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ABSTRACT
The relationship between oral and general health has been increasingly recognised during the past two
decades. Several epidemiological studies have linked poor oral health with cardiovascular disease, poor
glycaemic control in diabetics, low birth-weight pre-term babies, and a number of other conditions,
including rheumatoid arthritis and osteoporosis. Oral infections are also recognised as a problem for
individuals suffering from a range of chronic conditions, including cancer and infection with human
immunodeficiency virus, as well as patients with ventilator-associated pneumonia. This review
considers the systemic consequences of odontogenic infections and the possible mechanisms by which
oral infection and inflammation can contribute to cardiovascular disease, as well as the oral conditions
associated with medically compromised patients. A large number of clinical studies have established the
clinical efficacy of topical antimicrobial agents, e.g., chlorhexidine and triclosan, in the prevention and
control of oral disease, especially gingivitis and dental plaque. The possible risks of antimicrobial
resistance are a concern, and the benefits of long-term use of triclosan require further evaluation. Oral
infections have become an increasingly common risk-factor for systemic disease, which clinicians should
take into account. Clinicians should increase their knowledge of oral diseases, and dentists must
strengthen their understanding of general medicine, in order to avoid unnecessary risks for infection
that originate in the mouth.
Keywords Bacteraemia, odontogenic infections, oral disease, prevention, review, triclosan
Accepted: 17 June 2007
Clin Microbiol Infect 2007; 13: 10411047
atherosclerosis [44]. These cholesterol plaques progression of periodontal disease over a 35-year
that form at the site of injury can rupture, period in adults and adolescents with pre-existing
increasing the likelihood of myocardial infarction disease [4648]. It is expected that these benefits
or stroke. An interesting finding is that the known will compound with continued use over even
matrix metalloproteinase inhibitor tetracycline is longer periods of time [47]. This could have a
as effective as periodontal treatment in lowering significant impact on disease expression in the
the level of C-reactive protein in coronary heart population at large. The consequences of long-
disease patients with periodontitis [44]. Extensive term use of any antimicrobial agent are a concern,
studies have shown that systemic diseases, e.g., and the therapeutic advantages have to be
diabetes and cardiovascular disease, and perio- weighed against the possibility of reduced sus-
dontitis share links between biomarkers of ceptibility and the emergence of resistant strains.
systemic inflammation (C-reactive protein, inter- To date, there is no evidence that triclosan
leukin-6, tumour necrosis factor-a, matrix metallo- formulations for oral use will select for triclosan-
proteinase-9). resistant strains [49,50], but there are well-docu-
These pathogenic mechanisms are not mutually mented therapeutic benefits. It is interesting to
exclusive, but clearly establish the role of infection note that the major therapeutic benefit, in terms of
in the pathogenesis of atherosclerosis. Despite the chronic periodontitis, is seen in susceptible
lack of definitive long-term intervention studies, patients or those with pre-existing disease. Med-
the importance of preventing and treating infec- ically and immunologically compromised pa-
tions, especially chronic infections such as peri- tients represent a susceptible population, such
odontitis, should become paramount in terms of that it would be reasonable to expect that triclo-
the advice and treatment given to patients with san-containing toothpastes would be of value in
coronary heart disease. the control of oral infection in these patients.
However, this remains to be shown, and further
studies are necessary to determine the effect
PREVENTION OF ORAL INFECTIONS
of these products in medically compromised
Oral infection continues to be a major public patients.
health problem worldwide. Good oral hygiene is
essential for good oral health, and the routine
CONCLUSIONS
control of dental plaque is fundamental. How-
ever, the widespread prevalence of oral disease The number of individuals retaining more of their
indicates the inability of most individuals to natural teeth for longer periods of time has
achieve a level of plaque control consistent with increased during the past few decades. Adequate
good oral health. Approaches aimed at improving oral hygiene is difficult to achieve, and chronic
the oral hygiene of the population have therefore asymptomatic infections of teeth, their supporting
included the addition of antibacterial agents to tissues and oral mucosa are common. Mainte-
oral care products. While chlorhexidene is con- nance of oral health is a special challenge for
sidered to be the reference standard, it has medically compromised patients or those with
significant side-effects that limit its widespread acute illness. The mouth is a significant potential
long-term use. source of infection and inflammation that con-
Triclosan is an alternative antimicrobial agent tributes to the total burden of disease, and to
with a broad spectrum of activity against oral overall health, which should be systematically
microorganisms. This agent is more suitable for taken into account by all clinicians.
long-term use, as it does not have significant side-
effects and, importantly, it has a long history of
ACKNOWLEDGEMENTS
safe use in consumer products. Its dual antimi-
crobial and anti-inflammatory properties offer R. Rautemaa declares support during recent years from the
advantages in the management of periodontal Finnish Dental Society Apollonia, Helsinki University Central
Hospital Research Funds (EVO), and the University of Hel-
diseases and oral mucosal conditions, and there sinki, Finland. G. Seymour and M. Cullinan declare support
are now numerous studies demonstrating its during recent years from the NHMRC of Australia, the
effectiveness in reducing plaque and gingivitis Australian Dental Research Fund, Colgate Oral Care Australia
[45]. Triclosan has also been shown to slow the and Colgate Palmolive Ltd, USA.
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