The true power of dentistry is an untold story, and so is the devastation caused by chronic oral disease. In 2017, standing before a panel of industry leaders and dental professionals at Speaking/Consulting Network Conference’s Spotlight on Speaking (SOS) competition, I recounted my brother Tony’s tragic story of oral neglect, disease, and eventual death. I said what I knew to be true: “We are physicians of the oral cavity. When we diagnose and treat oral diseases, we save lives.” From that day on, I knew I had found my voice in dentistry.
While winning the SOS competition was an incredible honor, telling Tony’s story was painful, but it is one I continue to tell. Too often, both patients and doctors underestimate the seriousness of oral-systemic events, despite scientific evidence.1 Even some dentists underestimate the lifesaving power of dentistry; I have made it my mission to educate them.
l Periodontal disease (PD) has been linked to cardiovascular disease, heart attacks, stroke, atrial fibrillation, cancer, Alzheimer’s disease, diabetes, organ damage, rheumatoid arthritis, pregnancy complications, and respiratory infections.
l Compared to healthy individuals, people with PD have a 2- to 5-times higher risk of developing cancer of any kind.
l PD is directly linked to arterial inflammation; up to 50% of heart attacks and strokes are triggered by oral bacteria.
l Patients with PD have an 8.81-times higher chance of death from COVID-19, a 3.54-times higher chance of ending up in the ICU, and a 4.57-times higher chance of ending up on a ventilator.
l Eighty-four percent of thrombi from acute ischemic strokes contain cardiogenic bacteria originating from the oral cavity.
My Worst Nightmare
Like many middle-aged men, Tony did not pay proper attention to his oral health. Two years before his death, he visited me in Maryland and allowed me to examine him. My comprehensive exam revealed severe decay and PD, with mobile, depressible, and missing teeth. The brevity of his visit limited the treatment I was able to provide. I explained that more extensive treatment was needed, but despite my insistence, he never received it. Two years later, Tony landed in the ER with high fevers, chills, and rapid delirium caused by sepsis, a pathogen-induced blood infection. He also developed bacterial endocarditis. Within a week, a gangrenous infection led to a bilateral foot amputation.
After dozens of tests, medical specialists were baffled. One told me, “Dr. Glasper, we cannot figure out where his infection is coming from.” I told them I believed it was coming from his mouth. No one listened. Tony’s doctors shared every detail of his case with me. That ended when they discovered I was a dentist and not an MD. With that, my opinion seemed to become less relevant to them, and my ability to advocate for my brother was severely curtailed. I lost my brother to what I still maintain were complications from an untreated oral infection. He was 55 years old.
NFL Player Dies From Rare Dental Sepsis
A decade later, in late December of 2023, news outlets reported the death of 36-year-old former NFL player Mike Williams. The Hillsborough County Medical Examiner attributed Williams’ death to a “rare dental sepsis…cerebral abscesses…due to multiple dental caries and retained dental roots.”2 Williams’ case marked the county’s first known death due to dental-related sepsis; cardiovascular disease was listed as a contributing factor. Memories of my brother’s death came flooding back. My analysis of the events caused me to wonder: Could Williams’ death have been prevented with proper dental treatment?
As a physician of the oral cavity, I know that oral health and cardiovascular health are connected. Had his doctors understood that might they have treated him differently? And, as a rule, what actions should be taken when cardiac patients are also found to have severe oral health issues?
Could the fact that Williams was put on a ventilator have exacerbated his condition? We know that an overload of oral bacteria can contribute to pulmonary infections like pneumonia. When patients with oral disease are put on ventilators, billions of oral pathogens are circulated throughout the body, making them a primary cause of infection. If physicians treating Williams had noted and understood the significance of his oral condition, might they have taken some measures to protect him from the invasion of oral pathogens? Would they have taken him off the ventilator and pulled the decayed teeth? At that point, what can be done? In emergency situations, oral disease truly becomes a secondary concern for doctors administering life-saving measures; that doesn’t mean there shouldn’t be a diagnostic protocol for treating critical patients who present with severe oral health issues.
Oral-Systemic Links Still Unrecognized
In 2024, medicine still struggles to connect the mouth to the rest of the body, as too many physicians fail to recognize the oral-systemic connection. This doesn’t make sense. How can we overlook the importance of oral health when we know the mouth is the gateway to the body? Generally, physicians aren’t trained to evaluate oral disease. Though many systemic diseases present in the mouth, the last thing on a medical practitioner’s mind when treating critically ill patients is their oral health.
Thought leader and CEO of Total Health Dentistry, Dr. Susan Maples, points out that providers often overlook the links between oral health and overall health: “The mouth often indicates symptoms of acid reflux, sleep and respiratory disorders, type 2 diabetes, HPV-oral cancers, fungal infections, and other health issues. All of these degrade human health, both physiologically and psychologically.”
PD Is a Pervasive Health Threat
Dentists know that the mouth houses high concentrations of harmful bacteria that can severely compromise oral and systemic health. Dental abscesses from caries and PD are common threats detected daily in an average dental practice. Eighty percent of Americans over age 35 have gum disease; nearly half have periodontitis, the most severe form of PD. In those 65 or over, the prevalence rises to 70.1%. In this era of information access, it’s surprising that the average person is unaware that tooth decay can lead to severe complications, including sepsis. Despite being one of the most common chronic illnesses among children and adults, it occurs to the average patient as being inconsequential. Nothing could be further from the truth.
In the United States, PD affects half of all adults by the age of 30. Sepsis is also common, affecting almost 1.7 million individuals annually. We typically think of sepsis infections as relating to gangrenous toes from diabetes, drug-resistant pneumonia, or urinary tract infections. The mouth is rarely considered a primary source of infection in systemic illness. That has to change.
Dentistry Is a Branch of Medicine
Looking at the circumstances of his death, one can deduce that Williams’ poor oral health contributed to the systemic conditions that killed him; cardiovascular disease, cerebral abscesses, and pneumonia are all comorbidities linked to an overload of oral bacteria. The fact that neither patients nor non-dental practitioners understand the potential consequences of oral disease, indicates the need for dentists to redefine our role in health care, and become advocates for our patients’ well-being beyond drill and fill dentistry.
Unfortunately, the majority of the public does not view dentists and doctors in the same light. The view that dentists are not on the same level as other medical professionals has contributed to the woeful underestimation of the importance of oral health and the impact of oral disease. This is especially tragic when we consider that: (1) the 2 most common conditions worldwide are dental decay and gum disease, and (2) our work affects other doctors’ treatment outcomes. The truth is that dentistry is a potential lifesaver. Why, then, isn’t oral disease a bigger conversation, even within the dental community? Isn’t it time that dentists take their rightful place in the medical community as “physicians of the oral cavity?”
What caused Michael Williams’ death is not rare. Oral disease is a dangerous and pervasive public health matter that the dental and medical communities must address together. We must deepen our understanding of the links between oral health and overall health and the essential role we play in the health and lifespans of our patients. Unless we stand by dentistry’s crucial contributions to the medical field, these tragic stories will continue to occur.
The evidence is clear: We can no longer deny that oral health and systemic health are intrinsically linked. If quality patient care is a priority, the conversation surrounding oral health must be front and center across all healthcare professions. We must become champions for our patients’ well-being and establish ourselves as essential members of their healthcare teams. By owning our role as healthcare professionals, dentistry stops being a secondary concern when it should be a primary one.
REFERENCES
- Hudson, M. A Patients Guide to the Oral Systemic Connections. Integrative Dental Coaching; 2022:10-11.
- Afshar, P. Former NFL player Mike Williams died of dental-related sepsis, medical examiner says. CNN. https://www.cnn.com/2023/12/23/us/mike-williams-cause-of-death-sepsis/index.html. Accessed Aug 6, 2024.
ABOUT THE AUTHOR
Dr. Glasper is committed to advancing the perception of oral health. Dr. Glasper is the visionary behind the national oral health campaign, Teach Me Dental, and the CEO of The Comprehensive Dental Continuum. She is a lead legislative member of the Maryland Dental Action Coalition and has been awarded a Fellowship by the International College of Dentists and The International Academy of Dental-Facial Esthetics. She is an advocate for American Academy for Oral Systemic Health educators on the oral-systemic connection and has partnered with the American Heart Association, American Cancer Society, and The National Kidney Association to bring oral health education to the masses.
She can be reached at drglasper@gmail.com.
Disclosure: Dr. Glasper reports no disclosures.
