The red signal

“A lot of research is coming out that seem to suggest some possible link or associations” between oral infection and systemic disorders, says Sally Cram, a periodontist in the District of Columbia and consumer adviser for the American Dental Association.

There’s a certain logic, of course, to the idea that your mouth — your body’s key opening to the outside — would be 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 each other; they don’t attend the same conferences; they don’t read the same journals.

But recent research indicating a link between their disciplines is attracting attention from both doctors and dentists. Several studies show a startling correlation between gum health and atherosclerosis, a condition underlying much heart disease: The worse a person’s gum disease, the narrower his/her arteries due to a buildup 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, become inflamed or 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, is unclear.

“It is like setting up a garbage dump on the edge of a river. You wouldn’t be surprised if the lake downstream ended up polluted with the garbage from the dump,” Vincent J Iacono said in 2005, when he was president of the American Academy of Periodontology.

When Maurizio Tonetti, chair of the University of Connecticut’s Division of Periodontology, conducted a study looking 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. No, this does not necessarily mean better vascular function overall, but the experts say that these findings merit further study.

SYSTEMIC DISEASE LINK

So does a possible link between gum infections and pre-term labour: nearly 13 per cent of births in the US are considered pre-term (occurring before 37 weeks of gestation), and of these, almost half occur without explanation. This has prompted researchers to look at the role of gum disease.

Observational studies show rates of pre-term birth are higher for women with severe gum disease than those with milder or no such disease. A recent review in the journal American Family Physician noted that studies of nearly 15,000 women in “identified 24 studies demonstrating a positive relationship between periodontitis and pre-term birth, low birth weight, or both.”

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 to 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 pre-term labor, the question of what causes what has not been definitely answered. In diabetes, however, the body-mouth connection is clear-cut. 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”.

The cycle is very hard to break

You would think that 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.

Similarly, despite growing evidence of a link between pre-term labor and gum disease, only 22 to 34 per cent of US women consult a dentist during pregnancy, according to a 2001 report in the Journal of the American Dental Association; other studies also show lower use of dental services during pregnancy.

Among women who develop mouth problems during pregnancy, only 50 per cent seek help; many of the rest worry that mouth treatment may be harmful to their babies. Experts such as Caswell A Evans, director of the National Oral Health Initiative, think it is past time for patients to reconsider how they think about the dentist vis-a-vis the doctor. We minimise many mouth ailments, he says, shrugging off “blood on (our) toothbrush”.

And dental patients need to get past thinking of their dentist primarily as a cosmetic practitioner, a whitener and straightener of teeth, or 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 mouth, for example, are often the very first indications of infection by HIV, the virus that causes AIDS, 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.

TIME FOR COLLABORATION

For their part, dentists and doctors are beginning to realise they might help their patients by joining forces.

“There’s a desperate need for more collaboration between the two specialties,” emphasises Alan Douglass, an associate professor of family medicine at the University of Connecticut School of Medicine. Doctors, Douglass says, “need to serve as an entry point into the dental-care system.”

Evans, meanwhile, is urging fellow dentists to consider the whole person and be “cognizant of their medical needs” as well as their dental ones.

One thing both groups agree on is the power of prevention. Doctors can also help identify at-risk patients.

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

Brushing Up on Oral Hygiene

Here are a few ways to prevent tooth decay and gum disease:

• Do not smoke

• Limit alcohol to one to two drinks a day

• Brush teeth twice a day

• Replace your toothbrush every three or four months (sooner if the bristles are worn out)

• Floss daily (or use an inter-dental cleaner) to remove bacteria, plaque and food particles from between the teeth and under the gum line

• Go to a dentist regularly for oral exams and cleanings

Adults should see a dentist every six to 12 months, depending on their oral health status. Children should have their first visit at the time of the eruption of the first tooth and no later than 12 months of age

• Eat a balanced diet; limit snacking, especially of sticky or high-sugar foods

• Give supplemental fluoride to preschool children more than 6 months old whose primary water source is deficient in fluoride