So Why Do We Call It the Oral-Systemic Health Connection?

There has been of late an endless stream of articles and opinion pieces trumpeting the associations between oral and systemic health. Yet despite ever-increasing clinical and scientific evidence pointing to interrelationships between oral diseases and other conditions such as periodontitis and diabetes¹ or cardiovascular disease,² it has been difficult for dentistry to convince other professions and the public of the importance of such associations.

Should oral health and systemic health actually be considered two different entities? If we look at how the profession has publicized this emerging field of study, it would certainly seem so. In fact, by continuing to write and talk about the associations between oral and systemic health, dentistry is reinforcing the perception that—despite our protestations to the contrary—there is a difference between your ‘oral’ and your ‘systemic’ health. If this perception is allowed to persist, it will never be possible to discuss the oral health–systemic health connection in a convincing manner, as this choice of words unintentionally separates the mouth from the rest of the body.

Aren’t We Really Talking about Oral Health and Overall Health?

We propose that the associations between oral diseases and other diseases elsewhere in the body be discussed within the context of oral and overall health, much in the same way a physician would. For instance, a medical doctor would refer to a patient’s diabetes (a disease of the pancreas) as an endocrine disease that has a negative impact on overall health, including various organ and physiological systems. You are unlikely to hear a physician refer to a patient’s pancreatic and systemic health!

Even if we began using the words ‘oral’ and ‘non-oral’ health, this would serve our purposes better than referring to oral and systemic health—as if oral health and systemic health were not one and the same, or at the very least two sides of the same coin.

When discussing oral diseases, such as periodontitis and caries, we must remember that all we are doing is referring to a particular inflammatory or infectious disease that happens to be located in the mouth as a consequence of certain anatomically unique features found there. But many people incorrectly assume that such diseases would not be expected to have effects elsewhere in the body.

Considering all of these issues, we propose that when referring to oral diseases and their impact on other diseases and systems in the body, dentists refrain from using terminology that reinforces separateness between oral health and systemic health. Instead, research and treatment in this area should be framed by terminology which does not imply that diseases in the mouth are somehow separate conditions that (surprise, surprise!) have effects on other conditions in the body.

It would be far more productive and convincing if we began referring to oral health and overall health. After all, if a person has an oral disease, the person is simply not healthy. Conversely, if a person has a healthy mouth and does not have disease in other parts of the body, that person is healthy. Period.

THE AUTHORS

	Dr. Noguera-Filho is associate professor and director, graduate periodontics program, department of dental diagnostics and surgical sciences, faculty of dentistry, University of Manitoba, Winnipeg, Manitoba.
	Dr. Tenenbaum is professor, discipline of periodontology, faculty of dentistry, University of Toronto, Toronto, Ontario; adjunct professor, faculty of dentistry, University of Manitoba, Winnipeg, Manitoba.

Acknowledgements: The authors would like to thank Dr. Ray Williams, dean of the State University of New York at Stony Brook school of dental medicine, for his valuable assistance in discussions pertaining to the oral health and overall health continuum.

Correspondence to: Dr. Howard Tenenbaum, Faculty of dentistry, University of Toronto, 124 Edward St., Room 349C, Toronto, ON  M5G 1G6.

The views expressed are those of the authors and do not necessarily reflect the opinions or official policies of the Canadian Dental Association.