Reference Erdrich S, Harnett JE. Oral health is associated with disorders of gut–brain interaction in adult women. Dig Dis Sci 2025 Feb;70(2):638-43. That result echoed earlier research in patients with temporomandibular joint disorders (TMJ), where Mycoplasma had been detected in joint fluid and implicated in chronic jaw pain. “When we looked at migraine specifically, Mycoplasma species were strongly associated,” Dr. Erdrich says. “It starts to build a picture of microbes and pain.” Still, she is cautious about what these findings mean because association is not proof of cause. “This is an association study,” she says. “We’ve shown links, but not that fixing poor oral health cures pain. The next step is intervention and designing that aspect well is difficult. But the signal is there.” enough evidence for practical steps. She would like physicians to make oral health part of pain questions. “Dentists rarely ask about migraines, and physicians rarely ask about gums, but both should,” she says. She hopes that physicians will begin to see bleeding gums as a systemic risk marker. “Leaky gums are inflamed mucosa and disrupted barrier function. That’s not just a local problem,” she says. When early periodontal disease shows up in patients, she hopes dentists will think beyond the mouth. “Early periodontal disease? That’s a good moment to recommend a cardiovascular check-in. The two worlds need to talk more,” she says. Perhaps the most important thread in Dr. Erdrich’s work is conceptual. “Our data suggest that for some people, chronic pain may be, in part, an oral health story.” She puts it simply: “The mouth isn’t a separate department. It’s part of the body’s whole system. We need to start treating it that way.” To some, the mouth and musculoskeletal pain can seem worlds apart. Dr. Erdrich thinks that’s part of the problem. “Medicine has separated the mouth from the body,” she says. “Primary care almost never looks at teeth and gums beyond a quick view of the throat. I’d love to see oral health assessment become routine in medical visits.” The idea that periodontal inflammation is a door for microbial products and even microbes themselves meshes with long-established observations linking gum disease with heart disease. Modern DNA sequencing technologies have supercharged the field: genebased methods can now detect once unculturable microorganisms and, in some studies, focus on metabolically active microbes rather than DNA fragments alone. “Some people may forget that the mouth is the start of the digestive tract,” Dr. Erdrich says. “You swallow organisms from the oral microbiome all day. Biofilm on teeth creates micro-environments without oxygen, which is perfect for the anaerobes most implicated in periodontal disease and, in our data, in pain.” Dr. Erdrich is quick to say that more research and clinical trials are needed. Still, she believes there’s We’ve shown links, but not that fixing poor oral health cures pain. The next step is intervention and designing that aspect well is difficult. But the signal is there. 28 | 2025 | Issue 6 Issues and People
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