What Your Dentist Knows About Your Health
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.
December 2006
By Sid Kirchheimer
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, or 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, a gum infection around the molars,
usually the third molars or wisdom teeth; 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 saliva 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 saliva 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 if 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 medical
exam."
Published May 10, 2004.
Medically updated on Feb. 1,2006
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About Connecticut Oral Health Initiative
The Connecticut Oral Health Initiative, or COHI for
short, is a state-wide collaborative of dental
professionals, business and community leaders. Our
Mission is Oral Health Care for All. We work to
persuade, educate and inform decision makers and the
general public about the important issues involving
oral health. We started in 1992 as a project of the
Connecticut State Dental Association and
incorporated as a separate 501(c)(3) non-profit
corporation in 2003. We are supported by your
tax-deductible contribution and grants from
progressive foundations and businesses.
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Connecticut Oral Health Initiative
Marty Milkovic
Executive Director
phone:
860-246-COHI (2644)
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