The concept of sterile blood no longer exists. Bacteremia occurs when pathogens enter the bloodstream. Many microbes simply enter the bloodstream transiently. They are shed from the primary biofilm found in the mouth by chewing or routine dental hygiene at home.
Higher concentrations of pathogens enter the blood by invasive dental procedures, including mechanical debridement, extractions, and endodontic procedures. It requires only 60 seconds for a pathogen to travel anywhere in the body as a result of an invasive dental procedure.
Bacteremia results in “seeding” bacteria at potentially new systemic locations. These new sites are typically under stress and have become susceptible to invasion.
Translocation is a pathogen’s arrival at a new systemic site from its point of origin. New biofilms or microbiomes of pathogens emerge at sites where these species are not normally found. The impact of these pathogens is the same wherever they colonize: cellular destruction.
In the past several years, much evidence has shown a prevalence of periodontal pathogens in arterial biofilms and microbiomes. Recently, the term “co-occurrence” has become relevant as it describes the existence of two similar biofilms in the same patient at the same time.
A study published in February 2017 found that a large group of patients who had both the symptoms of periodontitis and of heart disease had a similar profile of periodontal high-risk pathogens at the two independent locations. For three pathogens, the co-occurrence was at the 95% confidence level. Eight other pathogens were simply determined to have a very high incidence of correlation.
In a dental practice, a simple salivary test can be performed to determine the specific bacteria that are present in the mouth, understanding that the very same bacteria that are found in high concentrations in the mouth also are found on the lining of the patient’s arterial walls.
The goal of periodontal therapy should be to eliminate the bacterial etiology. Successful periodontal therapy must include antimicrobials and or antibiotics specific to the pathogens present in a given individual’s oral bacterial flora or biofilm.
Talking With Your Patients
As a dental team member, there are always concerns with how to open the discussion with our patients so they understand and are committed to treatment. A chairside conversation may start like this:
“Mrs. Jones, recent evidence has proven beyond a doubt that the bacteria we are looking at on this saliva test you took last week are also on the artery walls of your coronary and carotid arteries. It was why we had you start the antibiotics today for this appointment.”
Another conversation may start like this:
“Mrs. Jones, as you know, we are living in an environment where it is increasingly difficult to stay healthy. We now know that a healthy mouth and healthy gums are directly connected to most of our chronic diseases. Certain bacteria from the mouth are now found to be destructive wherever they migrate. We now have the capability to find out exactly what high-risk bacteria you may have and target them. Not only can we manage healthier gums, but we also can make these ‘bugs’ far less available to create a problem elsewhere in your body.”
It also is essential as a dental practice to open the lines of communication with your patients’ primary care providers. One way to accomplish this is to send a letter to the physician explaining that your dental team is committed to a higher standard of care when treating periodontal disease. This letter can state that you look forward to collaborating with the physician to help manage and treat the hidden sources of chronic inflammation caused by oral pathogens in your shared patients.
If periodontal therapy is only delivered with a local focus, what will become of the already translocated and in-place biofilms and pathogens in hosts who are medically or genetically compromised and incapable of mounting an effective immune response? Does a systemic disease warrant a systemic response? These questions need to be considered when periodontal therapy is warranted.
Looking at periodontal disease as a bacterial infection that travels throughout the body is much different than looking at periodontal disease as a localized bacterial infection of the oral cavity only. Systemic mitigation of pathogens requires a total body wellness approach. Periodontal disease treatment must be considered a part of the preventive armamentarium for chronic disease management in the human body, which is a complex ecosystem.
Ms. Warner is an oral medicine coach and facilitator and a former adjunct professor at Baker College of Cadillac, Mich. She graduated from the Ferris State University School of Dental Hygiene and completed studies with Dawson Academy’s Dental Institute for Systemic Health. Also, she is a member of the American Academy for Oral Systemic Health. Throughout her almost 30-year career as a dental hygienist, Traci observed the connection between oral and systemic health in her patients, proactively partnering with them to better manage their total wellness. Traci’s mission is to raise awareness of oral health as a crucial part of an integrated approach to whole-body wellness. She can be reached at email@example.com.
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