Introduction:
The tooth is one of the vital organs, that is supported and held in its position in the jaw by the supporting tissues of the gums or gingiva, periodontal ligament or the supporting periodontal tissues, and the underlying alveolar bone. It would be astonishing to know that the oral cavity is home to almost more than 700 species of micro-organisms along with their varied prototypes, that can pave the way for opportunistic dental or oral infections, in the absence of proper oral hygiene and professional dental care. The complications are much higher systemically in certain high-risk groups.
What Happens if There Is Poor Oral Management?
While improper oral hygiene is one of the major risk factors for developing dental caries and periodontal disease, even other anaerobic-initiated bacterial, viral, or fungal infections of the oral cavity can occur. The oral tissues get infected when the oral immune defense gets breached.
Be it dental caries, periodontal diseases, salivary gland issues, oral lesions, oral pre-cancers, benign or even malignant tumors of the oral cavity, a lack of dental awareness can aggravate pre-existing issues, which necessitates the need for not just proper oral hygiene, but also demands professional dental care, which is the basis of primary disease prevention by diagnosis and is a part of the dental or oral management strategies.
Also, when oral infections are commonly left untreated or if professional dental care is absent, the situation can progress to even facial space infections or localized infections of the jaw tissues, of the neck, of the paranasal sinuses of the face, and so on. Loss of the alveolar bone of the jaw, the spread of infection from a dental source into the facial or perioral spaces, issues with lymphatic drainage, or loss of dentition leading to a debilitating oral quality of life are some of the common dental issues faced by a majority of individuals across the globe.
For instance, a classic example is dental caries which begins with demineralization of the enamel, with oral hygiene measures complemented with professional dental restorations and re-mineralization strategies that can repair tooth damage. Similarly, severely cavitated dental carious lesions need endodontic treatment (a dental procedure in which the infections in the center of the tooth are treated). If this is not done, then the pulp infections would spread to the periapical region (the tissues that surround the tooth’s root tip), with severe subsequent uncontrolled infections resulting in cellulitis (a common and serious bacterial skin infection) or Ludwig’s angina (a rare type of cellulitis that results in an infection under the tongue and the neck).
Gingival and periodontal infections on the other hand, when left untreated, in the absence of professional dental care by a dental operator or surgeon can cause limitations in mouth opening and can result in the progression of systemic complications like cavernous sinus infection, bacterial endocarditis (serious infection of the inner lining of the heart or heart valves), severe septicemia (a life-threatening situation that manifests when bacteria, viruses, or fungi enter the bloodstream and spread all over the body), toxemia (blood poisoning due to toxins from a local bacterial infection), pyemia (blood poisoning due to the spread of pus-forming bacteria released from an abscess), and so on.
What Are the Three Specific Research-Highlighted High-Risk Groups for Dental Systemic Complications?
The following are the three major high-risk population groups in whom a lack of professional dental care, as well as poor oral hygiene, can cause the above-enlisted local and systemic complications:
1. Pregnant Women - This population group is at the utmost risk of developing systemic complications if dental infections are not treated within a short period. This is because, in this dynamic phase of pregnancy, pregnant women are prone to hormonal or endocrine fluctuations. Also, the oral immune defense in pregnant women is significantly less pronounced because of the easy predisposition to invasion by periodontal pathogens or gingival inflammation.
Similarly, in the absence of proper oral hygiene methods, such as mechanical or chemical plaque control suggested by the dental surgeon or if there is improper professional dental care (like dental oral prophylaxis or scaling) which is usually recommended in the second trimester, pregnant women can become easy victims of dental or periodontal issues. Though in the first and third trimesters, dental procedures are usually avoided, researchers suggest the second trimester is safe for treating dental infections and minimizing the risk of maternal oral microbial infections.
Administration of drugs or medicines that may have teratogenic effects (anything that can cause developmental malformations in the fetus or embryo) during pregnancy should be avoided. Also, it is wise to avoid dental radiography during pregnancy to shield the patient from low-risk dental radiation.
2. Patients Who Have Undergone Radiotherapy of Oro-Facial Regions/Post-operative Radiotherapy - Radiotherapy is commonly advocated by many oncologists post-cancer surgery, especially for managing orofacial tumors, which puts these patients in the high-risk groups for systemic complications. Radiotherapy results in typical effects of reduced salivary flow resulting in dry mouth or xerostomia. It may also make the bone highly ischemic (reduced blood flow) or hypoxic (too little oxygen), predisposing the individuals who have undergone this therapy to dental and periodontal infections, resulting in a condition called osteoradionecrosis of the jaw (a condition in which the bone has died as a result of radiation exposure). Therefore, timely management of these patients, with professional follow-ups with the dentist regularly along with good oral hygiene maintenance is hence, a mandatory protocol.
3. Immunologically Compromised Patients - Commonly, the geriatric or elderly individuals above the age group of 60, who may have an age-related physiologic impact on their immunity and in general, a lowered immune defense orally fall under this category. In these groups, the immuno-compromised patients are specifically those with systemic conditions like type 2 diabetes (a long-term condition that affects how the body uses glucose or blood sugar) for energy, individuals suffering from hormonal imbalance, thrombocytopenias (an abnormally low count of platelets), viral or fungal infections, leukemias (a kind of blood cancer), and cancers.
Patients who have undergone cardiovascular surgeries or other systemic surgical procedures may also have altered immune defense and significantly lowered oral immune defense. Hence, in immunocompromised communities or population groups, as local infections can rapidly progress to systemic spread, there is a mandatory need for oral vigilance. These individuals must follow good oral hygiene methods at home and go for routine professional dental visits.
Conclusion:
Proper oral hygiene and professional dental care are extremely crucial in the above-mentioned high-risk population groups since there is a risk of rapid local complications progressing to systemic complications in these individuals. A general awareness of dental hygiene and professional dental care can go a long way in reducing the global burden of oral diseases in healthcare. The use of fluoridated toothpaste, mechanical and chemical plaque control agents such as flossing, use of mouthwashes, use of sugar-free gums to stimulate saliva in xerostomia patients, following a balanced and nutrient-dense fiber-rich diet, and having regular periodic professional follow-ups with the dentist are mandatory protocols for ensuring improved individual oral health in the high-risk groups.
