotic vascular disease, not simply ASSOCIATED. Research suggests endodontic apical lesions are the trigger for up to 50% of heart attacks!
  • Diabetes Complications – periodontal disease can have a direct impact on glycemic control in diabetic patients, leading to diabetic complications. Conversely, people with diabetes, especially those with poor glycemic control, are much more likely to have periodontal disease.
  • Alzheimer’s Disease – the bacteria associated with Alzheimer’s Disease have been isolated in the periodontal pockets and along the nerves from the teeth to the brain tissue. When these bacteria are introduced into brain cultures, beta amyloid is formed, which is the substance that is a cause of Alzheimer’s disease. Dr. Judith Miklossy of Switzerland, and the International Alzheimer’s Research Center, said “Indeed, six different oral periodontal pathogen spirochetes were found to be present in the brain of Alzheimer’s patients so it is extremely important to take care of oral health in order to prevent Dementia.”
  • Pregnancy Complications – Women with severe periodontal disease were found to have seven times the risk of giving birth early (preterm birth) as women who had healthy gums. They also had seven times the risk of having a baby with a low birth weight.
  • Respiratory Disease – the bacteria present in gum disease have also been located in lung tissue in patients with lung abscesses.
  • Rheumatoid Arthritis – high levels of bacteria found in periodontal disease (DNA and antibodies) have been found in the serum and synovial fluid of rheumatoid arthritis patients.
  • Head and Neck Cancer risk is increased by gum disease.
  • Pancreatic Cancer risk is increased by 64% in patients with gum disease a Harvard study shows. In addition, people with a history of gum disease, plus recent tooth loss, have a 2.7-fold higher risk of this fatal pancreatic cancer than people without gum disease or tooth loss. The worse the gum disease, the higher the risk.
  • Lung, Kidney, and Blood Cancers – studies suggest that tooth loss and periodontal disease might increase the risk of developing these cancers.

Nearly 50% of American adults have periodontitis.

  • 700 species of bacteria can live in your mouth. 11 species of oral pathogens in particular are linked to oral & systemic disease.
  • 5 species of oral pathogens – research has shown if we can test for just these 5 and control them, that most of the other pathogenic bacteria will also be controlled, because they all work together.
  • The major goal of Periodontal Therapy is now 1) To promote a shift from predominantly pathogenic microbiota to a host-compatible one, and 2) To achieve clinical and microbiological stability. It is no longer acceptable to just to control pocket depth and bleeding! You must also test for and control the specific pathogenic oral microbes!

Also, periodontal disease is transmissible! So be careful who you kiss (including your pet) and be sure your spouse or significant other also has good periodontal health!


Today about 60 million American adults have sleep or wakefulness disorder. About 22 million (6 to 9% of our population) suffer from Obstructive Sleep Apnea (OSA). Sleep apnea is associated with diabetes, asthma, acid reflux, weight gain, high blood pressure, heart failure, stroke, car accidents, and other concerns. Chronic headaches, migraines and TMD disorders are often related to and/or caused by airway, breathing and sleep disorders.

Obstructive Sleep Apnea is diagnosed either with a Polysomnogram at a sleep center, or now more commonly with a home sleep study. The dental office can provide home sleep study kits to patients, though only a physician can diagnose sleep apnea.

Oral signs of Obstructive Sleep Apnea include worn teeth, abfractions, bruxism, multiple fracture lines, fractured teeth, crowns on many posterior teeth (bruxism?), tori (buttressing bone), narrow dental arches; narrow high palate, lingual frenum, scalloped tongue, 4-bicuspid extraction, mouth breathing, retrognathic jaws, long face, gummy smile, large neck, large tonsils & adenoids, high Mallampati score (small airway at back of mouth), narrow nose, snoring, allergies & asthma, narrow airway on cephalometric X-ray, 3-D Cone Beam results, Epworth Sleepiness Scale, and STOP BANG scale.

Treatment Options and aids include sleep hygiene, positional therapy, nasal strips/dilators (Breathe Right), weight & nutrition, lifestyle improvements, posture, Orofacial Myofunctional Therapy, mouth taping, breathing re-training, lingual frenectomy, oral sleep appliances, dental arch development (lateral and A-P), CPAP, and surgery. The dental office can do all these except CPAP and some surgeries.

CPAP is the gold standard for treating sleep apnea, but about half or more people are intolerant of using it. So, the dental office is often asked to help with therapy, and it can be very effective.

Early recognition and interceptive therapy in children (ages 2-10) to correct narrow palates, incorrect breathing, deviate swallowing patterns, and allergy problems can prevent many dental, airway, and medical problems later in their lives.


Wow – what a huge topic! Let’s talk about just two examples of lifestyle factors that are related to Oral-Systemic health. There are MANY others!

  • Nutrition – tooth loss, decay, periodontal disease, and thermal sensitivity can all affect chewing, food choices, and getting the proper nutrition that is so essential for total body wellness. Conversely, proper nutrition can significantly affect dental health, including pocket depth and bleeding sites. So, the mouth affects nutrition, and nutrition affects the mouth.
    • A 60-day, double-blind clinical study conducted at Loma Linda University in 2000 gave antioxidant vitamin supplements to subjects with various levels of periodontitis. After just 60 days, the actual Pocket Depth (PD) reduction was 44.6% for 7mm pockets, 46.8% for 6mm pockets, 34.1% for 5mm pockets, and 23.3% for 4mm pockets.
  • Herpes Virus – 150 million people in the United States (one-third of the population) suffer from the pain and embarrassment of cold sores each year, and it is growing. Herpes Simplex Virus-1 (HSV-1) is historically the cause of oral herpes infections, whereas HSV-2 is historically the cause of genital herpes infections. Today, half of all first-time genital herpes infections in all age groups and more than 70 percent of patients under the age of 25 have first episodes of genital herpes that are caused by HSV-1, rather than the usual HSV-2, due to oral sex (a lifestyle behavior). These findings offer a strong new argument for rapidly controlling the oral infection episodes as doing so may help prevent the spread of HSV-1 to the genital area.


The American Academy for Oral Systemic Health (AAOSH) is the CENTRAL HUB for information about the Oral-Systemic Link. It is the starting point and center point. At AAOSH we help you with the:

  • Science
  • Implementation
  • Prevention
  • Screening, diagnosis, education, communication with patients, therapy, and maintenance
  • Marketing – internal and external – to your patients, the public, and to other healthcare providers
  • Collaboration with other healthcare providers; referrals
  • Improve your health and your life, as well as that of your family, friends, patients, and community
  • And the very best part of all – amazing networking and friendships that will last forever!


For more information and to start your incredible life-changing journey, check out www.AAOSH.org.

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