Healthy mouth, healthy body
Date Posted: April 1, 2007
In-Depth Report
Healthy mouth, healthy body
The health of your mouth and your overall well-being may be more closely linked than you realize. Some of the same lifestyle choices that can keep your body in tip-top shape also help keep your teeth and gums healthy. For example, limiting sweets and avoiding tobacco are good for both your oral and general health.
The connection extends beyond lifestyle choices. Medications used to treat various illnesses can affect your oral health. Plus, certain illnesses may make you more prone to dental problems, while some dental problems may make you more vulnerable to particular illnesses. Understanding the connection between your oral health and the well-being of your body will help you take good care of both.
Eat right
Bacteria need a steady supply of carbohydrates, especially sugary foods. A large and continuous source of sugar allows the bacterial population to multiply and produce enough acid to dissolve tooth enamel faster than the body can rebuild it. The rise in dental cavities tracks closely with the widespread availability of inexpensive refined sugar beginning in the 18th century.
Both how much sugar you eat and when you eat it can affect your risk for cavities. Foods such as these increase your chances of getting cavities:
Foods with sugar content of more than 15%–20%.
Sticky sweets such as honey, molasses, chewy candy, or raisins. These stay on the teeth longer than other sugars.
Slowly dissolving sugars. Slow-melting hard candies expose your teeth to sugar for a longer period of time compared with foods that are eaten quickly.
Sweets eaten alone. The saliva you secrete when you eat a meal may rinse away sugars.
Sweets eaten before bedtime. Unless you brush afterward, the sugar will remain undisturbed on the teeth until the next morning.
Starch and sugar combinations. Cookies, cakes, and other sweet baked goods are likely to cause decay.
Making positive food choices can be just as important as avoiding damaging items. Some foods, such as aged cheese and peanuts, actually lower the likelihood of decay by cutting the acidity of your saliva. Dairy products are high in natural sugar (in the form of lactose), but they also contain a protein that prevents bacteria from sticking to your teeth. In addition, dairy products are a natural source of calcium, an important nutrient for maintaining the strength of your teeth and bones. Insufficient calcium intake also contributes to periodontal disease.
Other nutrients you need for optimum oral health include
vitamin D for building and maintaining bone
folate, ascorbic acid, iron, and zinc to replenish the lining of the gums, especially in the pockets next to the teeth
protein and vitamins A and C to produce the connective tissue that supports the teeth.
Don't smoke
Tobacco is as devastating to your oral health as it is to the rest of your body. Not only does tobacco use cause such annoyances as tooth staining, tartar buildup, and bad breath, but tobacco users also risk developing tooth decay, severe gum disease, and mouth and throat cancers.
More than 30,000 new cases of oral cancer will be diagnosed among Americans in 2007, and approximately 7,400 people will die from the disease. The American Cancer Society reports that smokers are six times more likely to develop this disease than nonsmokers, and 90% of people with oral cancers use tobacco. Chewing tobacco is no less dangerous than smoking it; "smokeless" tobacco contains at least 30 carcinogens and can increase your cancer risk by four to six times. And because it contains high levels of sugar, it can promote decay.
Smokers are also at greater risk for gum disease. A 1994 study led by researchers at the State University of New York at Buffalo found that smokers were seven times more likely to develop periodontal disease than nonsmokers. The good news is that 10 years after quitting, former smokers are no more likely than nonsmokers to show signs of gum disease.
Medications and oral health
Hundreds of prescription medications have the potential to cause oral side effects. The most common side effect is dry mouth, which can be brought on by more than 400 different drugs. Dry mouth raises the risk of tooth decay and gum disease. Other common oral side effects include the overgrowth of yeast or other microbes, mouth sores, growth of excessive gum tissue, changes in taste, and staining of teeth. For example, tetracycline can stain teeth when it's taken in early childhood. The oral effects of medications are a particular problem for older adults, because they tend to take the most medication.
Table 1 lists some of the medications that can cause oral side effects. If you experience any of these effects, consult your doctor.
Table 1: Common oral side effects of medications |
|
Side effect |
Medications |
Dry mouth |
Tricyclic antidepressants, antihistamines, diuretics, anti-anxiety drugs, anticonvulsants, barbiturates, decongestants, muscle relaxants, bronchodilators, narcotic painkillers, and many others |
Staining of teeth |
Tranquilizers, oral contraceptives, antimalarial drugs, tetracycline (taken in early childhood when the teeth are developing), chlorhexidine |
Overgrowth of gum tissue |
Cyclosporine, calcium-channel blockers, antiseizure medication |
Oral yeast infection (thrush) |
Combinations of antibiotics and steroid drugs |
Death of bone tissue |
Bisphosphonates used intravenously in cancer treatment and, less frequently, oral bisphosphonates for osteoporosis prevention and treatment |
Jawbone destruction and bisphosphonates
Scientists are investigating a possible connection between the death of bone tissue (osteonecrosis) of the jaw and medications known as bisphosphonates. Bisphosphonates are commonly used to treat and prevent osteoporosis and to treat bone pain in cancer patients. Thus far, no clear cause-and-effect relationship has been established, and scientists are unsure why some patients develop osteonecrosis of the jaw. But there are good reasons to suspect that bisphosphonates play a role.
Cases in which people taking bisphosphonates experienced osteonecrosis first began surfacing in 2003. The vast majority of cases — about 94% — have involved cancer patients receiving intravenous drugs such as pamidronate (Aredia), clodronate (Bonefos), and zoledronic acid (Zometa). But this side effect also has been reported, with much lower frequency, in patients taking oral bisphosphonates such as alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva) for osteoporosis.
How common is this problem? Small studies have found that about 10% of patients with multiple myeloma (cancer of the plasma cells) treated with bisphosphonates are affected, as are nearly as many breast cancer patients who took these medications. Meanwhile, the American Dental Association has estimated that there will be about seven cases per year of osteonecrosis for every million people taking oral bisphosphonates.
Many of the reported cases occurred after dental surgery to treat infections, such as getting a tooth pulled. Before you start taking a bisphosphonate, it's a good idea to have a dental exam and complete any necessary extractions or implants. If you are already taking a bisphosphonate, tell your dentist so she or he can consider it in planning your treatment. Also, be aware of the symptoms of osteonecrosis, which include pain, swelling, or infection of the gums or jaw; gums that aren't healing; loose teeth; and numbness in the jaw.
Recognizing the warning signs for oral cancerPrevention and early detection are potent weapons in the fight against oral cancer. Prevention begins with avoiding tobacco and limiting alcohol use. Using tobacco — whether it's smoked or smokeless tobacco — significantly increases the risk of developing oral cancer. The more tobacco you use and the longer you've been using it, the greater your risk. But even if you've smoked or chewed tobacco for years, you can slash your chances of developing oral cancer substantially by quitting. Because heavy alcohol use also heightens the risk for oral cancer, limiting or eliminating its use offers protection, too. If you consume alcohol, the American Cancer Society recommends no more than two drinks per day for men and one drink per day for women. And your mom was right: You should eat your vegetables. Some studies have found that eating at least five servings of fruits and vegetables a day can help protect you from oral cancer, as well as other cancers. As with many other cancers, the sooner oral cancer is discovered, the better your chances of successfully treating it. The American Cancer Society reports that the overall five-year survival rate of oral cancer is 59%, but if the cancer is caught early and has not spread to additional parts of the body, that figure jumps to 82%. Early detection begins with you and your dentist. Ask your dentist to check your mouth for signs of oral cancer at each visit. If you're at high risk for oral cancer, you may want to examine your mouth for symptoms each month. Symptoms include a sore that bleeds easily and doesn't heal a white or red spot on your gums, tongue, or mouth lining a lump or thickening on your lip, cheek, or anywhere in your mouth persistent pain, tenderness, or numbness in the mouth or on the lips persistent sore throat or sensation of something being caught in your throat trouble chewing, swallowing, speaking, or moving your tongue or jaw a change in the color of your oral tissues. These symptoms do not always indicate cancer; many other disorders can have similar effects. However, if you notice any of these changes, consult your doctor or dentist as soon as possible, so the problem can be diagnosed and treated early. |
Oral health and other diseases
Some of the most intriguing oral health research is attempting to connect the dots between diseases of the mouth and other illnesses. For example, a 2007 study published in the Journal of the National Cancer Institute reported that gum disease may increase the risk of developing pancreatic cancer. So far it's unclear how periodontal disease might contribute to pancreatic cancer and no definite cause-and-effect relationship has been proven, but the findings are intriguing and will no doubt spur further research.
Links between other health conditions and gum disease have been studied in greater depth. Under particular scrutiny is how periodontal disease may relate to diabetes, heart disease, and pregnancy complications.
Diabetes
One of the most thoroughly researched topics in this arena is the relationship between gum disease and diabetes. Diabetes is thought to affect gum health in two ways. First, diabetes can cause circulatory damage, narrowing the arteries and restricting blood flow to the tissues, including the gums. As a result, periodontal tissue and bone become more susceptible to infection. In addition, diabetes can encourage the growth of oral bacteria. High blood sugar translates into increased levels of sugar in oral fluids. This allows the bacteria responsible for periodontal disease to thrive.
Diabetes can also lead to oral infections, such as thrush, as well as to dry mouth, which can hasten cavity development. Often, dry mouth is an early sign of undetected diabetes.
Researchers are also probing the possibility that periodontal disease may be a factor contributing to diabetes, not just a complication of it. One theory is that the inflammation in periodontal disease may increase resistance to insulin, which, in turn, makes it difficult to control blood sugar. However, more study is needed to clarify the relationship between these two diseases.
Several small studies suggest that periodontal therapy, such as deep cleaning, can improve blood sugar control. Researchers are also evaluating whether supplementing deep cleanings with oral antibiotics can help reduce blood sugar levels in diabetic patients.
While researchers haven't established that periodontal disease contributes to diabetes, brushing and flossing regularly and having routine dental cleanings makes sense for many reasons.
Heart disease
Does having gum disease put you at greater risk for heart disease? And, by extension, would averting gum disease actually reduce your chances for developing heart disease? Those questions have been — and continue to be — heavily researched. But a definitive answer hasn't been found yet, because studies have turned up conflicting results.
Numerous studies have suggested links between chronic gum infection and heart disease. According to the American Academy of Periodontology, people with gum disease are almost twice as likely to have heart disease as those without it. A 2006 study found that people under age 60 with a certain amount of alveolar bone loss from gum disease were at greater risk for heart disease. Two studies linked the bacteria of periodontal disease to heart problems. The first, a 2005 study in Circulation, found that older adults who had higher proportions of four gum disease–causing bacteria also had thicker carotid arteries, which is a predictor of stroke and heart attack. The second study, published in 2006, found that people with acute coronary syndrome — which encompasses a variety of heart problems ranging from unstable angina to heart attack — had higher levels of oral bacteria.
How might gum disease influence heart health? One possibility is that oral bacteria enter the bloodstream and attach to fatty plaques on artery walls, contributing to the formation of blood clots. Another is that inflammation from infectious agents damages artery walls and leads to the formation of plaques. The 2006 Journal of Periodontology study supports the idea that inflammation plays a role. This study showed that oral bacteria provoked an inflammatory response that elevated levels of white blood cells and C-reactive protein, both of which are linked to cardiovascular disease.
However, other research has failed to find a strong connection between gum disease and heart disease. A 2006 international Consensus Statement published in the journal Inside Dentistry found that the results of many studies have been inconsistent. In addition, a 2002 study concluded that the evidence supporting a cause-and-effect relationship between heart disease and chronic gum disease was weak.
Also unclear is whether treating advanced gum disease can reduce heart disease risk. Perhaps further study will clarify the relationship between the two diseases. In the meantime, practicing good oral hygiene and preventing gum disease will help you regardless of what future research turns up.
Pregnancy complications
Periodontal disease may increase a woman's risk of delivering a baby prematurely (before the 37th week of pregnancy). Premature babies are at greater risk for long-term health problems, and those who are born before their lungs have fully developed may not survive.
Researchers at the University of Alabama in Birmingham who followed a group of 1,300 pregnant women found that those who had periodontal disease between weeks 21 and 24 of their pregnancy were four to seven times more likely to give birth before 37 weeks. This study didn't examine whether treating gum disease during pregnancy could influence the outcome.
However, another study found that women with gum disease who were treated during their second trimester were less likely to give birth to low-weight or preterm infants than women who were not treated until after giving birth. Treatment included scaling and root planing, education on good oral hygiene, and the daily use of an antimicrobial mouth rinse. If gum disease worsens during the course of a pregnancy, there is evidence that the risk for premature birth rises.
According to the American Academy of Periodontology, the reason gum disease affects pregnancy is unclear, but some experts believe that gum disease may increase the levels of certain compounds that bring on labor.
Just as gum disease seems to have an impact on a pregnancy, pregnancy itself can influence the health of a woman's gums. Many pregnant women develop inflammation of the gums, known as pregnancy gingivitis. Their gums become swollen and red and may bleed easily. Usually, the condition subsides after they give birth. Experts believe that high levels of certain hormones, such as estrogen and progesterone, are to blame. While pregnancy gingivitis is common, studies have found that you may be able to avoid it by brushing and flossing daily and having your teeth cleaned regularly during your pregnancy.
Review Date: 2007-04-01
Harvard Medical School does not endorse products or services.
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