Your Mouth & Your Health

by Jerry Reves, M.D. and Tariq Javed, DMD*

OK, the title makes you think that saying something may influence your health, and maybe it will, but that is not the subject of this column. Rather, a part of one’s strategy to healthy aging involves an often ignored or over looked important matter – the condition of one’s gums and teeth.

What Can Go Wrong?

There are fundamentally two things that can go amiss in ones jaw. One is that teeth can become decayed and the other is the subject of this column – your gums can become infected. This happens when bacteria live along the teeth and form a sticky material that hardens and forms plaque and later tartar. The bacteria are alive and well, but this can make you sick – not just uncomfortable at the gum infection site, but other organs and diseases are impacted by this oral (mouth) infection of the gums. Infection of the gums in the less severe state is termed gingivitis and in the more extensive form periodontitis.

Gingivitis and periodontitis are both associated with diseases of the body. These include heart (both coronary artery disease and valvular heart disease), inflammation of the pericardium (sack around the heart), stroke, Alzheimer’s Disease, diabetes, and lung infections (bronchitis and pneumonia). The systemic response to infection, called the inflammatory response, is thought to lead to some of the distant organ and vessel diseases, whereas infection increases blood sugar that worsens diabetes control, and the infecting bacteria of the gums can be inhaled by the lungs leading to the lung infections. Similarly, diabetic patients who have active gum disease are reported to have difficulty in adequate control of their blood sugar levels. In the mouth, if periodontitis is not treated, the bone of the jaw can be eroded and teeth can be loosened or lost. So lots can go wrong from gum disease.

Risk Factors for Gum Disease

As always, age is a big risk factor. The older we get the more likely we are to encounter this problem. Diseases like diabetes or immune deficiency (AIDS) will also make us vulnerable. Other factors that we can’t control are gender (men are more likely to have gingivitis although female hormonal influences can cause flare-ups), and genetics (about 30 percent of people with gingivitis have a family history). Factors that we can control and that are known risk factors include smoking, stress, intimate contact with known infected people, poor oral hygiene, crooked teeth, and defective fillings in our teeth. Some medications – decongestants, antihistamines, opiates, and diuretics – can lead to less saliva which leads to more bacterial buildup. Those factors that we control to prevent gum disease should be eliminated so that our gums stay healthy.

Diagnosis & Treatment

Signs that one has gingivitis are bad breath or bad taste that won’t go away. Gums are swollen, red, and painful to touch. Gums may bleed and often do with teeth brushing. Loose and sensitive teeth as well as gums that have pulled away from the teeth are signs of this disease. Finally subtle changes in one’s bite or the way one’s teeth fit together when you bite are a sign. Any change in the fit of partial dentures also is a common sign of infection. Finally, a dentist can probe and measure the “pockets” that infection causes and determine the presence of infection. Some radiological studies can also be used.

Prevention

There are a number of steps one can take to maintain good oral health. The steps are listed below should be employed daily except for the visit to the dentist, which for people with no problems should be every six months for routine cleaning and evaluation of one’s teeth.

Protecting Ones Mouth From Disease

• Brush teeth at least twice a day (best after each meal)
• Use a good toothbrush (replace about every 3 months)
• Floss once a day
• Use a mouthwash, such as Listerine, at least once a day
• Eat a healthy diet
• Limit high sugar snacks and drinks
• See a dentist every 6 months

Treatment

Like some dental procedures, gum health and treatment is relatively inexpensive and painless. It all starts with you taking good care of your gums and teeth by brushing them daily and using floss every day. This helps rid the teeth of bacterial build up and the more dangerous plaque. A routine trip to the dentist for “professional” cleaning at least annually is also preventive maintenance and required. If gingivitis does occur a dentist can treat it or a dental specialist called a periodontist can perform “deep cleaning” that consist of scraping away plaque and tartar sometimes below the gum line (this can require some local anesthetic to avoid pain). Antibiotics may be used as well in some cases. If this deep cleaning doesn’t take care of the problem a number of more extensive dental surgery procedures can be used.

Summary

There are a host of reasons to keep ones mouth healthy. These involve local issues in the mouth and also body diseases that can be triggered or worsened by infections of the gums. The bottom line is that prevention with good oral hygiene and regular visits to the dentist is another good strategy for healthy aging.

* Dr. Javed is MUSC Associate Dean for Academic and Student Affairs and Professor, Division of Periodontics