Mind Your Mouth

There are strong links between poor oral health and systemic ailments like diabetes, Alzheimer’s, heart disease and certain types of cancer.

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The way to a person’s heart is through his stomach, the adage goes. Researchers now think the way to a healthy heart might be through your gums and teeth.

Evidence suggests that the healthier these are, the stronger and less disease-prone the heart is. If you don’t floss or brush, you might be setting yourself up not just for gum disease but also for heart disease. The link between what’s happening in your mouth and in the rest of your body goes further still: gum disease might be a kind of early warning system, with poor oral health linked to diabetes, kidney disease, preterm labour, osteoporosis, Alzheimer’s disease and even certain types of cancer.

“A lot of studies are coming out that suggest some possible link or associations” between oral infection and systemic disorders, says Sally Cram, a periodontist in the District of Columbia, in the US.

There’s a certain logic to the idea that your mouth — your body’s key opening to the outside — is a harbinger of bodily health. Yet the connection is one that many people, even medical professionals, often overlook. Patients tend to minimise oral health, treating mouth issues as merely “dental”. Professionals echo this artificial dichotomy: dentists and doctors don’t really talk to one another; they don’t attend the same conferences; they don’t read the same journals.

But recent research shows a startling correlation between gum health and atherosclerosis, a condition underlying much heart disease: the worse a person’s gum disease, the narrower that person’s arteries owing to a build-up of plaque. This holds even for young, healthy adults who have no other symptoms of heart disease.

Many questions remain about the nature of the body-mouth connection. In gum disease (called gingivitis in the early stages, before it develops into full-blown periodontal disease), the tissue that surrounds the bones supporting the teeth becomes infected. Often this results from the accumulation of bacteria in the plaque under the tissue holding the teeth. The bacteria release toxins and other chemicals that begin to destroy the bone. Scientists believe they circulate and cause damage elsewhere in the body; exactly how remains unclear.

When Maurizio Tonetti of the University of Connecticut in the US conducted a study into whether reversing the production of bacteria and toxins in the mouth would benefit patients who had atherosclerosis, the results were encouraging. He reported in the New England Journal of Medicine last year that patients who underwent an intensive, six-month programme of treatment for gum disease emerged not only with healthier gums but also with improved endothelial function — that is, better function of the lining of the blood vessels.

These findings merit further study of a possible link between gum infections and preterm labour. Observational studies in the US show that rates of preterm birth are higher for women with severe gum disease than those with milder or no such disease.

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Gum disease may also be implicated in a “small, but significant” increase in overall cancer risk for men, according to a recent study in The Lancet Oncology. The authors linked gum disease with a higher chance of lung, kidney, pancreatic and blood cancers. A similar pattern is emerging for kidney disease and Alzheimer’s. But as with heart disease and preterm labour, what causes what is not known.

In diabetes, however, the body-mouth connection is clear. Diabetics who have uncontrolled gum disease, Cram said, “have a much harder time (than other diabetics) controlling their blood sugar levels.” The reverse, she noted, is also true: people with uncontrolled diabetes are about “three to four times at greater risk of developing periodontal disease.”

You would think physicians would be telling their diabetic patients to make regular dental visits to head off gum disease and that dentists would be advising patients who develop persistent gum disease to be tested for diabetes. But neither group of practitioners has been especially good at making the connection.

Dental patients need to get past thinking of their dentist primarily as a cosmetic practitioner — a whitener and straightener of teeth — a “fireman” to be called only when there’s extreme tooth pain.

Regular visits to a dentist can make the mouth an early warning system for a variety of problems. Sores or fungus in the mouth, for example, are often the very first indications of infection by HIV or of cancer. Osteoporosis, a disease of the bones, could show up in a routine dental X-ray before you notice its impact on your hips or spine.

“There’s a desperate need for more collaboration between the two specialities,” says Alan Douglass, associate professor of family medicine at the University of Connecticut School of Medicine, the US.

One thing both groups agree on is the power of prevention, which means brushing, flossing and having regular professional cleaning.

Doctors can also help identify patients at risk. The good news is that if you catch gum disease in its early stages, Cram says, “you can reverse it” with procedures such as scaling and root cleaning.

So take care of your mouth. Your heart, your brain and your kidneys may thank you for it. As another US dentist puts it: “Oral health is not an out-of-body experience.”

Sources: The Telegraph (Kolkata, India)

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