Mikako Hayashi and Nairn Wilson: Time to put the mouth back in the body

mikako-hayashinairnwilsonWe believe that it is time to put the mouth back in the body—for medical, social, and financial reasons.

Healthcare worldwide needs to become more inclusive and holistic, to move from being curative to preventive, and to bring oral healthcare into the medical mainstream. A recent analysis from the British Dental Association, which estimated that 600 000 people a year in the UK go to their doctor with a dental problem,1 emphasises the importance of our message.

A quick question: what is the world’s most pervasive disease? No, not cancer, heart disease, malaria, or even diabetes or backache. The most prevalent disease is untreated dental caries (tooth decay)—with periodontitis (gum disease) also ranking highly among the most prevalent conditions—estimated to cost $500 billion a year. 2, 3

Research suggests that there are vital connections between oral and general health. Clinical studies of older people indicate that those who have kept their teeth, or have well fitting dentures, are more likely to be active longer and healthier than those who are edentulous.4 Kazuhiko Nakano, an Osaka University professor, and his team showed that gingival bacteria may cause critical cardiovascular conditions, possibly triggering strokes or heart attacks.5 There is a wealth of evidence showing strong associations between poor oral health and chronic non-communicable diseases, notably diabetes.6 Periodontitis has been proven to exacerbate a range of systemic conditions.7

But too many people in the West regard the dentist as a feared stranger. In the US, 89% of infants visit a paediatrician, but only 1.5% see a dentist.

Governments in every developed country are struggling with the rising costs of healthcare, especially as populations age. Dentistry, with an emphasis on prevention of disease, could help show medicine a healthier way.

Modern dentistry has advanced from the old regime of drill and fill. If a person follows a careful oral health regime, cleaning the teeth and mouth twice a day, eating healthily, limiting consumption of sugars and erosive sodas, visiting the dentist regularly—which should be a painless experience—she or he should be able to preserve their natural teeth, largely without fillings, and maintain healthy gums for most of their life.

Widespread, effective preventive care would promote healthier lives and save money for curative interventions where they are really needed.

Medical authorities should encourage doctors, dentists, and other healthcare professionals to cooperate closely in daily clinical practice, education, and research to promote an interprofessional wellness regime—especially given their common interest in conditions such as diabetes and obesity, linked through sugar intake and (un)healthy eating.

Mikako Hayashi is professor and head of the department of restorative dentistry and endodontology at Osaka University. She is the first—and so far only—woman professor of dentistry in the 65 year history of Osaka University. She advises the government of Japan on improving dental education. Her specialist research involves strengthening of tooth dentin, preventive care for the elderly without drilling, and how to advance integrated oral and general healthcare in developing countries.

Nairn Wilson is emeritus professor of dentistry, King’s College London Dental Institute. For 12 years (2000-12) he was dean of King’s College London Dental Institute—the largest dental clinical academic centre in Europe. He was the 2015-16 president of the British Dental Association. 

Competing interests: None declared.


  1. Guardian: Why are people taking dental complains to their GP? https://www.theguardian.com/global/2016/sep/10/why-are-people-taking-dental- complaints-gp-instead-dentist
  2. Marcenes W, Kassebaum NJ, Bernabe E, et al. Global burden of oral conditions in 1990-2010: a systematic analysis. J Dent Res 2013;92:592-597.
  3. Patel R. The state of oral health in Europe – report commissioned by the European platform for better oral health 2012. (http://www.oralhealthplatform.eu)
  4. Ikebe K, Hazeyama T, Enoki K et al. Comparison of GOHAI and OHIP-14 measures in relation to objective values of oral function in elderly Japanese. Community Dent Oral Epidemiol 2012;40:406-414.
  5. Nakano K, Hokamura K, Taniguchi N et al. The collagen-binding protein of Streptococcus mutans is involved in haemorrhagic stroke. Nature Communications 2011;2:485. (doi:10.1038/ncomms1491)
  6. The challenge of oral disease. Chapter 2 Oral disease and health, The Oral Health Atlas 2nd edition FDI, 2015 pp13-36.
  7. Periodontal disease and systemic health. American Association of Periodontology (https://www.perio.org/consumer/other-diseases)