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From Trisha's Desk Trisha E. O’Hehir, RDH, MS, Hygienetown Editorial Director

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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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