"We need to educate the public that the mouth isn't disconnected to the rest of the body," says Sally Cram, DDS, a periodontist in Washington, D.C., and spokeswoman for the American Dental Association.
How Gum Disease Spreads
Periodontal disease is an infection caused by unhealthy bacteria that lodge between the teeth and gums. Simply brushing your teeth is enough to put some of those bacteria into your bloodstream, says Robert J. Genco, DDS, PhD, an oral biologist at the University of Buffalo. The bacteria then travel to major organs where they can spur new infections.
Inflammation also plays a role in spreading the effects of bad oral health. Red and swollen gums signal the body's inflammatory response to periodontal bacteria. "If you have inflammation in your mouth, certain chemicals are produced in response that can spread [through the bloodstream] and wreak havoc elsewhere in the body," Cram says.
Evidence is mounting of the importance of the "mouth-body connection," as it is known, as dental problems are being linked to a growing list of other ailments.
Oral Health and Diabetes
Karabin has diagnosed several cases of diabetes from her dentist's chair. "When I see a patient with multiple abscesses in their mouth ... I immediately think 'diabetes.' I will send that patient for a glucose tolerance test." Nearly one-third of people with diabetes are unaware that they have it, and dentists can play a big role in diagnosing these patients, Genco says.
Diabetes and gum disease can interact in a vicious circle. Infections of any kind, including gum disease, cause the body to produce proteins called cytokines, which increase insulin resistance and make blood sugar more difficult to control, Karabin says. Conversely, uncontrolled diabetes impairs the body's healing mechanism, which makes it harder to control gum disease, Cram says.
Diabetic patients who avoid dentists out of fear or anxiety will have problems that go beyond tooth loss, says John Buse, MD, PhD, director of the Diabetes Care Center at the University of North Carolina School of Medicine. "You probably won't be able to do a good job taking care of diabetes unless you go to a dentist."
Gum disease may also speed the progression to full-blown diabetes in the 54 million Americans who are classified as prediabetic. According to the American Diabetes Association, many people first become aware they have diabetes when they develop dental disease.
In a 2007 study, Danish researchers compared prediabetic rats with gum disease to prediabetic rats without gum disease. The rats with gum disease soon displayed increased insulin resistance and other signs of progression toward type 2 diabetes.
Oral Health and Heart Disease
People with periodontal disease are nearly twice as likely to suffer from coronary artery disease as those without, according to the American Academy of Periodontology. One theory is that oral bacteria attach to fatty plaques in the coronary arteries and contribute to the clots that can lead to heart attacks. Another is that inflammation increases plaque buildup.
Although evidence has been mixed, more than 20 "good-sized" studies have demonstrated the relationship between gum disease and heart disease, Genco says. But that relationship is still not confirmed as with other known risk factors such as smoking or obesity. Genco is planning a major study to see whether treating gum disease can forestall a second heart attack in people who have already had one.
Recent analysis suggests that common oral problems could increase the risk of cardiac problems. Indra Mustapha, DDS, a periodontist who teaches at Howard University in Washington, D.C., and colleagues analyzed the results of other research studies and found that periodontal disease with signs of bacterial exposure was associated with greater risk of heart disease.
The American Heart Association states, "At this time, promoting dental treatment expressly to prevent atherosclerotic cardiovascular disease and/or acute cardiovascular events is not recommended."
Oral Health and Premature Birth
"Ob-gyns always knew that preterm and low-birth-weight births could be triggered by infections in the body," says Karabin. "They looked for urinary tract infections and throat infections, but never really thought about the mouth until a periodontic researcher looked into it."
Karabin says that severe periodontal disease in the mother may lead to an increase in the risk of premature birth. Remember those cytokines? Turns out they also increase the level of the hormone prostaglandin, which triggers labor, says Karabin. Fortunately, studies show that early treatment of gum disease and improved oral hygiene in women can reduce their risk of premature birth.
Other conditions that indicate a link between dental health and overall health include:
Osteoporosis. Osteoporosis and tooth loss often go hand in hand because the same decrease in mineral density that boosts the risk of hip and other fractures affects the jawbone and teeth. Measures taken to prevent or treat osteoporosis in postmenopausal women are likely to also help prevent severe gum disease, Genco says.
Rheumatoid arthritis. A study released in June 2008 found that patients with rheumatoid arthritis (RA) were nearly eight times more likely to have periodontal disease. RA, like periodontal disease, is an inflammatory disorder, which may help explain the link, Karabin says.
Alzheimer's disease. A 2005 study of identical twins showed that in twin pairs where one had dementia and the other didn't, the ones with dementia were four times more likely to have gum disease by midlife. The study doesn't say that good oral heath prevents Alzheimer's, but that inflammation early in life can have severe consequences later.
With the mouth and body so closely linked, dentists and physicians should collaborate more closely, Karabin says. "Physicians need to be trained to examine the mouth, and dentists need to understand more about systemic disease so they can pick up on some of the cues."
The findings also serve to bring home the importance of oral hygiene. Brush twice a day with a toothbrush with soft or medium bristles, Genco says. Clean between your teeth daily with floss, or try some of the interdental picks available at drugstores. If your gums bleed with flossing and don't stop after three to four days, see your dentist.In most cases, gum disease isn't painful. So even if you're feeling fine, visit your dentist regularly for professional cleanings and oral exams. You may find out more than you ever expected. "Today, more dentists aren't just looking at teeth and gums," says Cram. "They're giving you a good medical exam."