Introduction

Systemic diseases are the ones affecting multiple systems in the body rather than one organ or area. Examples of systemic disease range from infections, diabetes, high blood pressure, autoimmune diseases and cancer. When we say oral health, we are referring to the health of the teeth, surrounding tissues such as gums, bone, mucosa, etc. The tooth is a living structure of the human body, because inside the tooth is a structure called the pulp. Imagine any fruit that has this hard outer layer and a soft, juicy inner layer. The tooth has a setup that one can see as alike. The soft bit inside the tooth is the tooth pulp. The hard top parts are the enamel and dentin. All the blood lines and nerve bits that give life food to the rest of the tooth sit in this soft area. 

In this article, we will understand the effects of systemic diseases on the tooth pulp health.

Understanding the anatomy of the tooth 

At the core of every tooth in our mouth is a soft tissue called the dental pulp (dental is ‘relating to the teeth’). This dental pulp or tooth pulp contains blood vessels, nerves and connective tissue.

The dental pulp or tooth pulp is responsible for keeping the tooth alive or vital. Blood vessels in the tooth pulp provide the necessary nutrients and oxygen to the cells and keep them alive, healthy, promote repair or healing, and the white blood cells help fight any infection. The nerves in the tooth pulp are responsible for the sensations of pain, pressure, different temperatures, etc.

. This tooth pulp becomes unhealthy, infected, and inflammatory when we experience pain or observe cavities in a tooth. Damage to the tooth pulp leads to destruction of the outer layers of the teeth, inflammation of the surrounding gums and bone and may eventually lead to loss of tooth structure.

Overview of systemic diseases

Systemic diseases are diseases that affect the whole body and are not itself to one organ or area. Take the example of diabetes, high blood pressure, arthritis, kidney disease or liver disease; in any of these conditions, the whole body suffers, causing some disability or showing some symptom and affecting the health of the individual. Just as it affects all other parts of the body, it affects the tooth and the tooth pulp. This is because the tooth pulp contains blood vessels. The blood that flows through the entire body flows to the tooth pulp, too. Any bacteria, viruses, cancer cells, abnormal cells or foreign bodies that flow through the blood vessels will reach the tooth pulp and cause damage to it just as to any other part or organ of the body. So, if the body is disease-free, the tooth pulp will be healthy and vice versa.¹

The effects of systemic diseases on tooth pulp health

Now that we have understood the anatomy of the tooth, the importance of the tooth or dental pulp and the correlation of systemic disease with the health of the tooth pulp, let us have a look at the common systemic diseases and their effect on the health of the tooth pulp.

Diabetes mellitus

Our body needs glucose to produce energy. The human body has an in-built mechanism where specific hormones regulate the amount of glucose in the body from time to time based on the needs and energy consumed. When these natural regulators become ineffective for whatever reason, there is hyperglycemia (an increase in the blood glucose levels) in the body. This condition is called Diabetes Mellitus (DM). When the glucose in the bloodstream increases, such blood is circulated to all the parts of the body. Increased glucose in the blood leads to increased infections as this glucose-rich blood acts as food for the growth and multiplication of bad bacteria in the body, and as the bad bacteria increase, they cause delayed healing or repair. 

This process happens throughout the body, so you must have seen people with uncontrolled diabetes or high glucose blood levels with wounds that do not heal or a lack of sensation at their fingertips. The same happens with the tooth pulp. If the tooth is already infected with dental caries (infection of the tooth leading to cavities), and blood glucose levels are high, the bacteria grow faster and infect the tooth pulp. The tooth pulp becomes a home for the bacteria to safely grow, damaging the various tooth structures and causing pain and discomfort.

Cardiovascular diseases

Blood in the body is like a vehicle. It carries or transports materials from one place to the other. The blood carries everything, ranging from hormones and nutrients that are important to maintain optimal health to microorganisms and foreign bodies that can cause damage and ill health. In case of cardiovascular disease, such as hypertension (high blood pressure) or atherosclerosis, the heart is working overtime and finding it difficult to pump blood throughout the body. In such instances, the vitality of the tooth pulp is affected due to a lack of supply of blood nutrients and oxygen, leading to damage and delayed healing of the tooth structure.

Autoimmune diseases (e.g., lupus, rheumatoid arthritis)

 The human body has a way to fight off sickness and outside things. In some cases, the body's own defence system attacks its good cells in what are called autoimmune disorders. The defence cells can't spot the difference between strange or bad cells and the body's own cells. One part of the body that may get swollen from this mix-up is the dental pulp or tooth pulp. This largely affects the immunity of an individual, making them more susceptible to infections, including dental infections. Such inflammation in the tooth pulp may lead to the gradual death of the pulp, called pulp necrosis.

Infections (e.g., HIV/AIDS, tuberculosis, etc.)^2,3

Chronic infectious diseases make the immune system weak due to the increased load of microorganisms in the body. The medicines that we give to combat these microorganisms further lower the body’s natural immune response, making such individuals more susceptible to secondary infections. The tooth pulp will also be susceptible to catching infections faster, resulting in damage to the tooth.

Kidney disease

Kidneys perform the important function of removing waste from our bodies. When the kidneys are damaged and diseased, this filtering process is affected, and waste starts accumulating in the body. This same waste, when absorbed in the bloodstream, will travel to the tooth pulp and cause damage to the healthy pulp tissue. It also impacts the absorption of essential nutrients, leading to damage to the bone structure surrounding the tooth.

Other conditions (e.g., cancer treatments, asthma, etc.)⁴

Chemotherapy and radiation therapy affect the immunity of an individual. This increases the risk of secondary infections. Such therapies have an impact on the salivary glands (saliva or spit-producing organs in the mouth). They decrease the production of saliva, which can lead to pulp tissue damage.

Common symptoms of the affected tooth pulp

The most common symptoms and signs of an affected tooth include:

• Tooth sensitivity
• Tooth pain
• Swelling
• Pus discharge
• Formation of an abscess
• Decayed tooth or multiple teeth
• Broken or fractured tooth or teeth
• Mobile tooth
• Fever
• Pain on biting⁵

Diagnosis of tooth pulp issues

• Routine dental exams- Regular dental check-ups can help your dentist catch any early signs of damage to your tooth and diagnose tooth pulp problems.
• Diagnostic tests- Commonly used diagnostic techniques to identify the cause and diagnose the condition include thorough history taking to recognise underlying systemic conditions and medicines taken for those conditions, clinical examination, Sensitivity tests, percussion tests, X-rays, CBCT, etc⁶

Preventing and managing tooth pulp health with systemic diseases

Now that we have understood the connection between systemic diseases and how they impact tooth pulp health, let us have a look at some of the ways to manage these conditions:

• Managing systemic diseases

This could be achieved by implementing some lifestyle changes such as diet, exercise, regular sleep cycles and controlling the condition with the use of prescribed medicines.

• Maintaining oral hygiene

Inculcating regular oral hygiene will prevent the accumulation of microorganisms in the mouth and reduce the chances of infection. Simple techniques like brushing twice a day, flossing, eating less sugary and junk food will help achieve tooth pulp health.

• Periodic dental visits

Regular dental check-ups will help in the early detection of any infections or conditions and help in managing them effectively.⁷

Summary

• Systemic diseases are the ones that affect the whole body and do not limit themselves to one organ or area
• The effects of systemic diseases can be seen on the entire body, including the tooth pulp, also called the dental pulp
• Tooth pulp or dental pulp is the innermost soft tissue in a tooth that keeps the tooth alive and healthy, as it contains blood vessels and nerves. The blood vessels of a healthy pulp tissue carry nutrients and oxygen to the tooth, and nerves provide sensations in and around the tooth
• Systemic diseases that cause an increase in the number of microorganisms, waste products, abnormal cells and dysfunctional immune cells cause irreversible damage to the tooth pulp. Such damage could lead to pulp necrosis
• Managing the systemic condition or disease through medication, lifestyle changes and oral hygiene habits can help the tooth pulp stay healthy and repair itself from minor damages
• Regular dental check-ups help in identifying any dental conditions, correlating it with underlying conditions and managing not just the dental problem but also any underlying systemic condition through clinical examinations, history taking and diagnostic tests
• A direct correlation to pinpoint the exact effect of each systemic condition is not available at the time and needs further research, however, it is clear that systemic conditions have a direct impact on the health of an individual’s dental or tooth pulp
• To understand this cause-and-effect relation better, scientists recommend studying teeth removed from individuals with known systemic conditions