Caution required when discussing associations between oral and overall health

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

The mouth is connected to the body.

Yet much remains unknown about the subtle workings of that connection.

Research continues to identify associations between oral and systemic conditions. But it is too soon to draw conclusions about possible causal relationships between maladies such as gum disease and cancer, warn the authors of a June guest editorial in the Journal of the American Dental Association.

The authors cite recently published studies that have reported associations between edentulism (complete tooth loss) and mortality; gum disease (periodontitis) and some types of cancer.

“Given the results of these large studies, it would be tempting to conclude that preventing tooth loss and treating periodontitis lead to less cancer and prolonged survival,” wrote the authors, five prominent dental educators and researchers. “However this would be incorrect and misleading because association cannot prove causation,” they noted.

It may be tempting for dental providers, researchers and advocates to overstate what is known about oral systemic connections in an effort to attract media attention, to push for expanded health benefits, to recruit patients or to promote therapeutic approaches.

The authors of the guest editorial urged restraint.

“Our profession should take a cautious view that whereas oral disease might be causally related to other diseases, the main reason for maintaining good oral health is because it is important in and of itself,” they wrote.

“Effective and efficient chewing, enjoyment of food, pleasing appearance, self-confidence, and freedom from pain and infection are just a few of the benefits of good oral health,” they added.

For now, it is well known that untreated tooth decay can result in suffering, tooth loss, debilitating and in rare cases fatal complications. Gum disease can also result in tooth loss. Recognized as a side-effect of diabetes, periodontitis may also complicate the management of diabetes, according to the National Institute of Dental and Craniofacial Research and the National Institute of Diabetes and Digestive and Kidney Diseases.

Research to determine whether periodontal treatments result in better overall health outcomes for patients with diabetes and other systemic conditions is ongoing.

The findings so far are a subject of debate. Achieving a full understanding of the potential usefulness of such approaches will require more work.

The authors of the JADA paper stressed that steps forward should be based upon scientific evidence.

“Research should continue to explore the association and possible causal relation between oral and systemic health and disease as well as the costs and benefits of preventing and treating oral disease,” they observed.

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