Making the Connection
– by Trisha E. O’Hehir, RDH, BS, Hygienetown Editorial Director
The mouth is the doorway to the body and
research is accumulating that links oral bacteria to
infections, diseases and conditions in many parts of
the body. Cause and effect has yet to be proven, but
the bacteria do travel to other parts directly from the
mouth. Oral bacteria can be aspirated into the lungs,
enter the Eustachian tubes and move to the middle
ear, or enter the blood stream and travel to distant
parts of the body.
According to the American Rhinologic Society,
each year Americans suffer more than one billion
upper respiratory infections (URI) or the "common
cold." URIs have increased six percent per year since
1970, due in part to increased use of daycare centers
and over-the-counter use of antihistamines and
decongestants. Children in daycare experience an
average of six URIs per year. The upper respiratory
tract begins with the nose, includes the sinuses, pharynx
and larynx. It leads to the lower respiratory track
made up of the trachea, bronchi and pulmonary alveolar
spaces. We don't usually think of the nose and
sinuses as part of the oral environment we deal with,
but bacteria and viruses found in oral biofilms do
contribute to URIs and otitis media infections.
Within the oral pharynx, the Eustachian tubes
connect the oral cavity with the ears. These tiny
tubes provide a passageway connecting the upper
part of the throat to the middle ear. To picture where
the Eustachian tubes are located, imagine pointing
your finger all the way to the back of the throat, and
then turning it slightly to the side and going a bit
higher. You can't see it, but that's the location of
Eustachian tubes, one on each side of the nasopharynx,
near the adenoids. The Eustachian tubes supply
fresh air to the middle ear, drain fluids and maintain
air pressure between the nose and the ear. They are
generally closed, and open for a fraction of a second
to equalize the pressure between the middle ear and
the atmosphere.
Bacterial biofilm accumulating in the Eustachian
tubes can trigger inflammation, swelling and blocking
the drainage from the middle ear, causing an ear
infection or otitis media. In infants and children, the
high incidence of otitis media is due in part to small,
narrow Eustachian tubes positioned horizontally,
making it difficult for fluid to drain out of the ear.
With age and skull growth, the Eustachian tubes will
move up and slant downward.
Controlling the accumulation of oral biofilm and
keeping the Streptococcus bacteria in check is important
for more than just dental health. It will also help
control URI and the incidence of otitis media infections,
especially in young infants and children.
Educating parents about the importance of good oral
health should also include education about good
upper respiratory health.
Physicians have learned the value of xylitol in
controlling bacterial biofilm formation. Oral xylitol
in the form of gels, syrups, wipes, gums and candies
reduces bacterial counts. This also leads to prevention
of otitis media infections. In addition to oral
use of xylitol, it is also offered in a mild saline nasal
spray to control bacteria and virus attachment to
nasal and sinus tissues. Just as bacteria slide off the
teeth with oral xylitol use, bacteria are unable to
attach to soft tissues when xylitol is delivered to the
nose in spray form. With this information we can
broaden the scope of oral hygiene education to
include prevention of URI and otitis media infections.
The mouth, nose, sinuses and ears are definitely
connected.
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