The Connection Between Oral Surgery and Overall Health

Dr. Lieblick: Brandon, when we were in our surgical residencies, a significant portion of our training took place not in a dental clinic, but on rotations throughout the main hospital—in general surgery, in the emergency room, in anesthesiology.

Dr. Rehrer: That’s a great point, Russ. And that extensive medical training wasn't incidental; it was foundational. It was designed to give us a broad background in surgery… but it also instilled in us a deep understanding that the mouth isn't a separate, isolated part of the body. The health of the oral cavity is profoundly and directly interconnected with the health of the entire body.

Dr. Lieblick: It's a perspective shift, really. Moving away from seeing the mouth as an island and understanding it as the complex, interconnected system it is. The health of the gums, the bone, the teeth—it all has a direct line to the rest of the body.

Dr. Rehrer: It does. And this connection is something we see and manage in our practice every single day. The decisions we make and the treatments we provide can have significant implications for a patient's overall systemic health.

Dr. Lieblick: And that’s the vital relationship we want to explore today. Welcome, everyone, to Oral Surgery Insights. I’m Dr. Russ Lieblick, and I’m here with Dr. Brandon Rehrer. Today, we’re going to discuss the critical connection between the conditions we treat as oral surgeons and a patient’s overall health and well-being.

Dr. Rehrer: It's a conversation that moves beyond just teeth and gums. It’s about understanding the mouth as the gateway to the body, and how managing oral health is an integral part of comprehensive healthcare.

Dr. Lieblick: The core of this mouth-body connection really revolves around two main pathways: how diseases in the body can manifest in the mouth, and perhaps more importantly for our discussion, how diseases in the mouth can affect the rest of the body.

Dr. Rehrer: Let's focus on that second pathway, as it’s where our interventions as surgeons can make a significant impact. The primary mechanism here is chronic inflammation and infection. When you have a persistent, low-grade infection in your mouth—like advanced periodontal (gum) disease or a chronic dental abscess—your body is in a constant state of fighting it.

Dr. Lieblick: This isn't just a localized problem walled off from everything else.

Dr. Rehrer: Not at all. The bacteria from these oral infections, along with the inflammatory byproducts the body produces to fight them, can enter the bloodstream. Every site of chronic infection, whether it's an arthritic knee or your gums, contributes to the body's total "inflammatory burden." Our immune systems are constantly working, and a persistent oral infection adds a significant, unnecessary strain.

Dr. Lieblick: And that chronic strain is what can start to tip the scales, contributing to problems in other parts of the body.

Dr. Rehrer: One of the most well-researched and significant of these links is the connection between periodontal disease and cardiovascular health. A large body of scientific evidence has demonstrated a strong association between advanced periodontitis and an increased risk for cardiovascular diseases, such as atherosclerosis (hardening of the arteries), heart attack, and stroke.

Dr. Lieblick: And the link here is believed to be that inflammatory burden we just mentioned.

Dr. Rehrer: That’s the prevailing theory. The chronic inflammation from the gums, driven by bacteria, contributes to the overall level of inflammation throughout the body. This systemic inflammation is a known factor in the development and progression of plaque buildup in the arteries. What's even more compelling is that specific periodontal pathogens, the bacteria themselves, like Porphyromonas gingivalis, have been identified directly within the atherosclerotic plaques in coronary arteries.

Dr. Lieblick: So it's not just a theory; there's direct evidence of oral bacteria at the site of cardiovascular disease. For a patient with a family history of heart disease, taking every possible step to reduce their risk factors is critical. Managing their periodontal health becomes a very important part of that preventative strategy.

Dr. Rehrer: So when we, as surgeons, are treating advanced gum disease, perhaps by removing teeth with hopeless prognoses that are serving as reservoirs for infection, we're not just addressing a "mouth problem." We are actively helping to reduce an inflammatory and bacterial load on their entire cardiovascular system.

Dr. Lieblick: Another incredibly important connection exists with diabetes. This is often described as a "two-way street," and that's a perfect description.

Dr. Rehrer: It is. It’s a very clear bidirectional relationship. First, we know that patients with diabetes, particularly if their blood sugar is not well-controlled, are more susceptible to developing infections, including severe periodontal disease. High blood sugar levels can impair the body's immune response and its ability to heal.

Dr. Lieblick: So diabetes can make gum disease worse. But then we have to look at it from the other direction.

Dr. Rehrer: Correct. A significant, active infection in the mouth—like a dental abscess or severe periodontitis—is a source of chronic inflammation. We know that chronic inflammation can increase what's called insulin resistance. This means the body's cells don't respond as well to the insulin that's being produced, which in turn makes blood sugar levels much harder for a diabetic patient to manage.

Dr. Lieblick: We see this clinically. When we eliminate a major source of oral infection for a diabetic patient, they and their endocrinologist will often report a noticeable improvement in their glycemic control, what's often measured as their A1C level. It can be a very tangible benefit.

Dr. Rehrer: For our diabetic patients, then, managing their oral health is not an elective issue; it is a fundamental part of managing their diabetes. This is an area where we collaborate closely with their medical team to ensure their care is fully coordinated for their overall well-being.

Dr. Lieblick: The mouth-body connection extends to other areas as well. Respiratory health is one that's particularly important for certain patient populations.

Dr. Rehrer: Yes, especially in older or medically compromised individuals, or those in hospitals or long-term care facilities. The bacteria that colonize the mouth, especially in the presence of poor oral hygiene, can be aspirated, or inhaled, down into the lungs.

Dr. Lieblick: This can lead to a serious lung infection known as aspiration pneumonia. This is particularly a concern for our elderly patients or those who may be debilitated for other reasons. Their immune systems might be less robust, and their ability to cough effectively might be reduced, making them more vulnerable to these aspirated bacteria. Maintaining good oral hygiene for these populations is a key preventative measure.

Dr. Rehrer: There's also an established link between periodontal disease and certain adverse pregnancy outcomes.

Dr. Lieblick: This is a very important consideration for expectant mothers. A number of studies have suggested an association between severe gum disease and an increased risk of delivering a baby preterm or with a low birth weight.

Dr. Rehrer: The hypothesis there is that the inflammatory mediators produced in response to the gum disease, like substances called prostaglandins, can enter the bloodstream. These same substances, in high levels, can play a role in initiating uterine contractions and premature labor. It's another example of a localized oral problem potentially having distant systemic effects.

Dr. Lieblick: It really highlights the importance of achieving and maintaining excellent oral health before and during pregnancy. Any necessary oral surgery should be planned in careful consultation with the patient's obstetrician to ensure it's done at the safest possible time.

Dr. Rehrer: We also have to be extremely mindful of patients with specific medical devices, like prosthetic heart valves or artificial joint replacements, such as a new hip or knee.

Dr. Lieblick: This is why patients will hear us ask very detailed questions about their medical history. For these patients, bacteria entering the bloodstream from the mouth during a dental procedure could potentially travel and "seed" an infection on these artificial devices.

Dr. Rehrer: And an infection on a prosthetic joint or a heart valve is a very serious, potentially life-threatening complication. To prevent this, based on guidelines from organizations like the American Heart Association and the American Academy of Orthopaedic Surgeons, we often pre-medicate these at-risk patients with antibiotics before their surgical procedure. This practice is known as antibiotic prophylaxis, and it's a simple but absolutely critical safety step.

Dr. Lieblick: This all brings us back to the role of the oral surgeon. A significant part of what we do every day is directly managing and eliminating sources of chronic oral infection and inflammation that could be impacting a patient's overall health.

Dr. Rehrer: Exactly. Our surgical training allows us to manage these deep-seated infections within the bone of the jaws—areas that can't be reached with routine cleanings or standard dental care. Surgically cleaning out these sites and removing the source, whether it's an infected wisdom tooth or a failing root canal, is what truly eliminates that inflammatory burden on the body.

Dr. Lieblick: And when we place dental implants to help a patient restore their ability to chew properly, the benefit extends far beyond just the mouth. A patient who can chew effectively is often able to eat a more varied and nutritious diet—one that's rich in fiber, fresh fruits, and vegetables.

Dr. Rehrer: That shift away from a diet of soft, often more processed and carbohydrate-heavy foods, has direct and positive impacts on their systemic health, from better cardiovascular wellness to improved digestive health and blood sugar control.

Dr. Lieblick: The oral surgeon also plays a role as a diagnostician. The mouth can sometimes show the first signs of a systemic disease that the patient isn't even aware of yet.

Dr. Rehrer: That’s very true. Certain oral lesions or patterns of inflammation can be early manifestations of systemic conditions. For instance, autoimmune diseases like pemphigus or pemphigoid can present with painful blisters and erosions in the mouth before they appear on the skin. Or, unusual bleeding of the gums that isn't explained by local factors could be an early sign of an underlying platelet disorder.

Dr. Lieblick: Recognizing that a particular oral finding is not a standard dental issue but a sign of something systemic is a critical diagnostic skill. It allows us to get the patient to their primary care physician or the appropriate medical specialist for a full workup that they might not have otherwise sought, sometimes leading to a very early and important diagnosis of a medical condition.

Dr. Rehrer: So, Russ, it's clear that the concept of separating oral health from general health is completely outdated. The two are intrinsically and powerfully linked.

Dr. Lieblick: They are. The mouth truly is a window to our overall health. Chronic inflammation and infection originating in the oral cavity can have far-reaching effects on the rest of the body, contributing to or complicating serious medical conditions.

Dr. Rehrer: As oral and maxillofacial surgeons, our work is deeply connected to this principle. By surgically managing complex oral health problems, we are not only restoring the function and comfort of the mouth, but also contributing positively to the patient's overall systemic health and well-being.

Dr. Lieblick: It’s a responsibility we take very seriously, and it underscores the importance of a collaborative approach between dental and medical professionals for the complete care of our patients. We hope this discussion has provided a clearer understanding of this vital connection. Thank you for making Oral Surgery Insights a part of your day.

Dr. Rehrer: We appreciate you listening, and we trust this conversation has highlighted the importance of maintaining your oral health as a key component of your overall health.

Dr. Lieblick: We wish you all the best.