Word of Mouth




If you want a healthy body, be sure you have healthy teeth and gums.

Many of us occasionally let our floss container gather dust or skip a dental cleaning because we are busy or tired or have other things we’d rather do. But if you think that all you’re risking is maybe some minor tooth trouble, check out the latest studies that show associations between oral health and overall health — including risk of coronary artery disease and stroke.

Poor oral health, particularly gum or “periodontal” disease, which affects an estimated 80 percent of American adults, according to the National Institutes of Health, has been linked with a variety of ailments, including diabetes, heart disease, stroke, the birth of premature and low-birth-weight babies and respiratory illness. While a causal relationship has not been established, some experts are convinced that not only can oral health affect overall health, it can also provide clues and act as a sort of harbinger of illness that is seemingly unrelated to our teeth and gums.

Thigh bone’s connected to the knee boneThe leading theories that support a mouth-body connection rely on the idea that gum disease-induced bacteria or inflammation can contribute to events that affect the body’s other systems. Bacteria in the mouth, for instance, might travel through the bloodstream and worsen clot formation in coronary arteries, causing heart-related trouble.

In some instances, dental woes can signify current systemic health problems or even portend troubles that are brewing, says Bernard W. Ang, D.M.D., a general dentist at Amherst Village Dental. For example, some patients claim that their home care is meticulous, yet they show up at the dentist’s office with a lot of plaque on their teeth. Such a “telltale sign” can indicate a systemic problem — a calcium imbalance, perhaps — with implications that extend beyond the patient’s mouth, Ang says. Health problems can manifest themselves early in the mouth “because oral tissues get turned over very, very quickly,” he says, with mouth-related cells regenerating themselves rapidly. “It’s all connected,” Ang says.

“When you look into a patient’s mouth, you can get a picture of their overall health,” he says.

What to watch for

Gum disease does not always present itself in an obvious fashion to the average patient, though. Symptoms include red or swollen gums, gums that bleed easily, persistent bad breath and sensitivity, but “sometimes you can have no symptoms at all, and not be aware” that you have periodontal disease, says Robert N. Marshall, D.M.D., M.A.G.D., a general dentist at Aesthetic Dental Center in Concord. Even without any kind of gum tenderness or bad breath, you could be losing bone around your teeth, he says.

The typical test for detecting gum disease is periodontal probing, when a hygienist or dentist measures the amount of unattached tissue that surrounds each tooth. Too much unattached tissue means plaque and bacteria are spreading below the gum line. “Our teeth are like trees in the forest,” Marshall says. “As they lose the dirt around them or the supporting structure around them, they fall over.” If the gum disease is left unchecked, it will erode the bone around the teeth, eventually leading to tooth loss.

SolutionsPatients who develop periodontal disease have a broad range of treatment options. Antibiotics or frequent deep cleanings will be the Rx for some. Other, more serious cases might be referred to a periodontist for surgery. Treatment recommendations vary greatly depending on the extent of the disease, of course, but they also depend on the philosophy of the doctor, Marshall and Ang say. Some dentists believe surgery is the only effective way to treat gum disease, while others prefer to explore less invasive options first, such as scaling and root planing, which involve thoroughly cleaning the root surface of the tooth or applying antimicrobial agents to combat bacteria around teeth.

Regardless of treatment, for many patients with gum disease, a permanent solution can be hard to come by. “The easiest thing for me to fix is holes in teeth or cavities or decay around the tooth,” Marshall says. “The hardest thing is periodontal disease because periodontal disease is something that never goes away. You’re more prone, even after we treat it.” Why gum disease sometimes lingers is unclear, Marshall says, although he suspects that genetics might play a role in some cases, especially since even patients who diligently take care of their teeth sometimes end up with gum disease.

Gum disease that is unrelenting despite a doctor’s and patient’s best efforts could also indicate that the main problem or cause of gum trouble has not been identified, Ang says, and should prompt open-minded, holistic-based questioning and follow-up.

Taking a bite out of illness

As experts continue to mine our mouths for important clues and connections relating to overall health, the boundaries between dental and medical doctor might blur a bit. Dentists need to take the time to educate patients, Ang says, especially those who underestimate the power of oral health and the influence it can have over general health.

Patients need to understand that oral trouble “is not simply what it seems,” and that there’s more at stake than just the welfare of their teeth, Ang says.

Many people think that certain oral health problems are normal or inevitable, he says, and chalk up recession and mild gum disease to aging.

Plus, “it’s human nature” to skimp on oral care and downplay gum problems at least initially, he says, because gum disease often doesn’t hurt until it is advanced. But “just because it doesn’t hurt doesn’t mean that it’s healthy,”

he says. NH

So, you think you can brush?We all know that tooth brushing is one of the cornerstones of maintaining oral health. Doesn’t sound too tough, yet some of us aren’t doing it correctly. Brushing properly is not as easy as you might think, says Robert N. Marshall, D.M.D., M.A.G.D., a general dentist at Aesthetic Dental Center in Concord. “Something as simple as brushing your teeth, not done well, will drastically affect your health and gum tissue,” he says.

It’s like a spotty car-washing job done by local fundraisers in a parking lot on a sunny Saturday, he says: “Proper technique is key.” You can’t miss a bunch of places and expect good results.

But bad brushing is a common problem, with many people not realizing that they’re brushing improperly, Marshall says. So don’t be shy about asking your dentist for some pointers, and don’t be insulted if your dentist offers unsolicited brushing advice. You can also visit The American Dental Association’s Web site, www.ada.org, for brushing tips.

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