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Poor Oral Health and Oral Dysbiosis: A Link to Systemic Diseases and Cancer

Poor Oral Health and Oral Dysbiosis: A Link to Systemic Diseases and Cancer

Scientists have discovered a significant link between poor oral health and systemic diseases, including specific cancers. This connection is centered around so-called oral dysbiosis, a condition where imbalanced oral bacteria can lead to a range of health issues. It also emphasizes the crucial role of oral hygiene in promoting overall health.

The oral cavity houses more than 700 types of bacteria. While some bacterial species are beneficial for dental and overall health, in some cases, they can play a role in the development of serious systemic illnesses.

Studies show that maintaining a balanced microbial ecosystem in the mouth is crucial for oral health and it has a significant impact on how the body responds to various diseases. Dysbiosis, or an imbalanced oral microbiome, or ecosystem, can lead to various health issues ranging from common dental problems like cavities and gum disease to severe conditions such as heart disease, Alzheimer’s disease, and diabetes. [1, 2]

Recent studies have revealed that oral dysbiosis may even be involved in the development of life-threatening digestive cancers. Digestive cancers include cancers located in the esophagus, stomach, liver, pancreas, colon, and rectum. Their incidence and related mortality are increasing worldwide, with the majority of new cases of digestive cancers (63%) and related deaths (65%) occurring in Asia, followed by Europe and North America. [3].  

Scientists believe that many digestive cancer forms are influenced by various environmental factors that can be potentially changed. These include tobacco smoking, diet, alcohol consumption, and obesity. Some recent evidence also suggests a role of the human oral microbiota in the development of digestive cancers. Fusobacterium nucleatum is one bacteria species found commonly in the mouth, which is a key member of colorectal cancer-associated bacteria. However, many other oral pathogens can play a role in the development of cancer as well. [4,5]

Exposing the oral bacteria-pancreatic cancer link

One study published in the British Journal of Cancer (BJC) reported that Trepenoma denticola (Td), the bacteria responsible for periodontitis, may cause pancreatic cancer [6,7]. Pancreatic cancer is one of the deadliest forms of cancer caused by the abnormal and uncontrolled growth of cells in the pancreas – a large gland that is part of the digestive system. Around half of all new cases are diagnosed in people aged 75 or over. [8]

–  The Treponema bacterium can enter the bloodstream through inflamed gums and spread to other parts of the body. If left untreated and undiagnosed, periodontal disease contributes to the development and spread of cancer and cancer deaths – not only from oral cancer, but especially pancreatic cancer, explains Timo Sorsa, Professor of Oral and Maxillofacial Diseases at the University of Helsinki, findings of the study.

Professor Sorsa points out that Treponema bacterium shares a specific enzyme with some cancer types in the gut. This enzyme is called Treponema denticola chymotrypsin-like proteinase – or dentilisin – and it is usually found in the mouth, where it is known to contribute to severe gum disease (periodontitis). However, this same enzyme has also been observed in malignant and life-threatening tumors. [6,7].

In the oral cavity, dentilisin not only contributes to gum disease but also triggers other enzymes that promote cancer. These enzymes are called matrix metalloproteinases (MMPs), and they break down the material between cells and cell membranes, making it easier for cancer to invade healthy tissue. This connection raises concerns about potential health issues related to dentilisin in the oral cavity, Prof. Sorsa stresses.

The BJC study from 2017 was the first to show that virulence factors from gum disease bacteria could spread from the mouth to other parts of the body and take part in central mechanisms of cancer-related tissue destruction.

Since then, supplementary research has supported the study’s findings.  One report released in the International Journal of Cancer – also by Prof. Sorsa’s team – examined registry data for over 10 years on over 68,000 adults in Finland who had made a primary dental healthcare visit. This revealed that periodontitis was associated with a 33% increased risk for overall cancer mortality. The mortality risk associated with gum disease among individuals with pancreatic cancer was far higher, with a more than twofold increased risk, the study shows [7].

From fast diagnosis to a quick onset of treatment 

The links revealed so far between oral bacteria and cancer developments have inspired Prof. Sorsa’s team to search ways to help prevent cancerous developments. One potential solution is to detect gum infections in their initial stages through early diagnosis. By quickly identifying gum disease with a chair-side aMMP-8 rapid test, researchers believe that we might be able to prevent certain cancers because it allows for faster treatment of the underlying issue: gum inflammation. The test makes invisible visible, points out Prof. Sorsa. [9,10]

– Out of all MMP enzymes, especially active MMP-8 enzyme has been found to be elevated in patients suffering from gum disease leading to periodontal connective tissue destruction, Prof. Sorsa explains his team’s findings.

Periodontitis, or severe gingivitis, is a common disease that is estimated to affect as many as half of the global population – often without any symptoms at all. Early detection of these diseases is important because it allows for intervention and treatment before irreversible damage occurs. Traditional methods like check-ups and X-rays might, however, miss early signs of these diseases since they often show symptoms in later stages. Using biomarkers like aMMP-8, clinicians can spot subtle inflammation and tissue damage, allowing them to start treatment before the disease becomes visible.

–The aMMP-8 rapid test can measure and assess active periodontal adhesive tissue loss and the risk of its progression within five minutes in the dental chair non-invasively. The test complements the diagnosis, follow-up, and maintenance treatment of periodontitis and peri-implantitis, explains Prof. Sorsa. 

Advanced approaches for treating oral diseases

Periodontal and peri-implant diseases are conditions that affect the supporting structures of teeth and dental implants and can lead to tooth loss if left untreated. Gum infections can develop for various reasons. One key factor is the buildup of bacterial plaque, also known as biofilm, on the surfaces of teeth due to inadequate oral hygiene. [9]  

When discussing new treatment options and prevention of periodontitis, Prof. Sorsa emphasizes modern antibacterial methods for better oral hygiene and efficient plaque removal in periodontitis treatment and prevention. Also, research reveals that antibacterial photodynamic therapy (aPDT) is a promising approach to treat bacterial infections – even ones that do not respond well to antibiotics [12].

Lumoral treatment is the first aPDT treatment device designed for home use. It has been developed by Finnish scientists as a drug-free alternative for treating and preventing severe gum disease.

– Poor oral health is linked to over 200 chronic diseases. Lumoral is a product that enhances oral hygiene when used regularly at home, and research suggests that it can also enhance the effectiveness of professional dental care. What's more, it may reduce the need for conventional medications like antibiotics and chlorhexidine in the treatment of gum disease, according to Tommi Pätilä, a cardiac and organ transplant surgeon at the New Children's Hospital in Helsinki.

– Based on a light-activated antibacterial effect, Lumoral slows down plaque formation and significantly reduces the burden of harmful bacteria in the mouth, Pätilä explains further.

The product is suitable for patients of all ages, but it is particularly recommended for those with a history of problems with common oral diseases, tooth decay, and gum disease [9].

The crucial role of oral hygiene in cancer care

Brushing and flossing on a regular basis is key to maintaining a healthy mouth by removing dental plaque from the surfaces of teeth and interdental spaces. However, it is not always enough. Good oral hygiene requires adequate motor and mental skills. On the other hand, even when brushing teeth perfectly, studies show that even the most effective electric toothbrush only removes about 65% of harmful oral bacteria from the mouth [13].

– The key to overall well-being is good oral hygiene. For cancer patients, this is all the more important because they must maintain a high-calorie diet in order to fight the disease, notes Prof.  Dr. Tuomas Waltimo from the University of Basel.

Prof. Waltimo also acts as a private dentist at a clinic that offers dental services to patients with special dental needs, for example patients undergoing cancer treatments. He reminds that cancer treatments often bring along side-effects that can require special attention. Mucositis, as one example, can lead to generalised infection and even be life-threatening.

Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract. It can occur anywhere along the gastrointestinal (GI) tract, but oral mucositis refers to the inflammation and ulceration that occurs specifically in the mouth. Maintaining good oral hygiene habits is a prerequisite for treating oral mucositis. Lumoral supports regular mechanical dental hygiene, helps achieve gum health, and prevents inflammation when regular dental hygiene is insufficient. 

– Good oral hygiene is of paramount importance also in the management of oral mucositis. Initial findings suggest Lumoral treatment might help prevent and potentially treat oral mucositis, but this hypothesis requires further scientific research to confirm. We are, therefore, starting a new PhD study examining the topic at the University of Helsinki, Prof. Waltimo says.

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November is Stomach Cancer Awareness Month, and the goals of stomach cancer awareness primarily include: Raising public awareness and supporting educational efforts about stomach cancer, including risk factors, prevention, and early detection.

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References:

  1.   Maier, T. Oral Microbiome in Health and Disease: Maintaining a Healthy, Balanced Ecosystem and Reversing Dysbiosis. Microorganisms 2023, 11, 1453. https://doi.org/10.3390/microorganisms11061453
  2.   Silva DNdA, Casarin M, Monajemzadeh S, Bezerra BdB, Lux R and Pirih FQ (2022) The Microbiome in Periodontitis and Diabetes. Front. Oral. Health 3:859209. doi: 10.3389/froh.2022.859209
  3.     https://dceg.cancer.gov/news-events/news/2020/global-burden-gastro
  4.   Pignatelli, P.; Nuccio, F.; Piattelli, A.; Curia, M.C. The Role of Fusobacterium nucleatum in Oral and Colorectal Carcinogenesis. Microorganisms 2023, 11, 2358. https://doi.org/10.3390/microorganisms11092358
  5.   Reitano E, de'Angelis N, Gavriilidis P, Gaiani F, Memeo R, Inchingolo R, Bianchi G, de'Angelis GL, Carra MC. Oral Bacterial Microbiota in Digestive Cancer Patients: A Systematic Review. Microorganisms. 2021 Dec 14;9(12):2585. doi: 10.3390/microorganisms9122585. PMID: 34946186; PMCID: PMC8707512.
  6.   Nieminen, M., Listyarifah, D., Hagström, J. et al. Treponema denticola chymotrypsin-like proteinase may contribute to orodigestive carcinogenesis through immunomodulation. Br J Cancer 118, 428–434 (2018). https://doi.org/10.1038/bjc.2017.409
  7.   Heikkilä, P., But, A., Sorsa, T. and Haukka, J. (2018), Periodontitis and cancer mortality: Register-based cohort study of 68,273 adults in 10-year follow-up. Int. J. Cancer, 142: 2244-2253. https://doi.org/10.1002/ijc.31254
  8.     https://www.nhsinform.scot/illnesses-and-conditions/cancer/cancer-types-in-adults/pancreatic-cancer/
  9.   Pakarinen, S.; Saarela, R.K.T.; Välimaa, H.; Heikkinen, A.M.; Kankuri, E.; Noponen, M.; Alapulli, H.; Tervahartiala, T.; Räisänen, I.T.; Sorsa, T.; Pätilä, T. Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)—Three-Month Interim Results. Dent. J. 2022, 10, 206. http://hdl.handle.net/10138/350606
  10. Sorsa T, Gursoy UK, Nwhator S, Hernandez M, Tervahartiala T, Leppilahti J, Gursoy M, Könönen E, Emingil G, Pussinen PJ, Mäntylä P. Analysis of matrix metalloproteinases, especially MMP-8, in gingival creviclular fluid, mouthrinse and saliva for monitoring periodontal diseases. Periodontol 2000. 2016 Feb;70(1):142-63. doi: 10.1111/prd.12101. PMID: 26662488.
  11. Sorsa T, Nwhator SO, Sakellari D, Grigoriadis A, Umeizudike KA, Brandt E, Keskin M, Tervahartiala T, Pärnänen P, Gupta S, Mohindra R, Bostanci N, Buduneli N, Räisänen IT. aMMP-8 Oral Fluid PoC Test in Relation to Oral and Systemic Diseases. Front Oral Health. 2022 Jun 10;3:897115. doi: 10.3389/froh.2022.897115. PMID: 35757444; PMCID: PMC9226345.
  12. Liu Y, Qin R, Zaat SAJ, Breukink E, Heger M. Antibacterial photodynamic therapy: overview of a promising approach to fight antibiotic-resistant bacterial infections. J Clin Transl Res. 2015 Dec 1;1(3):140-167. PMID: 30873451; PMCID: PMC6410618.
  13. 1 Neha Aggarwal, Sunil Gupta, Rashu Grover, Gunmeen Sadana, and Karan Bansal; Plaque Removal Efficacy of Different Toothbrushes: A Comparative Study, Int J Clin Pediatr Dent. 2019 Sep-Oct; 12(5): 385–390.  doi: 10.5005/jp-journals-10005-1669

 

 

 

 

Koite Health signs Lumoral® deal with Dental Warehouse – UK’s leading distribution and fulfillment warehouse

Koite Health signs Lumoral® deal with Dental Warehouse – UK’s leading distribution and fulfillment warehouse

Finnish health technology company Koite Health Oy has signed a distribution agreement with Dental Warehouse Ltd. of the UK. Following the accord, Dental Warehouse will offer UK consumers and oral health professionals Lumoral® – the latest technology for improved oral health self-care.

Dental Warehouse is the leading distribution and fulfillment warehouse in the UK. The company sees Lumoral as a strong addition to its product portfolio, giving it a competitive edge in the dental industry. 

According to Alexandra Davis from Dental Warehouse, Lumoral’s unique technology – developed in collaboration with Finnish scientists and medical professionals – offers innovative plaque-targeting treatment capabilities, setting it apart from traditional oral care products. 

– The technology addresses plaque-related issues promptly, helping prevent severe oral health problems such as cavities and gum disease. Davis highlights that Lumoral caters to dental professionals and proactive consumers, expanding its target market.

Koite Health Ltd. will provide Dental Warehouse access to innovative and unique technology for dental plaque-targeted treatment through the agreement. 

– This can help differentiate us from competitors and attract customers seeking advanced oral care solutions, Davis says. 

Comprehensive oral health management

Poor oral health is a global concern that has prompted even the World Health Organization (WHO) to react. WHO estimates that oral diseases affect nearly 3.5 billion people globally. In 2022, the World Health Assembly adopted the global strategy on oral health with a vision of universal health coverage for oral health for all individuals and communities by 2030.

Poor oral health also affects children. The Oral Health Foundation of the UK called in March for urgent action after a new report by the Office for Health Improvement and Disparities highlights a “catastrophic rise in childhood tooth extractions”.

Figures released by the UK-based charity reveal an 83% increase in 0–19-year-olds admitted to hospital for tooth extractions under general anaesthetic due to tooth decay. There were 26,741 tooth extractions on 0–19-year-olds due to tooth decay between 2021-2022.

According to the report, significant disparities exist between areas within the UK. For example, Yorkshire and the Humber rates are over five times that of the East Midlands.

Alexandra Davis estimates that the UK dental market will reach a value of £9.62 billion in 2022. 46% of UK adults have visited a National Health Service (NHS) dentist in the last 12 months. 57% of people who have visited a dentist in the last five years received a general examination or check-up. 70% of British citizens use self-payment for their dental treatments.

Davis highlights a continuous need to improve prevention among patients in the UK regarding the oral health of adults and children. 

– While dental professionals emphasise the importance of preventive care, there are still areas where patients can benefit from better understanding and implementing preventive practices, she continues.

This is where new oral health-enhancing technologies such as Lumoral come in handy.

Lumoral is changing the future of dental care at home

Research shows that Lumoral's antibacterial aPDT phototherapy technology effectively eliminates harmful bacteria in the mouth while treating advanced gum disease. Similar light-activated antibacterial treatments have already been used in dental clinics. However, the problem has been the cost and frequency of these treatments to provide sufficient efficacy. 

Lumoral is a health technology product with a medical device status for treating and preventing oral diseases at home. Many dentists and the Finnish Association of Dental Hygienists already recommend the new teeth cleaning method, which improves traditional oral hygiene. Lumoral treatment does not replace mechanical oral hygiene but enhances it. Lumoral is also available for children aged four and above.

– Solid scientific evidence enhances the understanding of Lumoral's efficacy and showcases its benefits in treating periodontitis. Scientific backing helps to instill confidence in the effectiveness of Lumoral and contribute to its credibility within the dental industry, Davis says. 

Preventive health care, which includes using the antibacterial Lumoral method, will quickly pay for itself, bringing significant savings to society. This applies not only to dental care but to the entire healthcare system. Lumoral supports regular mechanical dental hygiene, helps achieve gum health, and prevents inflammation when regular dental hygiene is insufficient.

Dental Warehouse aims to provide its customers with the best possible modern treatment for oral diseases. Lumoral will be offered through dental practices through the Dental Warehouse website.

– This novel technology can appeal to individuals or organisations seeking advanced solutions in oral health. Dental plaque is a widespread issue that affects a large population. David highlights that Lumoral's ability to treat dental plaque efficiently can entice individuals and dental professionals looking for an effective tool to address this common oral health problem.

Davis continues that Lumoral's plaque-targeting capabilities align with the increasing emphasis on preventive healthcare. By proactively addressing dental plaque, Lumoral may help prevent more severe oral health issues, such as cavities and gum disease, without negatively affecting oral bacteria balance. This preventive aspect can attract those interested in maintaining optimal oral health.

According to Davis, increased awareness of oral health and hygiene drives the growing demand for advanced oral care solutions. Lumoral, with its innovative technology and ability to provide comprehensive oral health management, may meet this demand and be seen as a valuable addition to the market.

Taking oral health to a new level

Sakari Nikinmaa, Koite Health's CEO, says that partnership with the Dental Warehouse team is essential for Lumoral, enabling the company to serve dental professionals and their patients better in the UK. 

– By working with Dental Warehouse, we can take oral health to a new level in the UK and provide patients and consumers with the best possible treatment experience and outcomes. Koite Health's clinical results and the expertise of Dental Warehouse are perfectly combined with Lumoral's unique features and efficiency, says Nikinmaa.

The global oral healthcare market is estimated to be worth €470 billion. Koite Health aims to capture a share of it with their Lumoral solution. The company already has thousands of satisfied customers and ambitious future growth targets. Now, the aim is to make Lumoral a major global brand in the oral healthcare market through international partnerships.

– Our strategy is to partner with industry leaders to raise awareness among professionals about the Lumoral product and its benefits and to build a global sales structure to secure product availability globally, says Nikinmaa, one of the founders of Koite Health.

 

Sakari Nikinmaa, Co-founder and CEO of Koite Health Oy.

 

 

 

Lumoral is beneficial in healthy people, study confirms

Lumoral is beneficial in healthy people, study confirms

A plaque study conducted by a group of oral hygiene students as part of their final thesis, at the Metropolia University of Applied Sciences in Helsinki, Finland, has been completed. The study shows that using antibacterial Lumoral therapy twice a week benefits the oral health of otherwise healthy people. The study also revealed that the reduction in oral biofilm was significantly greater in the experimental group using Lumoral than in the control group.

The study was conducted by Carolina Cavalcante Bitu, Panu Halen and Susanna Lehti, oral hygiene students at Metropolia University of Applied Sciences. Their supervisor was Saila Pakarinen, lecturer, oral hygienist and researcher at the Metropolia University of Applied Sciences. The study was partly conducted in cooperation with the health technology company Koite Health Oy.

The purpose of the thesis was to investigate the efficacy of the antimicrobial Lumoral method in reducing oral biofilm as part of an oral self-care routine in healthy 18-70-year-old study volunteers.

Biofilm control prevents oral diseases such as gingivitis, periodontitis and caries. This thesis investigated the potential of indocyanine green (Lumorinse) activated photodynamic therapy of the Lumoral device in biofilm management to aid mechanical extraction from the mouth. In addition, the subjects' experiences in using the Lumoral device as part of their oral home care were analysed using qualitative methods.

The study divided the patients into two groups, an experimental group and a control group. The duration of the study period was one month. The control group, which received only oral self-care instructions, was used as a comparison. In addition to the oral self-care instructions, the experimental group received a Lumoral device and Lumorinse tablets to be used twice weekly.

The biofilm count was measured numerically using the Rustog index and the plaque index, once at the beginning of the study and again after one month. The resulting data were analysed using quantitative methods. In addition, a written evaluation was collected from the subjects of the experimental group about their experience with the Lumoral device.

All respondents found it easy to use the Lumoral device. The majority stated that they could continue to use Lumoral as part of their oral care routine, suggesting that healthy adults could also engage with Lumoral as a self-care measure to prevent oral disease.