The Mouth-Body Connection by Sid Kirchheimer, Reviewed by Brunilda Nazario, MD
From predicting
heart disease, diabetes, and premature birth to revealing leukemia,
eating disorders, and vitamin deficiencies, your teeth and gums say a
mouthful about your health.
The eyes
may be the window to your soul, but for a look into your physical
health, open wide: Your teeth and gums say a mouthful.
Receding or inflamed gums, cavities, tooth loss, gingivitis, and other
dental dilemmas in adults can indicate the presence of serious health
problems -- including heart disease, diabetes, cancer, vitamin
deficiencies, and even the risk of having a premature or
low-birth-weight baby. Usually, these dental problems result from poor
dental hygiene such as not brushing well or not flossing regularly. But
even by following your dentist's golden rule, you may still be hurting
your overall health.
"Every time you brush your teeth, especially if there's any
inflammation in the mouth, it puts some bacteria into your
bloodstream," says Honolulu periodontist Michael P. Rethman, DDS,
president of the American Academy of Periodontology. "This isn't good,
but it is normal."
That may explain a recent jaw-dropping study in the journal Circulation
that links any of five common dental problems with an increased risk of
heart disease. The kicker: Dental problems proved to be stronger
predictors of heart disease than more traditionally used risks factors
such as low "good" cholesterol, high triglycerides, or high levels a
clotting factor called fibrinogen.
And it doesn't end there.
Dental Detectives
and What They Find
"Often, it's a dentist or periodontist who is the first to identify a
systemic health problem because of what they see in the patient's
mouth," says Col. Brian Mealey, DDS, chairman of periodontics (the
treatment of gum diseases) at Wilford Hall Medical Center in San
Antonio, the nation's largest Air Force hospital. "And as more evidence
accumulates, I think you'll see more dentists looking at oral health
specifically to search for possible problems affecting the rest of the
body. They're now teaching this stuff in dental schools, which wasn't
the case 10 years ago."
So what can these dental detectives detect in those twice-yearly exams?
Diabetes
Undiagnosed diabetes, or poor blood sugar control in those already
diagnosed with the disease, can be identified by several dental woes,
says Sally Cram, DDS, a periodontist in Washington, D.C., and
spokeswomen for the American Dental Association.
"Diabetics tend to get periodontal disease at a rate three to four
times higher than people without diabetes, but when their condition is
controlled with medication, diet, or other treatments, their
periodontal condition will usually stabilize and return to health," she
tells WebMD. "If I see a lot of inflammation in someone who brushes and
flosses regularly, of they have an abscessed tooth (an infection-caused
pocket of pus in the tissue next to a tooth), I ask, 'Have you checked
your blood sugar lately?'"
That's because uncontrolled diabetes impairs white blood cells, the
main defense against bacterial infection -- and periodontal disease
results from bacterial infection. Besides gum problems, diabetes also
can produce dry mouth, thrush, a burning of the mouth or tongue, or a
distinct, telltale breath odor. "It's called 'acetone breath' and
produces a sweet smell that's associated only with diabetes," adds
Rethman. "Breath that really smells bad, meanwhile, could indicate
infection of the nose, mouth, lungs, or stomach."
Osteoporosis
Osteoporosis and tooth loss often go hand-in-hand because the same
decrease in bone mineral density that boosts risk of hip and other
fractures affects the jawbone and teeth. That's one reason why women
are especially vulnerable to tooth loss following menopause -- and why
despite its other health risks, estrogen replacement therapy has been
found to reduce their rates of tooth loss and gingivitis.
"Actually, there are four times in a female's life when she's more
vulnerable to oral problems," says Cram. "Besides menopause, during
puberty, during pregnancy, and around the time of her monthly period,
certain hormones levels are elevated that stimulate inflammatory
mediators that make them more susceptible and responsive to bacteria in
the mouth." So mark your calendar, ladies: It's during these times when
a dental exam is especially useful.
Heart Disease
In the recent Circulation study, after comparing the oral health of 256
adult heart patients with that of 250 others with no heart disease,
researchers did some math. Their calculations showed that the strongest
predictor of heart disease was pericoronitis, an infection around the
third molar; followed by root remnants, in which teeth decay to the
point that only the tip of the root remains; gingivitis, an
inflammation of gums around the teeth due to improper cleaning;
cavities; and missing teeth.
The possible connection: "It seems that bacteria often found in the
mouth can appear as the same atherosclerotic plaque associated with
cardiovascular disease," Rethman tells WebMD.
Premature and
Low-Weight Births
Research shows that women who have gum disease during pregnancy are
seven times more likely to have a baby that is born too early and too
small than other expecting mothers -- and the risk increases with the
severity of their gum problems. "That's because when you have
periodontal disease, the inflammation causes certain chemicals to be
released in your bloodstream that could affect the baby's birth weight
and delivery," Cram tells WebMD.
So if you're pregnant, head to the dentist or periodontist. A study
last year in the Journal of Periodontology suggests that performing a
common procedure to remove plaque and tartar from teeth that cause gum
problems could reduce risk of premature delivery.
Other Conditions
Leukemia causes gums to be fiery red, very inflamed, and spongy.
Bulimia. "When you binge and purge, it creates acid in the mouth that
eats away at tooth enamel, especially on the insides of teeth," says
Cram. "Bulimics also have a lot more gum recession and higher rates of
cavities."
Kidney problems can cause inflamed gums.
Gastroesophageal reflux disease (GERD) can also cause tooth erosion
from digestive acids entering the mouth.
Vitamin deficiencies. Not getting enough iron can cause sores at the
corners of the mouth, the taste buds to become small, or can lead to a
sore tongue. In some cases, advanced iron deficiency can lead to anemia
and may cause scarring in the throat and esophagus, making swallowing
difficult. While vitamin C deficiency causes gums to easily bruise and
bleed, deficiency can lead to tooth loss. Vitamin D deficiency boosts
risk of jaw fracture and gum disease.
Drugs Do Damage, Too
As you age, there's a natural decline in the amount of salvia you
produce. But to add insult to injury, hundreds of drugs -- including
antidepressants, high blood pressure medications, and allergy remedies
such as antihistamines and decongestants -- can cause dry mouth.
"When the mouth dries out, you don't have the protective enzymes in
salvia that help kill bacteria," says Cram. "Not only that, but gum
tissue dries, which causes cells to die on the surface, allowing it to
proliferate." Dry mouth can be avoided by drinking plenty of water or
using over-the-counter toothpastes, mouthwashes, and chewing gums, such
as Biotene, that are especially formulated to replace these protective
enzymes.
Still, the mouth-body connection stresses the importance that long
preached advice: See your dentist regularly, especially during those
vulnerable times of womanhood -- or if you're about to be hospitalized.
"If you're going in to the hospital for an extended stay, having an
oral exam and good cleaning is a great idea because you're going to
decrease the risk of hospital-acquired problems such as pneumonia,"
Mealey tells WebMD. "It's also advised to have a cleaning before
getting joint replacement surgery, because the mouth can be a source of
bacteria that, if it seeds, can cause an infection that could destroy
tissue around the joint."
But even you're feeling perfectly fine, there's good reason for opening
wide and staring at the ceiling as your mouth is picked and probed.
"Today, more dentists aren't just looking at teeth and gums," says
Cram. "They're giving you a good medial exam."
Published May 10,
2004.
SOURCES: Janket, S.
Circulation, March 9, 2004; vol 109; pp 1095-1100. Jeffcoat, M. Journal
of Periodontology, August 2003; vol 74; pp 1214-1218. Michael P.
Rethman, DDS, periodontist, Honolulu; president, American Academy of
Periodontology. Col. Brian Mealey, DDS, chairman of periodontics,
Wilford Hall Medical Center, San Antonio. Sally Cram, DDS,
periodontist, Washington, D.C.; American Dental Association consumer
advisory committee.
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