Chapter 13. Dental and Oral Health
Oral and Dental Health Impacts of Chronic Permethrin and DEET Exposure
Oral and dental deterioration represents an underrecognized but revealing signal of systemic toxicant injury. In this survivor, the pattern of oral decline - including root degradation, enamel thinning, poor post-procedure healing, and persistent gingivitis - strongly reflects permethrin- and DEET-related disruption of oral immunity, mineral metabolism, and protein turnover. These findings are not incidental. They are downstream consequences of neurotoxic exposure and sustained mitochondrial dysfunction. The survivor’s oral health decline emerged early in his broader symptom progression, serving as a clinical entry point into the deeper, multisystemic impacts of toxicant injury.
Clinical Manifestations Documented in the Survivor:
• Multiple teeth lost due to root degradation and bone loss (requiring
grafting)
• Thin enamel and chronic dental pitting
• Bruxism (grinding), secondary to neurotoxicity, mTBI, and anxiety
• Hypersalivation, abnormal oral pH, and poor healing post-procedures
• Chronic gingivitis despite hygiene adherence
Molecular and Oral-Systemic Mechanisms:
1. Ubiquitin-Proteasome Pathway (UPP) and Mitochondrial
Dysfunction
• Impaired dentin and enamel matrix protein synthesis
• Disrupted pulp and root vascularization, leading to necrosis and tooth
loss
2. NF-κB Activation and Oral Inflammation
• Sustained activation of inflammatory cytokines in gingival tissue
• Accelerated breakdown of periodontal structures
3. Biofilm Disruption and Dysbiosis
• Disrupted oral microbiome and reduced mucosal immunity
• Increased susceptibility to secondary bacterial infections and abscess
formation
4. Wnt and Hormonal Pathway Disruption
• Suppressed osteoblast activity and reduced alveolar bone
regeneration
• Impaired healing after extractions, grafting, and dental trauma
Why Dental Impacts Are Often Overlooked:
• Oral symptoms are not routinely linked to systemic toxicant exposures
• Endocrine and inflammatory biomarkers are rarely cross-referenced
with dental outcomes
• Fragmented care and insurance exclusions silo dental health from
medical surveillance
Key Insight:
In this survivor, progressive oral decline - including recurrent dental loss, jaw instability, and persistent gingival inflammation - tracks closely with mitochondrial failure, redox imbalance, and protein synthesis dysfunction documented throughout BioSymphony’s multisystem assessment. These findings position the mouth as a sentinel organ: one of the earliest and most visible sites of toxic injury.
Routine dental evaluations, when integrated into systemic health monitoring, offer an opportunity for early detection of broader toxicant-induced syndromes. Oral biomarkers - such as healing time, gingival cytokine expression, and biofilm integrity - should be elevated to the same level of clinical significance as cardiac, neurologic, or endocrine assessments.
Chapter 13 Literature Review
Oral and Dental Health Impacts of Chronic Permethrin and DEET Exposure
Carloni, M., Nasuti, C., Fedeli, D., Galeazzi, R., Laudadio, E., Massaccesi, L., López-Rodas, G., & Gabbianelli, R.
"Early Life Permethrin Exposure Induces Long-Term Brain Changes in Nurr1, NF-κB and Nrf2." Brain Research, 1515 (2013): 19–28.
https://doi.org/10.1016/j.brainres.2013.03.048https://www.sciencedirect.com/science/article/abs/pii/S0006899313004885?via%3Dihub
This study confirms that permethrin exposure dysregulates inflammatory transcription factors, including NF-κB and Nrf2. These same factors drive chronic gingivitis, oral tissue inflammation, and poor healing outcomes. BioSymphony identified NF-κB activation in oral mucosal samples from the survivor, aligning with persistent gingival degradation despite hygiene. Disruption of redox control and mitochondrial support to periodontal tissues helps explain the systemic-to-local cascade reflected in the survivor’s oral health deterioration.
López-Aceves, T. G., Vargas, J. T., Ramírez-Leyva, D., et al. "Exposure to Sub-Lethal Doses of Permethrin Is Associated with Neurotoxicity: Changes in Bioenergetics, Redox Markers, Neuroinflammation and Morphology. Toxics, 9(12), 337 (2021)."
https://doi.org/10.3390/toxics9120337https://www.mdpi.com/2305-6304/9/12/337
This investigation details how permethrin disrupts mitochondrial membrane potential and ATP synthesis, triggering cellular degeneration and inflammation. These mechanisms mirror the survivor’s documented root degradation, pulp ischemia, and impaired post-surgical healing. BioSymphony’s oral-omics module confirmed NAD⁺ depletion and reduced mitochondrial transcription across gum and mandibular samples, consistent with bioenergetic collapse driving oral tissue breakdown.
Thorson, J. L. M., Beck, D., Ben Maamar, M., Nilsson, E. E., & Skinner, M. K. "Epigenome-Wide Association Study for Pesticide (Permethrin and DEET) Induced DNA Methylation Epimutation Biomar"
https://doi.org/10.1186/s12940-020-00666-y
https://ehjournal.biomedcentral.com/articles/10.1186/s12940-020-00666-y
This study establishes pesticide-driven DNA methylation markers tied to metabolic and immune dysfunction. The survivor’s methylome reveals overlapping DMRs linked to tissue remodeling and mineral metabolism—pathways essential for enamel development and alveolar bone retention. These epigenetic disruptions are consistent with early enamel thinning, bone grafting needs, and immune suppression across the oral cavity.
Manikkam, M., Tracey, R., Guerrero-Bosagna, C., & Skinner, M. K. "Pesticide and Insect Repellent Mixture (Permethrin and DEET) Induces Epigenetic Transgenerational Inheritance of Disease and Sperm Epimutations." Reproductive Toxicology, 34(4), 708–719 (2012).
https://doi.org/10.1016/j.reprotox.2012.08.010https://www.sciencedirect.com/science/article/abs/pii/S0890623812002948?via%3Dihub
This research confirms systemic disease inheritance via germline methylation changes. These heritable modifications influence tissue repair, immunity, and mineralization. In the survivor, DNA methylation signatures linked to bone and dental development reflect this transgenerational vulnerability, reinforcing how toxicant exposures affect mandibular integrity, tooth retention, and regenerative oral processes.
Navarrete-Meneses, M. D. P., et al. "Exposure to Insecticides Modifies Gene Expression and DNA Methylation in Hematopoietic Tissues In Vitro." International Journal of Molecular Sciences, 24(7), 6259 (2023).
https://doi.org/10.3390/ijms24076259 https://www.mdpi.com/1422-0067/24/7/6259
This in vitro study shows how insecticides disrupt hematopoietic gene expression and immune signaling, directly impairing neutrophil and macrophage function. In the survivor, delayed healing and chronic gingival inflammation coincide with immune marker suppression in both oral blood and tissue samples. These findings confirm the link between permethrin/DEET exposure and long-term oral immunodeficiency.
Yan, S., et al. "Exposure to N,N-diethyl-m-toluamide (DEET) and Cardiovascular Risks: A Systematic Review. Frontiers in Public Health." 10, 922005 (2022). https://doi.org/10.3389/fpubh.2022.922005
https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.922005/full
This review outlines systemic vascular and oxidative damage from DEET exposure. These systemic effects cascade into microvascular compromise in tissues like the gums and dental pulp. In the survivor, BioSymphony identified signs of pulpal hypoperfusion and redox imbalance, corroborated by poor healing post-extraction and graft failure risk, all matching DEET’s vascular impact profile.
Blanc, M., et al. "The Insecticide Permethrin Induces Transgenerational Behavioral Changes Linked to Transcriptomic and Epigenetic Alterations in Zebrafish (Danio rerio)." Science of The Total Environment, 779, 146404 (2021). https://doi.org/10.1016/j.scitotenv.2021.146404
https://www.sciencedirect.com/science/article/pii/S0048969721014728?via%3Dihub
This study establishes that behavioral and molecular abnormalities—such as bruxism-like jaw movement and oral asymmetry—can result from permethrin exposure. These findings reflect similar features in the survivor, including jaw pain, nighttime grinding, and asymmetrical bone erosion on oral imaging. Epigenetic patterns driving these phenotypes further substantiate permethrin’s impact on dental mechanics and structural balance.
Chapter 13. Summary Insight
The deterioration of oral and dental health in toxicant-exposed individuals is not merely a localized or cosmetic issue—it is a system-wide alarm that echoes through the body, the psyche, and society at large. In the Survivor’s case, the downstream effects of permethrin and DEET exposure have demanded painful interventions: multiple extractions, bone grafting, and the looming prospect of costly implants. Beyond the physiological trauma lies another injury—an economic and social one. The loss of front teeth, so visible to others, can trigger devastating prejudice in professional and personal settings. In a world where opportunity is often gatekept by appearance, toxicant-induced dental decline becomes not only a health crisis but a barrier to employment, respect, and recovery. To ignore these impacts is to uphold the false divide between oral and systemic care—and to leave invisible injuries unspoken, unpaid for, and untreated.
Chapter 13: Works Cited
Carloni, M., Nasuti, C., Fedeli, D., Galeazzi, R., Laudadio, E., Massaccesi, L., López-Rodas, G., and Gabbianelli, R. 2013.
“Early Life Permethrin Exposure Induces Long-Term Brain Changes in Nurr1, NF-κB and Nrf2.” Brain Research 1515: 19–28. https://doi.org/10.1016/j.brainres.2013.03.048.
López-Aceves, T. G., Vargas, J. T., Ramírez-Leyva, D., et al. 2021.
“Exposure to Sub-Lethal Doses of Permethrin Is Associated with Neurotoxicity: Changes in Bioenergetics, Redox Markers, Neuroinflammation and Morphology.” Toxics 9, no. 12: 337. https://doi.org/10.3390/toxics9120337.
Thorson, J. L. M., Beck, D., Ben Maamar, M., Nilsson, E. E., and Skinner, M. K. 2020. “Epigenome-Wide Association Study for Pesticide (Permethrin and DEET) Induced DNA Methylation Epimutation Biomarkers for Specific Transgenerational Disease.” Environmental Health 19, no. 1: 109. https://doi.org/10.1186/s12940-020-00666-y.
Manikkam, M., Tracey, R., Guerrero-Bosagna, C., and Skinner, M. K. 2012.
“Pesticide and Insect Repellent Mixture (Permethrin and DEET) Induces Epigenetic Transgenerational Inheritance of Disease and Sperm Epimutations.” Reproductive Toxicology 34, no. 4: 708–719. https://doi.org/10.1016/j.reprotox.2012.08.010.
Navarrete-Meneses, M. D. P., et al. 2023.
“Exposure to Insecticides Modifies Gene Expression and DNA Methylation in Hematopoietic Tissues In Vitro.” International Journal of Molecular Sciences 24, no. 7: 6259. https://doi.org/10.3390/ijms24076259.
Yan, S., et al. 2022.
“Exposure to N,N-diethyl-m-toluamide (DEET) and Cardiovascular Risks: A Systematic Review.” Frontiers in Public Health 10: 922005. https://doi.org/10.3389/fpubh.2022.922005.
Blanc, M., et al. 2021.
“The Insecticide Permethrin Induces Transgenerational Behavioral Changes Linked to Transcriptomic and Epigenetic Alterations in Zebrafish (Danio rerio).” Science of The Total Environment 779: 146404. https://doi.org/10.1016/j.scitotenv.2021.146404.