Dental and oral bacteria have been linked to numerous chronic diseases throughout the body. Recent research indicates that thorough brushing and regular dental visits can also play a role in preventing strokes (1).

According to statistics from the World Stroke Organization (WSO), over 13 million people globally suffer from strokes each year, with one in four individuals experiencing a stroke in their lifetime. Surprisingly, up to 90% of these cases could be prevented through lifestyle changes such as adopting a healthier diet, increasing regular exercise, quitting smoking, and even improving oral hygiene practices (2).

In his recent doctoral dissertation in forensic medicine at the University of Tampere, Medical Licentiate Olli Patrakka examined the significance of oral bacteria, particularly viridans group streptococci, in stroke development. While these bacteria are normal mouth microbes, they can lead to serious illnesses like heart valve inflammation when entering the bloodstream, such as through inflamed gums during teeth brushing. (3).

Olli Patrakka suggests that these bacteria, attaching to tooth surfaces and initiating plaque formation, may similarly contribute to stroke and atherosclerosis development when entering arterial walls via the bloodstream during dental procedures or infections.

Poor oral hygiene is a risk factor for strokes

According to Patrakka, dental bacteria are present in the blood clots of stroke patients in about four out of five cases, with similar results yet to be reported. Blood clots were collected from stroke patients undergoing acute care in Tampere, Finland, for the study, along with samples from patients with symptomatic carotid artery stenosis used as endarterectomy tissues. (3).

Epidemiological studies have identified poor oral hygiene as an independent risk factor for strokes. Patrakka suggests that the inflammatory reaction induced by dental bacteria in atherosclerotic plaques could explicitly explain this connection.

The dissertation's findings are significant as they present new opportunities for stroke patient treatment development, Patrakka says. He also believes that the development of a vaccine may also be now feasible.

Patrakka stresses that while further research is necessary to establish causality, the study supports the importance of oral health, particularly in individuals at risk of srokes. He emphasizes that considering the inflammation caused by streptococcal bacteria in the mouth is crucial in stroke prevention as part of routine dental care. Moreover, investigating the potential benefits of timely antimicrobial treatment or bacterial vaccines in the future is essential.

Periodontitis is the root cause of many ailments

Studies show dental plaque bacteria are responsible for about 95 per cent of oral diseases. One of the most common oral diseases is periodontitis, a severe gum disease caused by dental plaque. Early signs of this disease include red gums, gum bleeding, and bad breath. (4)

In patients with periodontitis, the fibres that attach the tooth to the gum are destroyed, forming a periodontal pocket between the gum and the tooth. This pocket may expand around the entire tooth. If the infection is not treated promptly and oral hygiene is not improved, it can progress to destroy more extensively the supporting tissues of the teeth and, ultimately, the jawbone. (4)

Thorough oral hygiene is crucial for the prevention and treatment of oral infections. According to the Oral Health Foundation one-in-four (26%) British adults regularly brush their teeth only once a day raising concerns about the number of people willing to skip twice-daily brushing. (5)

The charity is especially worried by the number of people who regularly fail to brush their teeth last thing at night, when the health of the mouth is most likely to deteriorate.  Insights from the research show that one-in-four (25%) do not brush their teeth in the evening before they go to bed. (5).

Deficiencies in oral hygiene are directly reflected in the statistics of oral infectious diseases. More than 45% of adults in the UK are currently being affected by gum disease. Meanwhile, 10% are living with the most severe form, which can lead to tooth loss. (6)

Thorough mechanical brushing of teeth and cleaning of the interdental spaces are crucial because even asymptomatic oral inflammations can affect the body's overall health. According to statistics, individuals with healthy mouths even live longer, research shows (7).

– Every missing tooth reduces life expectancy. This is talked about far too little, says Tommi Pätilä, a heart and transplant surgeon at HUS New Children's Hospital in Helsinki, Finland.

Pätilä is also one of the developers of the antibacterial Lumoral method. Lumoral is a medical device designed to improve oral hygiene and oral health. The antibacterial oral care method is especially suitable for patients with difficult-to-treat gum diseases such as periodontitis who do not get adequate results from traditional oral hygiene methods such as brushing teeth and cleaning interdental spaces. (8, 9, 10).

The effectiveness of the novel oral health enhancing device relies on antimicrobial photodynamic therapy (aPDT), also referred to as photoantimicrobial chemotherapy. While this technology is already prevalent in dental clinics, the advent of a home-use device allows for more frequent application of this antibacterial treatment. (11)

aPDT technology itself utilizes light energy and a photosensitizer to generate an antimicrobial effect that eliminates problem-causing plaque bacteria from the mouth. Due to its targeted approach aPDT does not lead to bacterial resistance. (11)

The importance of interdisciplinary collaboration

According to Pätilä, the recent medical dissertation at the University of Tampere holds significance as it integrates oral health into overall body health. Enhancing collaboration between doctors and dentists is crucial and needs improvement across various European countries. While many medical doctors already evaluate their patients' oral health at clinics and refer them for additional treatment when needed, closer collaboration is essential.

Diabetes serves as a prime example of a disease where the importance of underlying inflammations is widely acknowledged. However, heightened collaboration is necessary to accelerate diagnoses and even prevent several common diseases.

Olli Patrakka's interest in oral bacteria stemmed from his responsibilities as a pathologist. Has the interest of young doctors in the impact of dental infections on general health increased?

– It hasn't increased significantly, but it should. In my basic medical training about five years ago, there was minimal discussion of the impact of dental infections on overall health. While the topic is relatively new, it's crucial that awareness and scientific evidence grow over time.

Patrakka underscores the importance of general practitioners recognizing when a dental issue necessitates a referral to a dentist. This could streamline the treatment of oral infections and potentially aid in achieving a balance in treating various general diseases.

– My research contributes to the growing evidence that oral health significantly influences overall health. The blood vessels of the tooth pulp directly connect to the systemic circulation. Therefore, if teeth are in poor condition, bacteria and their byproducts can circulate directly into our bodies.

References:

1. Shahi S, Farhoudi M, Dizaj SM, Sharifi S, Sadigh-Eteghad S, Goh KW, Ming LC, Dhaliwal JS, Salatin S. The Link between Stroke Risk and Orodental Status-A Comprehensive Review. J Clin Med. 2022 Oct 2;11(19):5854. doi: 10.3390/jcm11195854. PMID: 36233721; PMCID: PMC9572898.
2. Sen S, Giamberardino LD, Moss K, Morelli T, Rosamond WD, Gottesman RF, Beck J, Offenbacher S. Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke. Stroke. 2018 Feb;49(2):355-362. doi: 10.1161/STROKEAHA.117.018990. Epub 2018 Jan 15. PMID: 29335336; PMCID: PMC5780242.
3. https://trepo.tuni.fi/bitstream/handle/10024/154588/978-952-03-3315-7.pdf?sequence=2&isAllowed=y
4. Saini R, Saini S, Sharma S. Biofilm: A dental microbial infection. J Nat Sci Biol Med. 2011 Jan;2(1):71-5. doi: 10.4103/0976-9668.82317. PMID: 22470238; PMCID: PMC3312703.
5. Mehrotra N, Singh S. Periodontitis. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541126/
6. Oral health: What is gum disease? | British Dental Journal, Published 10 March 2017, Issue Date10 March 2017, DOI: https://doi.org/10.1038/sj.bdj.2017.196
7. Friedman PK, Lamster IB. Tooth loss as a predictor of shortened longevity: exploring the hypothesis. Periodontol 2000. 2016 Oct;72(1):142-52. doi: 10.1111/prd.12128. PMID: 27501497.
8. Pakarinen S, Saarela RKT, Välimaa H, Heikkinen AM, Kankuri E, Noponen M, Alapulli H, Tervahartiala T, Räisänen IT, Sorsa T, et al. Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)—Three-Month Interim Results. Dentistry Journal. 2022; 10(11):206. https://doi.org/10.3390/dj10110206
9. Nikinmaa S, Alapulli H, Auvinen P, Vaara M, Rantala J, et al. (2020) Dual-light photodynamic therapy administered daily provides a sustained antibacterial effect on biofilm and prevents Streptococcus mutans adaptation. PLOS ONE 15(5): e0232775. https://doi.org/10.1371/journal.pone.0232775
10. Nikinmaa S, Moilanen N, Sorsa T, Rantala J, Alapulli H, Kotiranta A, Auvinen P, Kankuri E, Meurman JH, Pätilä T. Indocyanine Green-Assisted and LED-Light-Activated Antibacterial Photodynamic Therapy Reduces Dental Plaque. Dentistry Journal. 2021; 9(5):52. https://doi.org/10.3390/dj9050052
11. Jao Y, Ding SJ, Chen CC. Antimicrobial photodynamic therapy for the treatment of oral infections: A systematic review. J Dent Sci. 2023 Oct;18(4):1453-1466. doi: 10.1016/j.jds.2023.07.002. Epub 2023 Jul 11. PMID: 37799910; PMCID: PMC10548011.

Periodontitis and diabetes are two prevalent diseases with a strong bidirectional relationship between them. Poorly managed diabetes promotes the progression of periodontitis and complicates its treatment. Conversely, active periodontitis adversely affects diabetes management and treatment.

In honor of World Health Day, Tommi Pätilä, a heart and transplant surgeon at HUS New Children's Hospital, in Finland, and Timo Sorsa, a professor of oral and maxillofacial diseases at the University of Helsinki, reflect on the connection between these two prevalent diseases from the perspective of oral health.

Diabetes and gum inflammation are two significant global health issues that require immediate attention. About half of the world's population suffers from gum inflammation, while nearly half a billion people have diabetes.

In Finland alone, there are approximately 500,000 diabetics, with about 50,000 suffering from type 1 diabetes and around 400,000 from type 2 diabetes. Additionally, it is estimated that there are up to 100,000 undiagnosed type 2 diabetics in Finland.

Understanding the Close Connection

Periodontitis is a disease of the tooth-supporting tissues that progresses from gum inflammation and can ultimately lead to tooth loss. Symptoms of the disease include red, swollen, and bleeding gums, gum recession, formation of gum pockets, loosening of teeth, bad breath, and possible swallowing and chewing problems.

Periodontitis is associated with many risk factors, such as smoking, genetic factors, and systemic diseases like diabetes.

The symptoms of the disease can vary from mild to severe and often require evaluation and treatment by a dentist or dental hygienist. Early detection and treatment are crucial for managing periodontitis.

Diabetic patients have an increased risk of developing periodontitis, and conversely, periodontitis has a negative impact on diabetes treatment and management. High blood sugar levels increase inflammation in the mouth and hinder the healing of periodontitis. The combined effect of these two diseases is also reflected in systemic inflammatory markers and blood sugar levels.

Traditional diagnostic methods are not always sufficient to identify the risk of periodontitis and diabetes. Therefore, new biomarker-based rapid tests have been developed to help identify the risk of these diseases at an early stage.

Oral Health Status Revealed in Minutes

The aMMP-8 rapid test developed in Finland is based on measuring the concentration of active matrix metalloproteinase 8 (aMMP-8) in mouthwash. Studies have shown that elevated levels of aMMP-8 may indicate both periodontitis and diabetes.

The aMMP-8 rapid test can be performed at the dentist's office, and the results are obtained immediately. This allows for early intervention in the development of periodontitis and assessment of the risk of diabetes. Additionally, the test provides patients with important information about their oral health and the risk of diabetes, which encourages better self-care and adherence to healthy lifestyles.

"The test allows for the detection of signs of periodontitis even before symptoms occur, which provides an opportunity for early treatment and prevention of complications," says Professor Timo Sorsa of the University of Helsinki's Department of Oral and Maxillofacial Diseases.

The test has proven to be useful in screening patients with type I, type II, and gestational diabetes.

Oral Health: A Crucial Factor for Diabetics

Diabetic patients with periodontitis require special attention, reminds pediatric heart and transplant surgeon Tommi Pätilä. Pätilä is also one of the developers of the Lumoral innovation, which enhances mechanical oral hygiene.

"It is especially important for diabetics to invest in regular oral hygiene and dental visits. This not only improves patients' quality of life but also reduces the risk of long-term complications," says Pätilä.

According to Pätilä, adjunctive therapies can be combined with at-home oral hygiene management, such as low-dose doxycycline acting as an aMMP-8 inhibitor and light-activated mouthwashes with anti-inflammatory effects.

"Antibacterial Lumoral treatment effectively removes harmful plaque bacteria from tooth surfaces and gum lines. Home-administered Lumoral treatment has been shown to be significantly more effective and better tolerated than chlorhexidine-based mouthwashes commonly used today," Pätilä explains.

Pätilä emphasizes that antibacterial treatment complements mechanical tooth cleaning and does not replace the need for brushing and cleaning between teeth. Why is additional treatment needed to enhance mechanical oral cleaning?

"Research shows that brushing only removes 65% of plaque. Residual plaque remains in the mouth even after the most effective brushing. Lumoral helps remove this residual plaque. Regular Lumoral treatment ensures that tooth surfaces are thoroughly clean. Diabetics, in particular, benefit from this removal of residual plaque," says Pätilä.

According to studies, regular adjunctive antibacterial treatment alongside traditional non-surgical standard treatment reduces inflammation in gum tissues and improves oral hygiene and healing of deep pockets in chronic periodontitis compared to conventional treatment.

Antibacterial treatment has also been shown to prevent and improve inflammation of peri-implant tissues. The treatment is suitable for everyone, but light-activated antibacterial treatment is seen as most effective for patients who require enhanced oral hygiene.

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World Health Day, launched by the World Health Organization (WHO), is celebrated globally on April 7th to increase awareness of health issues. This year, the timely theme "My health, my right" emphasizes the importance of health equity.

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References:

Trujillo K, Räisänen IT, Sorsa T, Pätilä T. Repeated daily use of dual-light antibacterial photodynamic therapy in periodontal disease—a case report. Dent J (Basel). 2022;10(9):163. doi:10.3390/dj10090163

Pakarinen S, Saarela RKT, Välimaa H, et al. Home-applied dual-light photodynamic therapy in the treatment of stable chronic periodontitis (HOPE-CP)—three-month interim results. Dent J (Basel). 2022;10(11):206. doi:10.3390/dj10110206

Gholami L, Shahabi S, Jazaeri M, Hadilou M, Fekrazad R. Clinical applications of antimicrobial photodynamic therapy in dentistry. Front Microbiol. 2023;13:1020995. doi:10.3389/fmicb.2022.1020995

Lähteenmäki H, Pätilä T, Räisänen I, Kankuri E, Tervahartiala T, Sorsa T. Repeated Home-Applied Dual-Light Antibacterial Photodynamic Therapy Can Reduce Plaque Burden, Inflammation, and aMMP-8 in Peri-Implant Disease – A Pilot Study. Curr Issues Mol Biol 2022; 44: 1273–1283. doi: 10.3390/cimb44030085

Clean teeth – for real. Through dual light therapy, the new Lumoral treatment removes 99.99 percent of harmful bacteria in your mouth – something that neither a toothbrush or flossing can do.

Plaque causes 95% of all oral diseases – and can ultimately also increase the risk of more serious diseases such as heart attack and diabetes. But simply brushing your teeth is not enough to remove the harmful bacteria.

– Mechanical brushing is a very important step that removes about 65% of the plaque, so we absolutely shouldn’t stop doing it. But to really get rid of all the harmful bacteria, a complement is needed, says Ing-Marie Albinsson, a dental hygienist at the clinic Lilla Tandkronan in Arvika, Sweden.

The Finnish innovation Lumoral does just that. Through dual light therapy, harmful bacteria are eliminated from the teeth surfaces and around the gums.

– Lumoral is truly a revolutionary technology that is also very easy to use. You first rinse your mouth with the green Lumorinse mouthwash and then use the Lumoral mouthpiece for 10 minutes, says Ing-Marie Albinsson.

Lumoral uses a patented light in two different wavelengths, which in combination with the Lumorinse mouthwash removes 99.9 percent of the harmful bacteria we have in our mouths. The method is very carefully tested and used in a number of medical treatments, so it is completely safe to use.

– My patients who have used Lumoral are very satisfied. Those who have had problems with even quite severe tartar describe it as if it feels like the tartar is running off the teeth, and even those with severe gingivitis have had very good results, says Ing-Marie Albinsson.

Bacteria spread through the gums

Lumoral is a Finnish innovation and was actually invented not by a dentist but by a heart surgeon.

– I have operated on many patients where we have seen that oral bacteria have caused heart problems. But about 10 years ago, I operated on a child who had a serious heart infection precisely because of oral bacteria, and I felt that enough was enough. I don't want to see another patient having to go through this because of poor oral health, says Tommi Pätilä, founder of Koite Health, which developed Lumoral.

Pätilä put together a research team, and seven years ago, Lumoral was launched and is now available in several European markets and soon in Asia.

– The tricky thing about oral infections is that they have no symptoms. If dental plaque is not removed thoroughly, it can pass through the gums into the bloodstream, says Tommi Pätilä.

So how can you prevent this from happening?

– Brushing your teeth thoroughly and using dental floss or interdental brushes is the first step. You also need to visit your dentist or dental hygienist regularly. And then use Lumoral. The treatment is preventive for everyone but is particularly important for those who have already had problems with tooth loss or gum inflammation, says Pätilä.