As a part of a regular preventive or periodontal maintenance visit with your dental hygienist, the topic of flossing usually comes up. Most people have at least heard of flossing, and while some people floss regularly, most patients I see report flossing less than the ADA recommended once per day. More often, people fall into the categories of flossing “once in a while” or “once in a blue moon.” While some people are embarrassed to admit this to their dental hygienist, the condition and health of your gums reveal a lot about your oral hygiene practices at home without you saying a word. (We can also read minds…just kidding.)
So, if most people have heard about flossing, and are reminded of it semi-annually by their dental hygienist, what is preventing them from actually cleaning between their teeth on a regular basis?
Maybe they don’t realize the impact that flossing has on the health of their gums and prevention of early tooth loss. Maybe it’s difficult for them to manipulate string floss (it’s harder than it looks). Maybe they are super busy (who isn’t?) and can’t find time to track down some floss and use it between their teeth. Maybe they ran out of the sample-size floss their hygienist gave them a their last visit. Maybe it hurts when they floss because their gums are inflamed, so they avoid the pain. Maybe they are really committed and diligent for the first while, and then life gets in the way and they fall out of the habit. All of these are totally understandable reasons, and I’ve been there. (Hygienists are human, too!)
The good news is, your dental hygienist is interested in helping you to keep your mouth and gums healthy, and offers a judgment-free-zone to learn how to properly perform oral hygiene techniques, like flossing, and to help you come up with some ways to integrate flossing into your daily routine. (Floss in the shower, floss while watching the intro to your show on Netflix, floss while on Facebook or scrolling through Pinterest, floss while at a red light on your commute, etc.)
The other awesome thing your dental hygienist does for you, is giving you a clean slate to work with! When your dental hygienist cleans your teeth by removing the plaque and calculus (calcified plaque) from your teeth, they are removing the bacteria that are causing the inflammation, pain, and bleeding in your gums. (Hooray!) Once these irritations are removed, the gums have a chance to heal, and by properly cleaning your teeth at home (brushing and flossing), you can keep them healthy. When the gums are healthy, they don’t hurt, they don’t bleed, they are easier to floss, and you have a faster, easier dental hygiene appointments. (Even when your hygienist is gentle, nobody enjoys being in that chair.)
If you’re still reading, check out this video my former classmates and I produced that demonstrates proper flossing technique and briefly explains why flossing is important. It’s a little cheesy, but definitely educational. Make sure your sound is on, there’s some great instruction and music.
After watching this video and practicing at home, if you’re still having difficulty with string floss, try some other interdental cleaners! Here’s a great article that talks about lots of interdental cleaners and how to use them (scroll about halfway down).
Remember, the best interdental cleaning tool is the one that you actually use consistently; if string floss just isn’t your thing, talk to your hygienist at your next visit, and we’ll be happy to give you some samples to try. Happy flossing!
Many people are realizing that there is a direct connection between oral health and total body health. It is finally being generally accepted that oral health and general health are to be interpreted as one entity, not separate as has been the view in the past. Dentists has been saying this for years, and finally science is proving them right! You cannot be healthy without good oral health.
“The mouth can act as a portal of entry for infection, ” says Salomon Amar, DMD, PhD, Professor and Director at the Center for Anti-Inflammatory Therapeutics at Boston University School of Dental Medicine. “Ongoing inflammation in your mouth can allow bacteria to enter the bloodstream, which may lead to more inflammation in other parts of your body, such as the heart.”
What conditions may be linked to oral health?
Your oral health might affect, be affected by, or contribute to various diseases and conditions, including:
Endocarditis. Endocarditis is an infection of the inner lining of your heart (endocardium). Endocarditis typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart.
Cardiovascular disease. Some research suggests that heart disease, clogged arteries, and stroke might be linked to the inflammation and infections that oral bacteria can cause.
In 2005, the NIH funded a study on this topic. They randomly selected 1,056 participants with no prior heart attacks or strokes. All were evaluated for levels of periodontal bacteria. After removing the effects of the other risk factors of age, gender, and smoking, Moise Desvarieux, MD, PhD, Associate Professor of Epidemiology at the Mailman School and lead author of the study stated, “It was found that there was an independent relationship between gum disease and heart disease.” One theory about why this may occur is that small amounts of bacteria enter your bloodstream while you’re chewing. “Bad” bacteria from an infected mouth may lodge itself inside blood vessels, ultimately causing dangerous blockages. Strengthening his theory is the fact that when scientists have looked at atherosclerotic blood vessels, they have sometimes found fragments of periodontal bacteria. Meanwhile, a study published in the New England Journal of Medicine in 2007, established that aggressive treatment of gum disease reduces the incidence of atherosclerosis within six months.
It has been found that up to 91% of patients with heart disease have periodontitis. “The theory is that inflammation in the mouth causes inflammation in the blood vessels,” says Sally Cram, DDS, PC, Consumer Adviser for the American Dental Association. “This can increase the risk for heart attack in a number of ways. Inflamed blood vessels allow less blood to travel between the heart and the rest of the body, raising blood pressure. There’s also a greater risk that fatty plaque will break off the wall of a blood vessel and travel to the heart or the brain, causing a heart attack or stroke.”
Pregnancy and birth. Periodontitis has been linked to premature birth and low birth weight.
Scientists believe that gum disease or inflammation in the mouth possibly triggers an increase in a chemical compound called prostaglandin, which induces early labor. While this theory has not yet been confirmed, a 2001 study found that pregnant women who develop gum disease between weeks 21 and 24 of their pregnancy are four to seven times more likely to give birth before week 37. There is evidence that poor gum health in the extreme can lead to low birth weight as well.
Babies born too early or at a low birth weight often have significant health problems, including lung conditions, heart conditions, and learning disorders. While many factors can contribute to premature or low birth weight deliveries, infection and inflammation in general seem to interfere with a fetus’ development in the womb.
Though men have periodontitis more often than women do, hormonal changes during pregnancy can increase a woman’s risk. For the best chance of a healthy pregnancy, Pamela McClain, DDS, President of the American Academy of Periodontology, recommends a comprehensive periodontal exam, “If you’re pregnant or before you become pregnant, identify whether or not you’re at risk.”
Diabetes. Diabetes reduces the body’s resistance to infection which puts the gums at risk.
Gum disease appears to be more frequent and severe among people who have diabetes. Research shows that people who have gum disease have a harder time controlling their blood sugar levels. Researchers at Columbia University’s Mailman School of Public Health followed 9,296 non-diabetic participants, measuring their level of periodontic bacteria over the course of 20 years. “We found that people who had higher levels of periodontal disease had a two-fold risk of developing type 2 diabetes over that time period compared to people with low levels or no gum disease,” explains Ryan Demmer, PhD, Associate Researcher at the Department of Epidemiology at the Mailman School and the lead author. There are a few theories about why this might be the case. One proposes that when infections in your mouth get bad enough, it can lead to low-grade inflammation throughout your body, which in turn wreaks havoc on your sugar-processing abilities. “There are all kinds of inflammatory molecules,” says Dr. Demmer, “and it’s believed that maybe some attach to insulin receptors and prevent the body’s cells from using the insulin to get glucose into the cell.”
It has also been noted that inflammation that starts in the mouth seems to weaken the body’s ability to control blood sugar. People with diabetes have trouble processing sugar because of a lack of insulin, the hormone that converts sugar into energy. “Periodontal disease further complicates diabetes because the inflammation impairs the body’s ability to utilize insulin,” says Dr McClain. Diabetes and periodontitis have a two-way relationship. High blood sugar provides ideal conditions for infection to grow, including gum infections. Diabetes can also slow the healing process and lower resistance to infections, including oral infections. Fortunately you can use the gum disease-diabetes relationship to your favor: managing one can help bring the other under control.
HIV/AIDS. Oral problems, such as painful mucosal lesions, are common in people who have HIV/AIDS. Studies suggest that oral bacteria and the inflammation associated with periodontitis, a severe form of gum disease, might play a role in some diseases. Certain diseases, such HIV/AIDS, can lower the body’s resistance to infection, making oral health problems more severe.
Osteoporosis. Osteoporosis, which causes bones to become weak and brittle, might be linked with periodontal bone loss and tooth loss. Osteoporosis and periodontitis have an important thing in common, bone loss. Researchers are testing the theory that inflammation triggered by periodontitis could weaken bone in other parts of the body.
Alzheimer’s disease. Tooth loss before age 35 might be a risk factor for Alzheimer’s disease.
–Dementia: The bacteria from gingivitis may enter the brain through either nerve channels in the head or through the bloodstream, that might even lead to the development of Alzheimer’s disease.
Pneumonia. A 2008 study of elderly participants found that the number who developed pneumonia was 3.9 times higher in patients with periodontal infection than in those free from it. “The lungs are very close to the mouth,” says Marsha Rubin, DDS, practicing Diplomat of Special-care Dentistry at New York-Presbyterian/Weill Cornell. “Even in a healthy mouth there is lot of bacteria, but bacteria in a not-healthy mouth can get aspirated into the lungs, causing pneumonia or aggravating COPD, chronic obstructive pulmonary disorder.” Several intervention studies cited by the CDC show that an improvement in oral health can lead to a reduction in respiratory infection. Periodontal disease may make pneumonia and chronic obstructive pulmonary disorder worse, possibly by increasing the amount of bacteria in the lungs.
Pancreatic Cancer. A study published in 2007 in the Journal of the National Cancer Institute surveyed 51,529 American men about their health every two years between 1986 and 2002. Of the 216 participants who developed pancreatic cancer, 67 of them also had periodontal disease. Independent of the participants’ smoking status, the study found that having a history of periodontal disease was associated with an increased risk of pancreatic cancer. This, according to the study, could be because of systemic inflammation or increased levels of carcinogenic compounds produced in the infected mouth. Interestingly, another viable theory about why gum disease may cause type 2 diabetes points to damage to the pancreas as well. “With the pancreatic cancer study, we thought it was very interesting that you have this localized infection that has an impact on a systemic organ that is very intimately tied to the pathophysiology of diabetes,” says Dr. Desvarieux.
Cancer. Your dentist and hygienist should screen for oral cancer and other cancers of the head and neck, including skin cancer, cancer of the jaw bone, and thyroid cancer, during routine checkups. He or she feels for lumps or irregular tissue changes in your neck, head, cheeks and oral cavity, and thoroughly examines the soft tissues in your mouth, specifically looking for any sores or discolored tissues. Survival rates greatly increase the earlier oral cancer is discovered and treated. During your next dental visit, ask your dentist to do an oral cancer screening. See your dentist immediately if you observe:
Any sore that persists longer than two weeks
A swelling, growth, or lump anywhere in around the mouth or neck
White or red patches in the mouth or on the lips
Repeated bleeding from the mouth or throat
Difficulty swallowing or persistent hoarseness
Scientists aren’t sure of the exact cause of oral cancer. However, the carcinogens in tobacco products, alcohol and certain foods, HPV infections, as well as excessive exposure to the sun, have been found to increase the risk of developing oral cancer. Risk factors for oral cancer may also be genetically inherited. You can help prevent oral cancer by:
Not smoking or using spit tobacco
Limiting your alcohol intake
Eating plenty of fruits and vegetables
Also, periodic self-examinations can increase your chances of detecting oral cancer, so be sure to examine your face, cheeks, jaw and neck regularly for any changes or lumps.
Other conditions. Other conditions that might be linked to oral health include Sjogren’s syndrome, an immune system disorder that causes dry mouth, and eating disorders.
Because of these potential links, be sure to tell your dentist if you’re taking any medications or have had any changes in your overall health, especially if you’ve had any recent illnesses or you have a chronic condition, such as diabetes.
How can I protect my oral health?
To protect your oral health, practice good oral hygiene every day. For example:
Brush your teeth at least twice a day.
Eat a healthy diet and limit between-meal snacks.
Replace your toothbrush every three to four months or sooner if bristles are frayed.
Schedule regular dental checkups.
Also, contact your dentist as soon as an oral health problem arises. It is important to let your dentist know your full family medical history. If you have periodontal disease, make sure you see your dentist frequently and get it treated promptly, before it progresses to the point where you begin losing teeth or it starts to affect your overall health. Remember, taking care of your oral health is an investment in your overall health.
One thing is clear: the body and mouth are not separate. Your body can affect your mouth and likewise, your mouth can affect your body. Taking good care of your teeth and gums can really help you live well longer.