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Last Updated: 29.05.23

Patricia Corby, D.D.S.: Relationship Between Poor Oral Health and Systemic Disease

Dr. Patricia Corby is Associate Professor of Oral Medicine and Associate Dean of Translational Research at Penn Dental Medicine. Dr. Pat provides an overview of dental anatomy, the importance of oral hygiene to overall health, and the association of poor oral health and systemic diseases like cancer and diabetes. She addresses tooth decay, oral hygiene in children, the utility of dental products, and ideal oral care regimens for different populations. She also discusses issues specific to immunocompromised patients and those with chronic illnesses as well as her own research with cancer patients undergoing radiation treatment.

Key Takeaways

High level takeaways from the episode.

Oral health is often an underappreciated aspect of overall health. The connection between oral health and systemic health.

Dental pain is one of the most severe types of pain due to nerve connections. Nervous connection may serve as an early warning indicator for infections and inflammation.

Dental implants can still function for breaking down food, but natural teeth are better for overall oral health.

Importance of proper occlusion (alignment) for oral health:

  • Prevents damage to ligaments and inflammation
  • Poor occlusion can lead to facial pain and headaches

Saliva plays a crucial role in oral health. Protects and maintains a balanced oral microbiome. Prevents dysbiosis (imbalance of bacteria).

Over 700 different bacteria live in the mouth. In a healthy mouth, approximately 50% aerobic, 50% anaerobic, and 30–40% facultative bacteria.

Dysbiosis can occur when oral hygiene is neglected or other factors change the oral environment.

  • Allows harmful bacteria to grow and suppress beneficial bacteria.
  • Changes in the abundance and diversity of bacteria

Study on flossing

  • Non-​​flossing group had increased gingival inflammation and bleeding. Periodontal bacteria (P. gingivalis, T. denticola, A. actinomycetemcomitans) became more abundant in the non-​​flossing group.
  • Demonstrates the importance of flossing for oral health and preventing periodontal disease.

Sugar (fructose, sucrose, lactose, and complex starches) is harmful to teeth

  • Kyogenic bacteria metabolize sugar, producing acid that destroys enamel
  • Glucose is the worst, especially in high concentrations (e.g., syrup)
  • All sugars can be metabolized by bacteria, including fructose from fruits and vegetables

Mechanical removal of plaque is essential for oral health

  • Brushing disrupts the biofilm matrix, preventing accumulation and overwhelming bacterial growth
  • Flossing cleans between teeth

Brushing the oral mucosa and tongue can help decontaminate against bacteria

  • Often neglected in oral hygiene routines

Oral health is crucial for cancer patients, especially those undergoing radiation treatment.

  • Radiation damages salivary glands, causing dry mouth and changing the oral microbiome.
  • Opportunistic organisms can prevail, leading to fungal infections and local inflammation.

Flossing helps clean anaerobic bacteria hiding between teeth

  • Brushing also stimulates and strengthens gums

Recommended order: brush, floss, rinse or brush again, and brush tongue

  • Brushing first removes biofilm and bacteria from tooth surfaces
  • Flossing after brushing can reintroduce bacteria into the mouth

Pilot study showed that cancer patients who received comprehensive periodontal treatment had suppressed inflammatory markers in saliva.

  • Suggests a systemic benefit from improved oral health care during cancer treatment.

Cancer patients are at greater risk of systemic infections arising from the mouth

  • Immune compromise from treatment and loss of immune barrier in the mouth contribute to this risk
  • Dry mouth from radiation treatment increases susceptibility to infections and inflammation
  • Improved oral health care for cancer patients could lead to better treatment outcomes and overall health

Focus on prevention and intensive oral care for people with disabilities – educate caregivers on optimal oral hygiene practices.

Sugarless chewing gum or lozenges can help stimulate saliva production

  • Xylitol-​​based products may be beneficial.
  • Hydration and drinking water are important for oral health.

Tooth color

  • Varies among individuals and can be influenced by genetics and environmental factors. Some people have naturally yellow teeth that won’t change.
  • Excess fluoride in water can cause stains on teeth.
  • A study with twins showed that environmental factors, such as diet, can affect tooth color.
  • Black tea and red wine are common causes of tooth discoloration.

Teeth whitening involves bleaching the teeth. Excessive use can be detrimental, causing loss of minerals and potential gum damage.

Fluoride varnish can be applied to teeth every six months to help prevent decay.

Brushing before bedtime is crucial for preventing tooth decay. Avoid giving children baby bottles overnight, as it can lead to decay.

Tongue scraping vs. brushing

  • Both methods remove bacteria from the tongue
  • Brushing with toothpaste provides additional antibacterial benefits

Electric toothbrushes can provide a more thorough cleaning than manual brushing.

Additional tips

  • Toothpicks can be used for removing food particles, but should not replace flossing
  • Xylitol-​​based toothpaste with fluoride is a good option for cavity prevention

Additional Tips

  • Mouthwash can provide extra cleaning and freshening, but should not replace brushing and flossing.
  • Mouthwash can kill both good and bad bacteria in the mouth. It’s not recommended for daily use, especially if you have a healthy oral environment. Overuse of mouthwash can lead to bacterial resistance and possibly fungal overgrowth
  • Clean and dry your toothbrush after use to prevent bacterial growth

Ideal oral care regimen

  • Brush teeth three times a day: morning, after meals, and before bed
  • Floss daily to remove plaque and prevent inflammation
  • Incorporate a water pick or mouthwash for additional cleaning, but not as a substitute for brushing and flossing

Regular dental checkups and cleanings are essential for maintaining oral health – six months is the recommended time between checkups for most people. People with systemic health issues, such as diabetes, may need more frequent checkups


Science-​​based tools and supplements that push the needle.

Ideal Oral Care Regimen


Focus on Oral Care for Cancer Patients



We recommend using this distillation as a supplemental resource to the source material.

  • Patricia Corby, D.D.S.: Relationship Between Poor Oral Health and Systemic Disease

    The Drive #166

    Dr. Patricia Corby, Penn Dental Medicine’s Associate Dean of Translational Research, covers oral health’s significance to overall health, including decay, hygiene, and illnesses.

    Sourced from

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