By David M. Kaffey, DDS

It’s all connected.

Black and White.

Up and down.

Ying and Yang.

Sun and Moon.

Ketchup and Mustard (ok, that’s not a great example but you get the point.)

Why should we think that the health of our bodies is any different? For the longest time, in Western society people didn’t recognize the connection between the health of one part of the body to the health of other parts. In fact, many people still don’t recognize these connections, as hard as that is to believe. Now, I must say, I am not a Zen based fully organic all natural no artificial colors kind of guy. I like my Coco puffs, full strength caffeinated coffee, and thin mint Girl Scout cookies. Don’t get me wrong. I have nothing against the all-natural crowd; it’s just not who I am. I’m a dentist who has studied science and healthcare his entire life. My thought process is very analytical, evidence based, and I need facts before I form an opinion on a subject. I think many of you are probably a little like me, if not a lot like me.

Your mouth is the mirror that can reflect the overall health of your body. Over the past several decades, there has been a tremendous amount of research directed at discovering the links between oral health and overall body health. It has long been believed that since the mouth is an easily accessible window to the body, that perhaps the health status of our mouths can give us a strong indication of the health of our bodies. The area of our mouths that has been the focus of this intense research over the years has been our gums. Surely, not a topic as glamorous as spider vein surgery or tummy tucks, but one that can save your life.

Did you know there is a connection between the health of your gums and your potential to have a heart attack, have a preterm low birth weight baby, or have increased complications with diabetes? How about the association between gum disease, osteoporosis and lung disease? As more and more research and studies are conducted on the associations between oral health and general body health, it is becoming very clear that in order to get healthy, be healthy, and stay healthy, you must have and maintain a healthy mouth.

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. It can affect one tooth or many teeth and it begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene and, at this stage, is reversible with professional treatment and good oral home care. Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. When this occurs, toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Approximately 15 percent of adults between 21 and 50 years old and 30 percent of adults over 50 have the disease. Often, this destructive process has very mild symptoms including bad breath, slight bleeding when brushing, and red/tender gums. Eventually, teeth can become loose and may have to be removed.

The main cause of periodontal disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. However, factors like the following also affect the health of your gums:

Smoking/Tobacco Use
As you probably already know, tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. What you may not know is that tobacco users also are at increased risk for periodontal disease. In fact, recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

Pregnancy and Puberty
As a woman, you know that your health needs are unique. You know that brushing and flossing daily, a healthy diet, and regular exercise are all important to help you stay in shape. You also know that at specific times in your life, you need to take extra care of yourself. Times when you mature and change, for example, puberty or menopause, and times when you have special health needs, such as menstruation or pregnancy. During these particular times, your body experiences hormonal changes. These changes can affect many of the tissues in your body, including your gums. Your gums can become sensitive, and at times react strongly to the hormonal fluctuations. This may make you more susceptible to gum disease. Additionally, recent studies suggest that pregnant women with gum disease are seven times more likely to deliver preterm, low birth weight babies.

Stress
As you probably already know, stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. What you may not know is that stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

Medications
Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

Diabetes
Diabetes is a disease that causes altered levels of sugar in the blood. Diabetes develops from either a deficiency in insulin production (a hormone that is the key component in the body's ability to use blood sugars) or the body's inability to use insulin correctly. According to the American Diabetes Association, approximately 16 million Americans have diabetes; however, more than half have not been diagnosed with this disease. If you are diabetic, you are at higher risk for developing infections, including periodontal diseases. These infections can impair the ability to process and/or utilize insulin, which may cause your diabetes to be more difficult to control and your infection to be more severe than a non-diabetic.

Poor Nutrition
As you may already know, a diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Because periodontal disease is a serious infection, poor nutrition can worsen the condition of your gums.

Since July of 1998, evidence has continued to mount to support these links. While more research needs to be completed to say definitively that people with periodontal disease are at higher risk for developing heart disease, stroke, uncontrolled diabetes, preterm births and respiratory disease, it is clear that periodontal disease is a bacterial infection, and all infections are cause for concern.

Periodontal bacteria can enter the blood stream, travel to major organs, and begin new infections. Research is suggesting that this may:

1.      Contribute to the development of heart disease, the nation's leading cause of death

2.      Increase the risk of stroke

3.      Be linked to osteoporosis

4.      Increase a woman’s risk of having a preterm, low birth weight baby

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.

Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Researchers have suggested that a link between osteoporosis and bone loss in the jaw exists. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation. However, hormone replacement therapy may offer some protection against this destructive process. A study published in the Journal of Periodontology concludes that estrogen supplementation in women within five years of menopause slows the progression of periodontal disease. Researchers have suspected that estrogen deficiency and osteoporosis speed the progression of oral bone loss following menopause. The study concluded that estrogen supplementation might decrease gum  inflammation and the rate of destruction of the fibers and bone that support the teeth  in women with signs of osteoporosis.  

Now evidence is mounting that suggests a new risk factor – periodontal disease. Pregnant women who have periodontal disease may be seven times more likely to have a baby that is born too early and too small. Ongoing research indicates that periodontal disease triggers increased levels of biological fluids that induce labor. Furthermore, data suggests that women whose periodontal condition worsens during pregnancy have an even higher risk of having a premature baby.

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because diabetics are more susceptible to contracting infections. In fact, periodontal disease is often considered the sixth complication of diabetes. A study in the November issue of the Journal of Periodontology found that poorly controlled type 2 diabetic patients are more likely to develop periodontal disease than well-controlled diabetics are. Research has emerged that suggests that the relationship between periodontal disease and diabetes goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts diabetics at increased risk for diabetic complications and periodontal disease in these people needs to be aggressively treated. This recommendation is supported by a study reported in the Journal of Periodontology in 1997 involving 113 Pima Indians with both diabetes and periodontal disease. The study found that when their periodontal infections were treated, the management of their diabetes markedly improved.

Bacterial respiratory infections are thought to be acquired through aspiration (inhaling) of fine droplets from the mouth and throat into the lungs. These droplets contain germs that can breed and multiply within the lungs to cause damage. Recent research suggests that bacteria found in the throat, as well as bacteria found in the mouth, can be drawn into the lower respiratory tract. This can cause infections or worsen existing lung conditions. People with respiratory diseases, such as chronic obstructive pulmonary disease, typically suffer from reduced protective systems, making it difficult to eliminate bacteria from the lungs. Scientists have found that bacteria that grow in the oral cavity can be aspirated into the lung to cause respiratory diseases such as pneumonia, especially in people with periodontal disease. This discovery leads researchers to believe that these respiratory bacteria can travel from the oral cavity into the lungs to cause infection.

Chronic obstructive pulmonary diseases (COPD) cause persistent obstruction of the airways. The main cause of this disease is thought to be long-term smoking. Chemicals from smoke or air pollution irritate the airways to cause obstruction. Further damage to the tissue and working function of the lungs can be prevented, but already damaged tissue cannot be restored - untreated or undetected COPD can result in irreversible damage. Scientists believe that through the aspiration process, bacteria can cause frequent bouts of infection in patients with COPD. Studies are now in progress to learn to what extent oral hygiene and periodontal disease may be associated with more frequents bouts of respiratory disease in COPD patients.

To help reduce your chances of developing periodontal disease there are several key steps that must be taken. Firstly, good home care needs to include brushing at least twice a day, and flossing daily. We have all heard that before but now you know why it is so important. You should also consider the use of an oral antibacterial rinse with the American Dental Association seal of acceptance is part of your daily hygiene regiment. Secondly, regular check ups and gum disease evaluations at least twice a year by your dentist are critical. Should you have periodontal disease, your dentist will be able to advise you on which treatments are best suited for you. They will also continue to educate you on ways to prevent the condition from developing.

It’s all connected.

On and Off

North and South

Big and Small

Right and Left

And most importantly Brush and Floss