Bad oral health can cause blindness!

Mechanisms causing this strange association of oral health and glaucoma

There are several mechanisms underlying the association of periodontitis with systemic illnesses, such as glaucoma.(4)

1. Periodontitis is a common bacteria-induced oral inflammatory condition that destabilizes the tooth structural support apparatus and it can produce transient bacteremia, which may lead to systemic endothelial dysfunction and chronic inflammatory responses in various extra-oral tissues.
2. Second, inflammatory markers generated from the affected periodontal tissue can also travel via the bloodstream to reach other tissue beds like the eye. For example, in neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, there is growing evidence that peripheral inflammation exacerbates the development of neuronal cell loss.
3. The third mechanism is the immune response to the bacteria, which involves the generation of antibodies to bacteria and their toxins, which may have off-target effects in extra-oral tissues (e.g., cross-reactive antibodies that contribute to atherosclerosis).

In simple words - Periodontitis may trigger a series of events where the bacteria from the inflamed gums spreads to the optic nerve. This can cause pressure on the optic nerve, putting the patient at a high risk for glaucoma. Hence it’s important to ensure that any infection in that area be treated as quickly as possible to avoid its spread.

What can a responsible dentist do?

• For patients with chronic periodontitis, insist on regular dental exams and scalings. Counsel the patient that this is important to keep their mouth healthy and lower chances of infection spreading to other parts of body.
• If any dental procedure requires sedation in a glaucoma patient, you should avoid sedatives that contain ingredients that can increase pressure in the optic nerve. These includes benzodiazepine sedatives such as diazepam, alprazolam and triazolam.
• In cases of trigeminal neuralgia coupled with periodontitis, avoid using topiramate. Topiramate is contraindicated in glaucoma and if the patient has poor oral health, he is at risk for developing glaucoma.
• If a patient has extreme chronic periodontitis, suggest an ophthalmic examination to him. If such a patient complains of blurry vision, eye pain, redness or halos around eyes, refer him to an ophthalmologist immediately with a note explaining the possibility of glaucoma in chronic periodontitis patients.
• If the patient gives a history of anti-depressant use, and has extreme chronic periodontitis, refer him to his psychiatrist with a note explaining the possibility of glaucoma in chronic periodontitis patients. Tricyclic antidepressants such as amitriptyline are contraindicated in patients with glaucoma or at risk, and the psychiatrist may consider changing his medication if necessary.

To conclude

Bad oral health can cause devastating effects in extra oral tissues and body systems too. People with periodontitis are at a greater risk of glaucoma than individuals without periodontitis. Ocular health exams and good oral health maintenance should be emphasized for such patients.

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