Dental Consequences of Pain Management
Oral Health interacts with and impacts the whole body.1 Periodontal Disease can contribute to serious internal medical problems.
Recently, scientific studies have documented that bacteria and its accompanying inflammatory processes—which are present on teeth in the form of biofilm, both above and below the gum line—can enter the blood stream and cause an increased risk of developing systemic health problems and/or aggravate existing systemic diseases.
Bacteria from this biofilm contribute to periodontal disease. These bacteria, entering the bloodstream, have been shown to increase the risk of developing and/or aggravating existing systemic diseases, such as:
- Heart Problems2-4
- High Blood Pressure5
- High Cholesterol7
- Arthritic Conditions8-10
Periodontal Disease is an inflammatory condition where bacteria and deposits on teeth beneath the gum tissue cause inflammation in the hard and soft tissues surrounding teeth. If not treated, this inflammation will progress and both bone and soft tissue surrounding the teeth will be lost.
Recent research has shown that colonies of hundreds of different types of bacteria form a conglomeration under the gums called biofilm. This conglomeration of colonies of bacteria attach to the surfaces of the teeth and the gum tissues. This biofilm of bacteria produce inflammation by secreting polysaccharides and toxins in and under the tissues surrounding the teeth. Through this inflammatory process, bacteria readily enter the blood stream and travel throughout the body causing and/or contributing to inflammatory havoc throughout the body.
Periodontal disease can be caused by numerous issues such as poor oral hygiene and dental neglect. Diabetes, as well as smoking, can contribute to inflammation of the gums. Auto-immune diseases and hormonal imbalances can also contribute to periodontal issues.
Pain Contributions to Periodontal Disease
The oral environment is kept in balance and controlled by saliva. Qualitative and quantitative changes in the salivary process enable bacteria in the mouth to flourish, thereby promoting gum inflammation and periodontal disease.16 Changes in the saliva can occur due to stress, where stress has been shown to cause or aggravate periodontal disease.17-21 Stress can weaken the immune system and thereby allow periodontal disease process to progress.
Qualitative changes of the saliva can be caused by medications taken for pain management. The changes in saliva caused by medicines have been shown to cause or aggravate periodontal disease and even contribute to dental decay.22
Other contributors to periodontal disease due to salivary changes include:
- Dry mouth from pain-related sleep disorder.23
- Gastric reflux from GERD has gastric acids entering the mouth, changing the acidity of the oral environment. Oral acidity can aggravate periodontal disease issues (and also cause demineralization of the teeth).24
- Loss of sleep25
- Bruxism (clenching and grinding of the teeth) places pressure on the teeth and the surrounding tissues and accelerates periodontal bone loss around the teeth.26
- Facial muscular pain can interfere in an individual’s ability to chew foods causing a decreased stimulation of salivary flow.27
- Pain (and/or stress) causes increases in salivary cortisol which is linked to alveolar bone loss and periodontal disease.28
- Individuals in pain can neglect to take care of their teeth (brushing and flossing) and thus aggravate periodontal disease.
“Controlling periodontal disease may minimize development and/or aggravation of systemic health problems in the pain patient.”
Pain and its associated issues can contribute to the bacterial growth and inflammatory processes of periodontal disease. The bacteria and its inflammatory processes can enter the blood stream and cause an increased risk of developing systemic health problems and/or aggravate existing systemic diseases such as heart problems, high blood pressure, Diabetes, high cholesterol, and cancer.
It is imperative that physicians be aware of and consult with a knowledgeable dentist whenever there is a patient that has chronic pain, long term drug use, and/or emotional stressors that may expose the patient to an increase in periodontal disease. Controlling periodontal disease may minimize development and/or aggravation of systemic health problems in the pain patient.