October is National Dental Hygiene Month — what better time to discuss how having good dental hygiene can reduce the risk of disease and infection in other parts of the body?
According to the Journal of the American Dental Association (JADA), more than 40% of U.S. adults age 30 years or over are estimated to have some degree of periodontitis, and 7.8% of those adults have severe periodontitis. The Centers for Disease Control and Prevention (CDC) notes that the incidence of periodontal disease increases with age, as more than 70% of adults 65 years and older have periodontal disease.
The National Institute of Dental and Craniofacial Research (part of the National Institute of Health, or NIH) states that poor dental hygiene allows plaque to build up under the gum line, which then can’t be removed except by a dental care professional. Plaque buildup is the leading cause of gum disease, and gum disease is the leading cause of tooth loss.
The Three Stages of Gum Disease
Gum disease typically starts as gingivitis, marked by slight gum tenderness, bleeding during brushing or flossing, and/or tooth sensitivity to temperature changes or pressure. Midstage peridontitis usually presents as gums that are perpetually red, puffy and painful, and which may start receding away from the teeth. Pockets form between the gum and the teeth, and more bacteria start to multiply in these tiny hiding places.
In late-stage periodontal disease, the bone holding teeth in place begins to dissolve, causing teeth to loosen and fall out. More bone loss takes place below the empty socket, and adjacent teeth begin to migrate into the gap, also loosening and eventually falling out. In due course, most people with advanced untreated periodontal disease lose all of their teeth and become completely edentulous (toothless.)
Researchers noticed that many people with periodontal disease also had glaucoma. This prompted studies to find out if the relationship between gum disease and glaucoma development was causal, meaning that the gum disease contributes to the development of glaucoma, or simply correlative, meaning many older people tend to develop both conditions independently.
The CDC reports that approximately 3 million Americans have glaucoma, but that only around half of them are aware they have the disease. The most common form of glaucoma is open-angle glaucoma, in which increased fluid causes pressure on the optic nerve, damaging it slowly over time.
Glaucoma is the second leading cause of blindness among U.S. adults, second only to diabetic retinopathy. There are no early symptoms of glaucoma, and by the time vision loss begins to occur, the damage is irreversible.
According to the National Eye Institute (also part of the NIH), a dilated eye exam is the only way to diagnose glaucoma, which has no cure. However, early detection and treatment can significantly slow the progression of the disease and help reduce vision loss.
In 2016, researchers began to conduct studies to establish the link between periodontal disease and glaucoma.
Findings based on data from the ongoing Health Professionals Follow-up Study (following more than 40,000 men who were asked biennial questions about their health over a 26 year period) reported a connection between tooth loss and primary open-angle glaucoma (POAG.)
Every two years, men over 40 with a recent eye exam and no sign of POAG were noted. Those who developed POAG over the intervening two years before the next round of interviews were evaluated in relation to other health conditions.
It was discovered that tooth loss in the past 2 years was associated with a 1.45-fold increased risk of POAG and a 1.85-fold increased risk if the tooth loss was accompanied by prevalent periodontal disease.
Researchers associated with the study theorized that oral infections with inflammatory microbes (like those present in chronic periodontal disease) could cause a damaging reaction in the eye if the microbes arrived there by circulating through the nervous system. They believed that the systemic adverse effects of poor dental hygiene could indeed impact eye health, potentially contributing to an increased risk for glaucoma.
In another 2016 study, mouthwash specimens from patients with glaucoma and control subjects were analyzed to see how much oral bacteria was present. In patients with glaucoma, there were statistically significant higher bacterial oral counts compared to control subjects.
The conclusion from this study was that there was also a link between periodontal disease and the risk for glaucoma. In both cases, all of the study subjects were male, but since women and men suffer from periodontal disease and glaucoma in similar numbers, researchers agree the link is likely the same across genders.
Reducing periodontal disease can significantly decrease the risk for any number of diseases for which a link has been proven, including diabetes, cardiovascular disease, stroke, dementia, and kidney problems. Now, glaucoma can be added to that list.
In turn, identifying glaucoma early with a comprehensive dilated eye exam can allow treatment to begin as early as possible, helping to halt the progression of the disease and safeguard sight. The key in both cases is access to health services.
More than 25% of Americans don’t have access to regular dental care. Two out of 5 people without dental insurance are retirees, and 2 out of 3 are women.
Of an estimated 93 million Americans at risk for vision loss, only around half have had a comprehensive eye exam in the past two years and many of them also cite lack of access as their reason for skipping exams.
There is a clear connection between eye health and dental health. Having access to both contributes to better outcomes for health plan members. Versant Health is committed to safeguarding eye health. Find out how to add vision care to your health plan’s offering today.
© 2021 Versant Health Holdco.