Brushing Up on Oral Health
However perfect your oral hygiene, your mouth is still filled with microbes — about 700 species of them, give or take. While some of these organisms are beneficial, many others are responsible for the growth of plaque, the sticky film that paves the way for tooth decay and gum disease. What’s more, the same germs that can cause bad breath and lead to bleeding gums have been linked to an array of systemic health problems that, at first glance, might seem like they have little to do with your mouth.
The exact relationship between oral health and conditions such as heart disease and dementia is still being teased out, and there’s no proof that failing to floss directly causes them. Yet it’s already clear that oral health and full-body health are inextricably linked.
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“Studies suggest that periodontitis, which is an infection of the gums and surrounding tissues, is associated with conditions like dementia, heart disease and diabetes,” says Ada Cooper, a New York-based dentist and consumer adviser and spokesperson for the American Dental Association. By the same token, she notes, periodontitis is more likely to be present in people who have those other conditions. While she stresses that these for now are only associations, not known causes and effects, “they’re interesting and concerning, and we want to know more.”
Inflammation could explain the mouth-body link
At the moment, there are two main theories to explain why problems in the oral cavity — especially gum disease (aka periodontitis) — might increase the risk of disease in far-flung parts of your body. “One is inflammation,” says Frank Scannapieco, doctor of dental medicine and chair of oral biology at the University at Buffalo School of Dental Medicine. He likens gum disease to an abscess on your leg: Tissue gets wounded, and inflammatory chemicals rush in to help it heal and keep invaders like bacteria at bay.
When this happens in your gums, “the same inflammatory mediators produced by cells in the tissue there can be released into the blood,” which enables these substances to travel to other organs and damage them, he explains.
The second theory also has to do with inflammation, albeit indirectly. Periodontitis makes the gum tissue more permeable, which means it’s easier for bacteria and other microbes in the mouth to enter the bloodstream. The bacteria can then migrate to various body parts and cause inflammation and damage in those areas.
Either way, older adults are particularly at risk. Periodontal disease and other oral health problems become more common with age, at a time when many people lack the resources to properly address them. “The lack of dental access through programs like Medicare has left more than 26 million people without dental benefits,” says Julie Frantsve-Hawley, director of analytics and evaluation at the CareQuest Institute for Oral Health.
On a positive note, research has shown that when people do obtain proper treatment for periodontal disease, this translates to lower levels of inflammatory substances that are linked to cardiovascular disease, diabetes and Alzheimer’s. That’s why it’s so important to see a dentist at least twice a year, in addition to regularly brushing and flossing.
You’ve probably already heard a lot about the connection between diabetes and oral health, as it’s been well-established and seems to go both ways: Diabetes increases the risk of oral health problems, while gum disease is linked to higher blood sugar, which may predispose you to type 2 diabetes.
Here’s a look at a few of the lesser-known reasons why staying on top of your oral health might benefit your entire body.
1. Improved heart health
This one might sound familiar, but it’s worth repeating. Numerous studies have found a strong connection between periodontal disease and an increased risk of cardiovascular problems, including atrial fibrillation, atherosclerosis (narrowed arteries) and heart failure. Poor oral health also has been linked to an increased risk of heart attack and stroke.
2. A sharper brain
Data from the National Institute of Health (NIH)’s third National Health and Nutrition Examination Survey (NHANES III) found that people with bleeding gums and periodontal detachment (a loosening or separation of ligaments that connect teeth to gums) have a higher likelihood of developing age-related cognitive problems, including Alzheimer’s. Research, including a new study from the Journal of the American Medical Directors Association, also has found that older adults who’ve lost a significant number of teeth face a significantly higher risk of dementia.
3. A better sex life
One important link between poor oral health, heart disease and diabetes? It’s endothelial dysfunction, aka narrowing of the blood vessels. That same blood flow challenge might explain why men with chronic periodontitis have a higher risk of erectile dysfunction.
4. A lower risk of serious COVID complications
It’s not in the same universe of protection as getting vaccinated, but consider good oral health as one more tool in your arsenal when it comes to dodging severe COVID. Research published in Frontiers in Medicine found that people with periodontal disease who contracted the virus were more likely to die compared with those who tested positive yet didn’t have gum disease.
“Poor oral health can be linked to conditions such as diabetes, heart disease, respiratory illness and even Alzheimer’s — all diseases that particularly impact our older citizens and put them at greater risk for COVID-19,” says Frantsve-Hawley.
5. Better odds of staying healthy in the hospital
If you or a loved one end up in the hospital for any reason, don’t forget a toothbrush. A pilot study from the Veterans Affairs Medical Center in Salem, Virginia, found that simply brushing your teeth (or having a nurse do it, if you can’t do it yourself) cuts the risk of non-ventilator-associated hospital-acquired pneumonia by a whopping 92 percent.
Cleaning the mouths of intubated patients is also essential, says Scannapieco. “When you’re intubated, the tube is a direct highway from your mouth to your lungs. Bacteria grow and divide and run down the tubing,” he says.
6. A longer, healthier life
Kidney disease. Cancer. COPD. These all often overlap with periodontal disease, says Scannapieco. Add diabetes, heart disease and other top killers that are associated with oral disease to the list and it’s not hard to understand why several studies have found a connection between poor oral health and all-cause mortality (death for any reason). One large study followed more than 76,000 people ages 16 to 89 for about three years and found that participants who had gum inflammation or more than 10 missing teeth were significantly more likely to die within the study period.
Tooth loss can impact nutrition, social habits and even mental health, says Frantsve-Hawley. She also notes that the inflammatory response caused by periodontitis might make preexisting conditions like diabetes and heart disease harder to manage. “It’s like adding fuel to the fire,” she says.
Barbara Brody is a New York-based freelance writer who specializes in health and wellness. Her work has appeared in many outlets, including WebMD, Health and Prevention.