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.

In the field of dental care, changes are constant as fresh ideas shape the industry. A recent collaboration agreement between Finland’s Koite Health Ltd and Trading Co., Ltd. from Thailand is set to revolutionize dental care standards by introducing innovative light-activated technology to the country.

Founded in 2017, Innodent has been at the forefront of delivering cutting-edge dental solutions to Thailand's healthcare sector. Driven by a commitment to leverage the latest advancements in high-tech solutions, the company aims to provide the most innovative technologies to the dental industry. This strategic vision led to a partnership with Koite Health, and the introduction of Lumoral, a Finnish med-tech innovation, to the dental market in Thailand.

– The introduction of Lumoral to Innodent's product portfolio was the result of a personal recommendation from Dr. Hildebrand, a renowned maxillofacial surgeon from Berlin. Dr. Hildebrand's successful clinical experiences with Lumoral convinced the team at Innodent to explore this revolutionary technology further, explains Thomas Constantin, CEO and owner of Innodent Trading Co., Ltd.

Lumoral: an innovative personal healthcare device

So, what exactly is Lumoral, and how does it work? Mr. Constantin reminds that the close link between oral bacteria and overall health and well-being is an important factor that sparked interest in the Finnish oral health-enhancing innovation in the first place.

– Oral bacteria can cause dental caries and bad breath but there can also be more severe secondary effects such as cardiovascular diseases, dementia, psoriasis and many more. Overall health starts with a healthy mouth. It is therefore important to regularly clean the mouth thoroughly.

Lumoral is an innovative personal healthcare device designed to remove 99.9% of harmful oral bacteria while preserving the healthy mouth flora. Traditional oral hygiene methods can only remove approximately 60% of bacteria, leaving behind a significant risk of oral health issues, Thomas explains.

Lumoral's advanced technology utilizes color molecules in its Lumorinse mouth rinse, which adhere to harmful oral bacteria attached to teeth surfaces and gum tissue in the mouth. Subsequently, the light emitted by the mouthpiece reacts with the green sensitizer, effectively breaking down the cell membrane of bacteria and destroying them both from inside and outside. This method ensures the eradication of harmful bacteria without the risk of resistance development.

Long-term benefits for implant patients

The addition of Lumoral to Innodent's product portfolio aligns with the company’s focus on dental implantology, with a specialization in ceramic implants. While the industry predominantly utilizes titanium implants, scientific evidence suggests a significant risk of peri-implantitis, an inflammation of the tissues surrounding these metal implants, over time.

– Lumoral presents a solution to mitigate this risk, offering long-term benefits for implant patients, Constantin says.

Furthermore, Lumoral's versatility extends beyond implant care, offering benefits for individuals with various oral health concerns, including chronic bad breath, gum disease, and orthodontic patients wearing braces or clear aligners.

– This accessibility makes Lumoral an invaluable addition to Innodent's offerings, catering to a diverse range of dental needs in Thailand.

– The great advantage of Lumoral however, is that everyone benefits from removing harmful oral bacteria. Whether you are wearing braces or clear aligners, suffer from chronic bad breath, gum disease or simply want to have a perfectly clean and healthy mouth, Lumoral is your solution.

Promising prospects for both companies

The collaboration between Koite Health and Innodent holds promising prospects for both companies and dental patients in Thailand. Mr. Constantin says that for Innodent, this partnership marks a significant expansion into the business-to-consumer (B2C) market, enabling the company to reach individual consumers through online channels like their dedicated webshop.

– This shift opens new avenues for marketing and sales, enhancing accessibility to innovative dental solutions for patients across the country. Ultimately, the collaboration aims to raise awareness about oral health and its crucial role in overall well-being among the Thai population.

– By introducing Lumoral's advanced technology to the market, Koite Health and Innodent are paving the way for a new era of dental care in Thailand, one that prioritizes prevention, innovation, and improved patient outcomes.

Duodecim, Finland's leading medical association, has published the book "The Healing Power of Medicine" (Lääketieteen Parantava Voima), which presents Finnish advancements in healthcare for disease prevention, easier diagnosis, and more effective treatment. The book also introduces Lumoral treatment, an antibacterial oral hygiene method recognized as one of Finland's significant breakthroughs in dentistry.

Edited by Emerita Professor Anne Pitkäranta, Professor Kaija-Leena Kolho, and Emeritus Professor Kimmo Kontula, the book emphasizes the importance of scientific research in society and its impact on healthcare outcomes. 

The book highlights the antibacterial Lumoral method, now available in 16 European countries. In the article "Light for Teeth" (Valoa hampaille), one of the developers of Lumoral, a specialist in heart and organ transplant surgery, Dr. Tommi Pätilä, discusses the method's origin and its potential to revolutionize oral health on both individual and societal levels.

"Dental and periodontal diseases are among the most common chronic infectious diseases worldwide. Chronic inflammation of the supporting tissues of the teeth, periodontitis, is considered a public health problem due to its prevalence as the sixth most common disease globally," Dr. Pätilä points out.

Lumoral is an antibacterial and light-activated oral hygiene method used as part of a regular oral hygiene routine, alongside brushing and interdental cleaning. Research shows that Lumoral treatment slows plaque formation and significantly reduces the number of bacteria in the mouth, which contribute to gum inflammation.

According to Dr. Pätilä, incorporating light-activated and antibacterial treatment into daily oral hygiene routines enhances the effectiveness of tooth cleaning, especially when traditional oral hygiene methods fall short.

"Lumoral treatment is suitable for everyone but is particularly beneficial for individuals with oral health issues. The method also freshens breath. Its antimicrobial effect targets harmful bacteria in the mouth while preserving the normal bacterial flora that maintains oral health," Dr. Pätilä explains.

Rapid Diagnosis - Effective Disease Management

Dr. Tommi Pätilä also contributes to another article in the book, "Finnish Oral Medicine Innovations Enable Rapid Diagnosis and Plaque Control for Gum Disease" (Suomalaiset suulääketieteelliset innovaatiot mahdollistavat iensairauden pikadiagnostiikan ja plakkikontrollin). The article discusses significant Finnish advancements, particularly in diagnosing and treating severe gum diseases. The article also emphasizes the connection between periodontitis and various systemic diseases. Therefore, early detection and treatment of the disease are crucial.

To expedite the diagnosis of periodontitis, researchers from the University of Helsinki and Helsinki University Hospital have developed chairside testing based on active matrix metalloproteinase-8 (aMMP-8) markers. The test complements the diagnosis of periodontitis and peri-implantitis and monitors treatment response and maintenance. It can be performed by a healthcare professional or independently by the patient at home, similar to COVID-19 antigen or traditional pregnancy tests.

Dr. Pätilä highlights that untreated periodontitis or peri-implantitis sustains and intensifies the body's low-grade systemic inflammation and is associated with several systemic diseases. Therefore, early diagnosis of gum diseases is essential. Rapid diagnosis also allows for the prompt initiation of effective treatment, halting or preventing disease progression. With the Lumoral method, patients can enhance their self-care at home.

"Low-grade inflammation is a condition where the body reacts to irritation by secreting mediators. Although the body's 'muted' inflammation is not a disease in itself, prolonged inflammation becomes harmful to health, especially in the aforementioned systemic diseases," Dr. Pätilä says.

Poor oral health incurs additional diseases for both individuals and society, emphasizes Professor Timo Sorsa, professor of oral and maxillofacial diseases at the University of Helsinki and developer of the aMMP-8 rapid test.

"Finnish dental and periodontal diagnostic and therapeutic inventions may significantly impact the detection, treatment, and prevention of the world's sixth most common disease, periodontitis/peri-implantitis. They also enable plaque and gum disease control," states an article in book.

***

"The Healing Power of Medicine - 100 Stories from Cells to Applications," edited by Emerita Professor Anne Pitkäranta, Professor Kaija-Leena Kolho, and Emeritus Professor Kimmo Kontula, 1st edition 2024, 365 pages, paperback

"The Healing Power of Medicine," edited by Emerita Professor Anne Pitkäranta (right), Professor Kaija-Leena Kolho, and Emeritus Professor Kimmo Kontula, is a testament to the importance of research in society. Vilja Harala (Duodecim)