Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Oral and systemic health

Paul S Casamassimo, DDS, MS
Erin L Gross, DDS, PhD, MS
Section Editor
Ann Griffen, DDS, MS
Deputy Editor
Mary M Torchia, MD


Oral and systemic health are closely related. Abnormalities in the oral cavity can affect the systemic health, growth, and development of children. Likewise, systemic conditions or their treatments can affect the oral cavity or the feasibility of delivering dental care.

The oral conditions that affect systemic health and the systemic conditions that affect oral health and/or the delivery of dental treatment are reviewed here. The oral manifestations of systemic, genetic, or infectious disease are described in the topic reviews for those conditions. (See appropriate topic reviews).


The oral cavity plays an important role in nutrition, speech, and facial appearance. Each of these functions may be affected by abnormalities in the oral cavity.

Children with cleft lip and palate, for example, have difficulty feeding, require speech therapy, and are at increased risk for otitis media. In addition, they are at risk for long-term psychosocial effects. Ninety-six young adults who were born with a cleft lip and/or cleft palate were assessed in a follow-up study [1]. Up to one-third of them experienced psychosocial maladjustment, with a high rate of persistent dissatisfaction with appearance, hearing, speech, teeth, and social life.

Dental caries is the most common oral condition that affects systemic health and nutritional status. Moderate or severe caries, particularly in young children, may affect growth and development. In a matched, case-control study, the weights of 115 children who underwent anesthesia or sedation for treatment of nursing caries were compared with the weights of children without gross caries [2]. Case children were more likely than controls to have weights that were less than 80 percent of their ideal body weight (8.7 versus 1.7 percent).

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jun 29, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Heller A, Tidmarsh W, Pless IB. The psychosocial functioning of young adults born with cleft lip or palate. A follow-up study. Clin Pediatr (Phila) 1981; 20:459.
  2. Acs G, Lodolini G, Kaminsky S, Cisneros GJ. Effect of nursing caries on body weight in a pediatric population. Pediatr Dent 1992; 14:302.
  3. Gift HC, Reisine ST, Larach DC. The social impact of dental problems and visits. Am J Public Health 1992; 82:1663.
  4. Kozol J. Savage Inequities: Children in America's Schools, Crown Publishers, New York 1991.
  5. Moss ME, Lanphear BP, Auinger P. Association of dental caries and blood lead levels. JAMA 1999; 281:2294.
  6. Watson GE, Davis BA, Raubertas RF, et al. Influence of maternal lead ingestion on caries in rat pups. Nat Med 1997; 3:1024.
  7. Dasanayake AP. Poor periodontal health of the pregnant woman as a risk factor for low birth weight. Ann Periodontol 1998; 3:206.
  8. Offenbacher S, Katz V, Fertik G, et al. Periodontal infection as a possible risk factor for preterm low birth weight. J Periodontol 1996; 67:1103.
  9. McGhee JR, Michalek SM. Immunobiology of dental caries: microbial aspects and local immunity. Annu Rev Microbiol 1981; 35:595.
  10. Hamada S, Slade HD. Biology, immunology, and cariogenicity of Streptococcus mutans. Microbiol Rev 1980; 44:331.
  11. Beck J, Garcia R, Heiss G, et al. Periodontal disease and cardiovascular disease. J Periodontol 1996; 67:1123.
  12. Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontal disease and coronary heart disease risk. JAMA 2000; 284:1406.
  13. Hong L, Levy SM, Warren JJ, et al. Association of amoxicillin use during early childhood with developmental tooth enamel defects. Arch Pediatr Adolesc Med 2005; 159:943.
  14. Villa MP, Malagola C, Pagani J, et al. Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up. Sleep Med 2007; 8:128.
  15. Pirelli P, Saponara M, De Rosa C, Fanucci E. Orthodontics and obstructive sleep apnea in children. Med Clin North Am 2010; 94:517.
  16. Bonuck K, Freeman K, Chervin RD, Xu L. Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years. Pediatrics 2012; 129:e857.
  17. Beebe DW, Ris MD, Kramer ME, et al. The association between sleep disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood. Sleep 2010; 33:1447.
  18. Marcus CL, Moore RH, Rosen CL, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med 2013; 368:2366.
  19. Karjalainen KM, Knuuttila ML. The onset of diabetes and poor metabolic control increases gingival bleeding in children and adolescents with insulin-dependent diabetes mellitus. J Clin Periodontol 1996; 23:1060.
  20. Genco RJ. Current view of risk factors for periodontal diseases. J Periodontol 1996; 67:1041.
  21. Hart TC, Kornman KS. Genetic factors in the pathogenesis of periodontitis. Periodontol 2000 1997; 14:202.
  22. Kinane DF, Marshall GJ. Periodontal manifestations of systemic disease. Aust Dent J 2001; 46:2.
  23. Gendron R, Grenier D, Maheu-Robert L. The oral cavity as a reservoir of bacterial pathogens for focal infections. Microbes Infect 2000; 2:897.
  24. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116:1736.
  25. American Academy of Pediatric Dentistry. Guideline on antibiotic prophylaxis for dental patients at risk for infection. Pediatr Dent 2011; 33:S265.
  26. French GL. How should prophylactic antibiotics be used during dental work or bacteraemia associated procedures? Pediatr Nephrol 1993; 7:346.
  27. Kumagai T, Sakamaki H, Tanikawa S, et al. Utility and safety of Hickman catheters for venous access after bone marrow transplantation. Intern Med 1998; 37:286.
  28. American Academy of Pediatric Dentistry. Management of pediatric patients receiving chemotherapy, hematopoietic cell transplantation and/or radiation. Pediatr Dent 2011; 33:S270.
  29. Lockhart PB, Loven B, Brennan MT, Fox PC. The evidence base for the efficacy of antibiotic prophylaxis in dental practice. J Am Dent Assoc 2007; 138:458.
  30. Raether D, Walker PO, Bostrum B, Weisdorf D. Effectiveness of oral chlorhexidine for reducing stomatitis in a pediatric bone marrow transplant population. Pediatr Dent 1989; 11:37.
  31. Ohrn R, Enzell K, Angmar-Månsson B. Oral status of 81 subjects with eating disorders. Eur J Oral Sci 1999; 107:157.
  32. Rytömaa I, Järvinen V, Kanerva R, Heinonen OP. Bulimia and tooth erosion. Acta Odontol Scand 1998; 56:36.
  33. Dyment HA, Casas MJ. Dental care for children fed by tube: a critical review. Spec Care Dentist 1999; 19:220.
  34. Kaste SC, Hopkins KP, Bowman LC, Santana VM. Dental abnormalities in children treated for neuroblastoma. Med Pediatr Oncol 1998; 30:22.
  35. Cleary MA, Francis DE, Kilpatrick NM. Oral health implications in children with inborn errors of intermediary metabolism: a review. Int J Paediatr Dent 1997; 7:133.
  36. Kilpatrick NM, Awang H, Wilcken B, Christodoulou J. The implication of phenylketonuria on oral health. Pediatr Dent 1999; 21:433.
  37. Alvarez JO. Nutrition, tooth development, and dental caries. Am J Clin Nutr 1995; 61:410S.
  38. Alvarez JO, Eguren JC, Caceda J, Navia JM. The effect of nutritional status on the age distribution of dental caries in the primary teeth. J Dent Res 1990; 69:1564.
  39. Durward C, Thou T. Dental caries and sugar-containing liquid medicines for children in New Zealand. N Z Dent J 1997; 93:124.
  40. Kumar A, Aitas AT, Hunter AG, Beaman DC. Sweeteners, dyes, and other excipients in vitamin and mineral preparations. Clin Pediatr (Phila) 1996; 35:443.
  41. Maguire A, Rugg-Gunn AJ, Butler TJ. Dental health of children taking antimicrobial and non-antimicrobial liquid oral medication long-term. Caries Res 1996; 30:16.
  42. Casamassimo PS. A primer in management of movement in the patient with a handicapping condition. J Mass Dent Soc 1991; 40:23.
  43. Mealey BL. Impact of advances in diabetes care on dental treatment of the diabetic patient. Compend Contin Educ Dent 1998; 19:41.
  44. Rehorst ED, De Groot GW. Preoperative management of glucocorticoid-dependent pedodontic patients. J Am Dent Assoc 1976; 93:809.
  45. Mathew T, Casamassimo PS, Wilson S, et al. Effect of dental treatment on the lung function of children with asthma. J Am Dent Assoc 1998; 129:1120.
  46. Ruggiero S, Gralow J, Marx RE, et al. Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer. J Oncol Pract 2006; 2:7.
  47. Levy-Polack MP, Sebelli P, Polack NL. Incidence of oral complications and application of a preventive protocol in children with acute leukemia. Spec Care Dentist 1998; 18:189.