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Floss For Your Life

Posted: Tuesday, January 20, 2004

Having immaculate spaces between your molars and bicuspids isn't as sexy as bleaching them a pearly white, but it has far greater implications for your overall health, doctors now believe.

While it's long been known that gum disease can lead to tooth loss if left untreated, researchers point to a growing body of evidence that inflammation below the gum line may also be associated with more insidious and far-reaching health effects.

Studies increasingly suggest that gum problems may contribute to heart disease and stroke, exacerbate diabetes and spur preterm labor in pregnant women. Unhealthy gums may also be a sign of broader systemic illnesses, such as diabetes. Scientists suspect they've only just begun to discover what health problems might be linked to gum disease.

"What's going on in the mouth can be a mirror for what's going on systemically," said Dr. Sally Cram, a consumer adviser for the American Dental Association.

"And it would be better if people were more aware of it," said Dr. Michael Rethman, president of the American Academy of Periodontology.

To be sure, swollen, bleeding gums have long been perceived as harmless enough to most members of the public. Trips to the dentist have more often been initiated out of desires to get teeth lightly buffed or a nagging toothache addressed than concern about gum health.

Cram used to tell gum-disease patients they were suffering from "a really chronic, low-grade infection, but it really doesn't kill people." But now, she says, she tells them the opposite.

With research in the past few years indicating that gum disease patients are likely to be at higher risk for heart attacks and strokes, the best thing she can say about the ailment is that "it is totally preventable," she said.

An estimated 80% of American adults have some form of gum disease, according to the National Institutes of Health. Also known as periodontal disease, it is characterized by red or swollen gums, persistent bad breath, bloody gums, loose teeth and pain while chewing.

It often starts innocently enough, with the slight buildup of bacteria on teeth. Any of this filmy paste that is not removed with thorough and regular brushing and flossing can then harden, becoming a substance known as tartar that only a professional cleaning can eliminate.

In its earliest stage, this inflammation of the gums is called gingivitis, a mild form of gum disease that can often be reversed through good dental cleanings.

When left untreated, it can become much more severe, a condition known as periodontitis, that everyone would certainly be better off avoiding. Gums pull away from the teeth and bacteria spread below the gum line. Then the bacteria create toxins that can eat away at the teeth, producing significant bone loss, Cram said.

Some studies have also suggested these bacteria can travel throughout the body, where they may settle and cause inflammation that can wreak havoc.

"We are pretty sure people who have moderate to severe disease" in their gums "do seem to have other things at the same time at a higher rate. These include heart disease and stroke," said Dr. Mark Ryder, chair of periodontology at the University of California at San Francisco. "If you are a diabetic with periodontal disease, your odds of having worsened diabetes are also higher." But saying that gum disease is the direct cause of these other woes "is so hard to prove," Ryder said.

The mouth as window

In one of the more telling studies to date, however, researchers reported last fall that the more teeth a person has lost, the more likely he or she is to have advanced gum disease and potentially dangerous plaque in the carotid artery, the main vessel that leads to the brain.

Published online in the journal Stroke, the report supports the notion that bacteria from the gums can enter the circulatory system and then, quite possibly, cause or contribute to disease in other regions of the body.

Other studies have found an association between gum disease and the birth of preterm, low-birth-weight babies in pregnant women, and the development of pneumonia and chronic obstructive pulmonary disease in seniors.

But if gum disease can give way to other health problems, research suggests the converse might also be true. Having diabetes may predispose people to having gum problems because the disease can make them more susceptible to infection and probably contribute to the breakdown of tissues around the teeth, Ryder said.

In fact, in many patients who have weakened immune systems, such as those with HIV or AIDS, there tends to be a greater incidence of gum disease and bone loss around teeth, according to Cram.

In this regard, gum disease is both the chicken and the egg, likely coming both first and last, scientists believe. At times it may help contribute to diseases, and at others it may result from them.

Either way, the mouth "may be a window to a whole bunch of things that are awfully important," Rethman said.

Dentists can help patients get a sense of whether their gum disease is advanced by taking X-rays of the teeth and measuring the gums.

Healthy gums resemble a good-fitting turtleneck: The collars of flesh are snug, yet flexible, Cram said. They might separate from the teeth a little bit, creating pockets of about 2 to 3 millimeters. But those that are infected are more reminiscent of a cowl neck. "The collar starts loosening up and pulling away from the tooth," Cram said.

With periodontitis, pockets may be 5 or 6 millimeters deep; patients with severe forms of the disease can have pockets 10, 11 or 12 millimeters deep.

Treatment can be as simple as a deep-cleaning method known as scaling and root planing or the administration of any of a number of anti-bacterial medicine. Surgery also might be warranted.

But dental professionals say that prevention remains the best medicine. And they believe that more people could use a healthy dose.

"Almost everyone has some area in their mouth where they have gingivitis," said JoAnn Galliano, a professor of dental hygiene at Chabot College, in Hayward, Calif. "It's rare to find someone who has no areas in their mouth that bleed."

Preventing gum problems

  • Brush your teeth every morning and every night, spending at least two minutes doing so. Set a timer so you don't stop too early.
  • Consider using an anti-bacterial toothpaste, such as Colgate Total, which can target plaque.
  • Floss your teeth – daily.
  • Buy an electric toothbrush if you find your brushing is a bit sloppy.
  • Recognize that while mouthwash can be a nice adjunct to cleanings, it shouldn't replace brushing or flossing.
  • Stop smoking.
  • Visit a dentist for regular checkups and cleanings.
  • Show your dentist how you brush and floss and ask if you are doing each correctly.
  • Source: New York Daily News

     
     
     
     
     
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