Poor oral health linked with body pain and migraines in women

The study identified specific oral microbes correlated with certain pain conditions

Peer-Reviewed Publication

University of Sydney

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

New research from the University of Sydney has revealed poor oral health is significantly associated with higher instances of migraines, abdominal and body pain in women. 

Published in Frontiers in Pain Research, the world-first study identified specific oral microbes correlated with certain pain conditions, suggesting a potential relationship between the oral microbiome and the nervous system.   

The findings highlight the importance of good oral health to potentially mitigate pain and improve overall wellbeing, prompting further exploration into the role of oral microbiota in chronic unexplained pain conditions. This includes fibromyalgia, a condition experienced by 67 percent of the study participants. 

“This is the first study to investigate oral health, oral microbiota and pain commonly experienced in women with fibromyalgia, with our study showing a clear and significant association between poor oral health and pain," said lead investigator Associate Professor Joanna Harnett from the Faculty of Medicine and Health. 

“Our findings are particularly important to fibromyalgia which, despite being a common rheumatological condition, is often underrecognised,” said first author and PhD candidate in the Faculty of Medicine and HealthSharon Erdrich.  

“Fibromyalgia is a chronic condition characterised by widespread musculoskeletal pain, and headaches including headaches, as well as fatigue, sleep disturbances, and cognitive problems.” 

How the research worked  

The research examined associations between self-reported oral health, the oral microbiome, and various pain presentations in a group of New Zealand women with and without fibromyalgia.   

Oral health was assessed using the WHO oral health questionnaire and evaluated against body pain, headaches, migraines, and abdominal pain using validated instruments, including the Short-form 36 (which measures quality of life), the International Headache Society headache survey and the functional bowel disorder severity index. Strong associations were evident between oral health scores and pain and each of these were associated with specific microbes found in the mouth, which were assessed using advanced genomic technology.   

Participants with the poorest oral health were more likely to suffer from higher pain scores: 60 percent were more likely to experience moderate to severe body pain, and 49 percent were more likely to experience migraine headaches. Lower oral health was a statistically significant predictor of frequent and chronic migraine. 

Four oral microbial species from the Dialister, Fusobacterium, Parvimonas and Solobacterium genera were significantly associated with pain after age, BMI and added dietary sugars were considered.   

A weak but significant inverse correlation with diet quality and oral health was also found, though the researchers note this has yet to be investigated in detail. 

The Australian Dental Association recommends regular oral hygiene appointments and dental health checks, in addition to twice daily teeth brushing and flossing.  

Bad breath, bad news: how gum disease could worsen liver conditions

 

 

Caption

Oral and gut microflora associated with healthy states and dysbiosis.

Credit

By David Hudson, Gustavo Ayares, Zahra Taboun, et al.

Peer-Reviewed Publication

First Hospital of Jilin University

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

 

image: 

Oral and gut microflora associated with healthy states and dysbiosis.

view more 

Credit: By David Hudson, Gustavo Ayares, Zahra Taboun, et al.

There is growing recognition in medicine that what happens in one part of the body can ripple through others. That idea is now being explored in a surprising place: the mouth. A new review by an international group of researchers has examined the mounting evidence linking periodontal disease—commonly known as gum disease—to chronic liver conditions, including cirrhosis, metabolic dysfunction-associated steatotic liver disease (MASLD), and alcohol-related liver disease. Though the mouth and liver are separated by both distance and function, the paper makes a compelling case that these two systems are more connected than we thought.

Gum disease, especially in its more advanced form known as periodontitis, is a chronic inflammatory condition caused by bacterial infections in the tissues that support the teeth. It is one of the most common diseases worldwide, and its severity tends to increase with age, smoking, alcohol use, and poor access to dental care. For patients already struggling with liver disease—many of whom share these same risk factors—oral health often takes a back seat.

But ignoring the mouth could be a mistake. The review lays out multiple ways that periodontitis may aggravate liver disease. The first is via the "oral-gut-liver axis," a term researchers use to describe the complex interplay between oral bacteria, the gut microbiome, and liver function. Pathogenic bacteria from the mouth can be swallowed or enter the bloodstream during everyday activities like chewing and brushing. Once in the gut, these microbes may alter the composition of the intestinal microbiome, leading to dysbiosis and increased gut permeability—also known as a "leaky gut." This can allow bacterial products such as endotoxins to reach the liver, triggering inflammation and fibrogenesis.

Animal models offer further support for this theory. Studies have shown that oral administration of specific periodontal pathogens, such as Porphyromonas gingivalis, can exacerbate liver steatosis and inflammation in mice with pre-existing metabolic disease. These microbes, or their byproducts, have even been found in liver tissue, suggesting that translocation from the mouth to the liver is biologically plausible.

The immune system also plays a central role in this interaction. Chronic periodontal inflammation leads to the release of pro-inflammatory cytokines like TNF-alpha and IL-6, which have long been implicated in the progression of liver disease. Additionally, the review highlights the involvement of Th17 cells—a type of immune cell activated by oral pathogens that may migrate to the liver and worsen metabolic dysfunction. Together, these pathways form a vicious cycle: liver disease impairs oral health, while oral inflammation accelerates liver damage.

The clinical data, while still developing, supports this association. Patients with cirrhosis consistently show worse oral health than the general population, with higher rates of gingival overgrowth, attachment loss, and bone loss. The prevalence of periodontitis among patients awaiting liver transplantation can be as high as 72 percent. Studies have also found links between severe periodontal disease and increased mortality in cirrhosis patients.

For those with MASLD, the most common form of chronic liver disease, the evidence is also compelling. Population-level studies have found that people with advanced periodontitis are significantly more likely to have MASLD, even after adjusting for shared risk factors like obesity and diabetes. And in a small trial, periodontal treatment led to a short-term improvement in liver enzyme levels—a tantalizing hint that oral health interventions could influence liver function.

That said, the review authors caution that the research is still at an early stage. Much of the clinical data comes from observational studies, which cannot definitively prove cause and effect. There is also the challenge of disentangling shared lifestyle and socioeconomic factors that affect both oral and liver health. Still, the biological plausibility, consistency of findings, and preliminary interventional data make a strong case for paying more attention to the teeth and gums of patients with liver disease.

The review ends with a call for multidisciplinary collaboration. Gastroenterologists and hepatologists, who typically manage liver disease, may not think to ask about oral health or refer patients for dental care. Yet the data suggest they should. Similarly, dental professionals may not be aware of how their work could influence liver outcomes. Closer cooperation between these specialties could lead to earlier detection and better care.

Until more definitive evidence is available, one message is clear: brushing, flossing, and regular dental visits might be more important than we ever realized, especially for those living with chronic liver conditions. In the meantime, researchers are calling for larger, high-quality trials to test whether treating gum disease can slow liver disease progression or reduce complications. If the connection holds, the humble toothbrush could become an unexpected tool in the fight against liver failure.

An antiviral chewing gum to reduce influenza and herpes simplex virus transmission

Researchers at Penn Dental Medicine and collaborators have used a clinical-grade antiviral chewing gum to substantially reduce viral loads of two herpes simplex viruses and two influenza A strains in experimental models

Peer-Reviewed Publication

University of Pennsylvania

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

 

image: 

The engineering and evaluation of anti-viral bean gum.

view more 

Credit: Yuwei Guo, Rachel Kulchar, Rahul Singh, and Geetanjali Wakade

In today’s interconnected world, infectious diseases pose an escalating threat, as demonstrated by the coronavirus pandemic and outbreaks of H1N1, SARS, Ebola, Zika, and H5N1 (bird flu) viruses—all of which have had significant global health and economic impacts.

But more common viral diseases also contribute to global health challenges and economic costs. For example, seasonal influenza epidemics occur annually, causing a substantial global disease burden and economic losses exceeding $11.2 billion each year in the United States alone. Meanwhile, herpes simplex virus-1 (HSV-1), spread primarily through oral contact, infects over two-thirds of the global population and is the leading cause of infectious blindness in Western countries.

Low vaccination rates for influenza viruses and the lack of an HSV vaccine underscore the need for a new approach—one that targets reducing viral loads at the sites where transmission occurs. And for viruses like these, which are transmitted more efficiently through the mouth than the nose, this means focusing on the oral cavity.

Now, in a study published in Molecular Therapy, researchers at the School of Dental Medicine at the University of Pennsylvania and collaborators in Finland, have done just that.

Building on their previous work—now in clinical trial—showing that a similar approach was able to reduce SARS-CoV-2 in COVID-19 patient saliva or swab samples by more than 95%, Henry Daniell, W.D. Miller Professor in Penn’s School of Dental Medicine, and collaborators tested the ability of a chewing gum made from lablab beans, Lablab purpureus—that naturally contain an antiviral trap protein (FRIL)—to neutralize two herpes simplex viruses (HSV-1 and HSV-2) and two influenza A strains (H1N1 and H3N2). The chewing gum formulation allowed for effective and consistent release of FRIL at sites of viral infection. 

They demonstrated that 40 milligrams of a two-gram bean gum tablet was adequate to reduce viral loads by more than 95%, a reduction similar to what they saw in their SARS-CoV-2 study.

Importantly, the researchers prepared the gum as a clinical-grade drug product to comply with the FDA specifications for drug products and found the gum to be safe. Daniell notes, “These observations augur well for evaluating bean gum in human clinical studies to minimize virus infection/transmission.”

Daniell and his colleagues are now looking to use lablab bean powder to tackle bird flu, which is currently having a significant impact in North America. In the previous three months, 54 million birds have been affected by H5N1, and several human infections have been reported in the U.S. and Canada.

Previously, bean powder was shown by others to effectively neutralize H5N1 and H7N9—two strains of influenza A known to cause bird flu in humans as well as in birds. Daniell and colleagues are currently looking to test its use in bird feed to help control bird flu in birds.

“Controlling transmission of viruses continues to be major global challenge. A broad spectrum antiviral protein (FRIL) present in a natural food product (bean powder) to neutralize not only human flu viruses but also avian (bird) flu is a timely innovation to prevent their infection and transmission,” says Daniell.

Henry Daniell is the W.D. Miller Professor in the Department of Basic & Translational Sciences at the School of Dental Medicine at the University of Pennsylvania.

Other authors include Gary H. Cohen, Yuwei Guo, Uddhab Karki, Rachel J. Kulchar, Rahul Singh, and Geetanjali Wakade of Penn Dental Medicine, Hamid Khazaei of the Natural Resources Institute Finland (Luke) and the University of Finland and Juha-Matti Pihlava of the University of Finland.

Research performed in the Daniell lab is supported by NIH grant R01 HL 107904.