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James Merrett DDS
Oral Health: Don’t Brush it Aside
Your mouth is trying to tell you something.
By Rich Maloof for MSN Health & Fitness
What motivates you to visit the dentist: A sore molar? Time for a cleaning? A crush on the hygienist? These are all (or nearly all) sound reasons for keeping your semi-annual appointment. But there’s a significant link between your smile and your overall health that has recently come to light.
Dental experts and medical physicians are learning to recognize striking correlations between oral hygiene and serious diseases, providing all new incentives to take excellent care of your teeth and gums.
Try a little tenderness
Unless you floss every day—and only 10 percent of the population does, according to the American Dental Association (ADA)—chances are good that your gums swell and bleed during a dental cleaning. A little inflammation and tenderness is normal and can be brought under control.
“If your gum is tender, it’s because you have inflammation caused by bacterial plaque,” explains Dr. Kimberly Harms, consumer adviser for the ADA. “There are toxins in the bacteria that are sitting between your tooth and gum. That bacteria is already at work in those little pockets if your gums are bleeding.”
About 70 percent of adults over 35 have some form of gum disease. Gingivitis, or inflammation of the gums, is reversible; floss regularly and your gums will regain resilience and a health pink hue. However, unhealthy gums that remain sensitive and inflamed can lead to far more trouble than a little discomfort in the dentist’s chair. When moderate to severe inflammation sustains for a period of time, the bone that holds your teeth in place begins to decay.
“Once you have bone loss, that’s not reversible. You can’t bring that bone back,” says Dr. Harms.
Bone loss (periodontal disease) can in turn cause loss of teeth—which is bad enough in its own right. But at least that condition is confined to the mouth. Growing evidence indicates that chronic gum inflammation is associated with life-threatening inflammations deeper in the body.
Tracing the pathway
Jonathan B. Levine, DMD, PC, is an associate professor at the NYU School of Dentistry and has a degree from Cornell University in microbiology, so he’s acutely aware of the damage unchecked bacteria can wrought on the body. He explains here the pathway bacteria takes from the mouth to critical systems.
“When there’s chronic gum inflammation, bacteria byproducts start accruing around the roots of the teeth,” Dr. Levine describes. “If the wall of the gum tissue gets too inflamed, it can thin to a point where it’s permeable. There are these micro-cuts in the gum lining, almost like tiny cuts on your finger. With the gum opened, there’s a pathway — a portal of entry for bacteria to get into the bloodstream.”
The current thinking is that when these bacterial byproducts enter the bloodstream, they end up nicking the walls of the arteries. As the immune system dispatches its cellular soldiers to heal the nicks, there’s a cascade of inflammation that eventually leads to clot formations and plaque buildup in the arteries.
“There have been studies showing that the plaque from periodontal disease is the same plaque that builds up on the carotid artery,” says Dr. Levine. “So now you’re at risk for cardiovascular disease, or CVD. And if the plaque gets dislodged, you’re looking at the potential for a stroke.”
Dentists as detectives
Research confirms a connection between oral and arterial plaque, though no one would claim that gum inflammation is as much a risk factor as smoking or obesity. For cardiologists and dentists, though, an understanding of the link can quite literally be a life-saver. CVD and stroke, two of the nation’s leading killers, are not the only systemic conditions that have been related to oral bacteria, either. A 2008 study from Dr. Levine’s own institution provided evidence that gum inflammation contributed to brain inflammation and resulted in threefold memory loss. The NYU study supported a long-held hypothesis about the link between periodontal disease and Alzheimer’s.
All of these connections to oral hygiene position the dentist as a first line of defense against disease. The reality is, people see dentists a lot more often than they see internists.
“We’re the dental detectives,” says Dr. Levine. “When there’s no obvious cause of chronic inflammation, we have to move into risk assessment. Is the patient on medication? Some meds can cause inflammation. But so can diabetes. Diabetics have a much higher percentage of periodontal disease.”
Thanks to advances in technology, dentists today are also better equipped to detect oral cancers. Using a device called the VELscope, Dr. Levine can identify classic warning signs in the tissues of the mouth. Every visit to his office is a de facto cancer screening.
About that “apple a day”…
So, what can you do to improve your oral hygiene? A healthy lifestyle in the broadest terms contributes to a healthy mouth, and it all begins with nutrition. Dr. Levine notes that Americans favor a diet of high-protein meats and a lot of sugars—both of which make for an acidic oral environment in which damaging bacteria thrive. Adding more fruits and vegetables, which are alkaline, to the diet balances the pH and gives the gums a fighting chance against bacterial invaders.
The ADA also recommends brushing three times a day for two minutes each time (that’s 30 seconds in each quadrant of the mouth) and flossing every day. But you knew that already. If it seems like too much time to commit, consider how long it took to eat that cookie after lunch, or how long you chew on one piece of gum. Most of the damage we do to our mouths can be undone in a fraction of the time.
Be sure to catch your dental checkups and cleanings twice a year. You may be too old for a pat on the head and a free toothbrush on the way out. But when your dentist leaves you with a clean bill of health, it’s one gift you are sure to appreciate.
Rich Maloof is a regular contributor to MSN Health & Fitness. He specializes in health as well as technology and music. Rich has also written for CNN, Yahoo!, Women's Health, Billboard and the “For Dummies” book series.
