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“THE MEDICAL LIABILITY OF THE MOUTH, The Forgotten Infective Inflammatory Source”

Steven Jaksha DMD, Odontology, Oral Diseases, TMJ/TMD

Today there is a proverbial “medical” 800 lbs gorilla in the room that everyone is trying ignore but if we are not careful, professionally we’ll be crushed one day by such ignorance. It’s all about bacteria, inflammation and it’s source.  We are all aware of some of the huge E coli and Staph infections that create emergency room news headlines but are there other sources?

“Five dead, nearly 200 sick in E. coli outbreak from lettuce. And investigators are stumped” read a recent news headline.  E coli (Escherichia coli) is a natural bacteria found in the our intestinal gut for digestive purposes.  E coli bacteria typically has had a bad reputation due to news reports where an E coli poisoning occurred.   For the most part, most E coli strains live uneventfully in the guts of mammals helping to process food digestion at a microscopic level.  At this activity level, there is a no-harm, host benefit unless E coli is found extra-intestinal, outside it’s natural habitat, usually from contaminated food.

Pathogenic, extra-intestinal E coli strains can cause a variety of septicemic illnesses creating conditions of vomiting, diarrhea, dysentery, neonatal meningitis and in some cases, kidney failure and even death.  This is a great example of a bacteria, when found in it’s natural location, is good but when found extra-intestinal, very serious health issues can occur.

Staphylococcus is another bacterium that is part of our body’s normal bacteria flora commonly found in the nose, respiratory tract, and on the skin.   When this bacterium is found in variant forms, outside it’s normal flora location, very serious life-compromising infections can occur.  Bacteria is an organism of “opportunity”, so when found outside it’s normal flora location, infections and inflammation can occur at different levels of seriousness.   Another news “bacteria-gone-awry” headline read, A MRSA Infection Cost Me $300,000—and Nearly Killed Me lends itself to the seriousness of bacteria outside it’s normal flora location.  MRSA (Methicillin-resistant Staphylococcus aureus) is a serious staph infection. MRSA can cause infections in different parts of the body and since it is resistant to some commonly used antibiotics it is tougher to treat than other staphylococcus aureus strains.  Depending on the infection location, the seriousness of MRSA symptoms can differ from visible skin infections/rash, headaches, muscle aches, chills/fever, fatigue, coughing, shortness of breath and chest pain.

So where is that “medical” elephant or gorilla in the room that many are ignoring?   With the trillions of natural bacteria that live harmoniously in and on our body’s, there are several billion doing the same in our mouth’s.  Just like E coli and staphylococcus bacterium that can become “opportunistic” infections and inflammation, significant research (NIH, JP,  JPR, JAMDA) is now indicating that there are several opportunistic oral bacterium related to several significant somatic disease/illness conditions.  Odontologists have long been aware of the oral-systemic disease/illness connection, but only recently has medical research demonstrated a causal link.  Even though the oral-systemic connection is not new, for some it is hard hard to visualize.  Maybe this example will help. Imagine an unattended, palm-sized, purulent skin infection (MRSA?) on any limb.  This is a serious condition because it is creating an initial bacteremia often leading to a septicemia which would get the immediate treatment attention of any physician.

The tissue surrounding the oral dentition is estimated to have the same “palm sized” surface area as described above, also sharing the same vascularity as any somatic wound site. Unfortunately, the vast majority of practicing physicians do not see and/or know how to properly diagnose any oral-dental related infections (periodontal disease).  The seriousness of this is simple because it can adversely affect both the patient’s health and the physician’s practice.  Research is now demonstrating oral infection/inflammation vectors that can create or augment other very serious somatic conditions, worsening a physician’s  patient health and welfare.

Imagine a pyretic patient with chronic, indefinite pain, lethargy, with an abnormal WBC supported with inflammation test bio-markers such as an ESR and CRP demonstrating an inflammation process but the initial physical examination shows nothing.  Additional tests are taken, yet still no definitive cause-and effect diagnosis.  Ask yourself this?  Have we looked everywhere? Is there an oral-periodontal infection? Has a simple PSR examination been performed?  Had a proper oral-periodontal exam been performed as part of a medical examination, demonstrating an initial Class 3 or 6 periodontitis or ANUG, there would be a strong cause-and-effect for the abnormal WBC, ESR and CRP correlation allowing for appropriate treatment action.

In the mouth there are an estimated one billion bacteria living, at any one time, with some 200-300 different types layered in the mouth-specific bio-film that starts in the mouth that continues throughout the digestive tract.  In this bio-film flora there are several bacterium types that localize themselves in periodontal disease creating oral health issues, but when these bacterium (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola or Fusobacterium nucleatum) find themselves systematically via the vascular system they can create numerous inflammatory disease/illness processes.  Research indicates that these disease processes can manifest themselves in a higher percentage of patients as cardiovascular atherosclerosis, stroke, breast cancer, diabetic and pregnancy complications.

It has been estimated that almost 50% of the United States general adult population has periodontal oral infections that rises to 70% of the 65 and older adult population.  It is a good bet that 50% of patients in any medical reception area has an oral-periodontal infection potentially creating a systemic inflammatory process that will affect other systemic conditions. The compromised health patient or the patient with an idiopathic inflammation process is at a greater systemic risk when an undiagnosed oral infection is present.  Failure to address this newly researched health aspect compromises both the patient and the treating physician.  The question is now “Is there an 800 lbs medical-gorilla lurking in your practice reception area?”

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