According to a study in the Journal of Dental Research, nearly half of all adults in the United States have some form of gum disease, also known as periodontal disease. If you’re in this group, chances are you’re already concerned with the swelling, bleeding, and threat of tooth loss that comes with the condition. But could it be a sign of worse to come? There are many studies that show a strong connection between heart disease and gum disease; here’s what you need to know about this link and the risks involved.

If you missed Part 1 of this series, you can find it at www.thetowncommon.com.

Personalized Gum Disease Prevention and Treatment

I ended last week with a statement that I have used numerous times before – just because it doesn’t hurt doesn’t mean there isn’t a problem. We keep learning more and more about the link between the mouth and the rest of the body. It is essential that dentists and physicians do a better job at co-managing patients, and learn more about the relationship between oral and systemic disease.

It is clear that if you want to take better care of yourself, you need to take better care of your mouth. Familial history is very important. If you know of any family history of dental problems, you are at higher risk. Higher risk individuals need to be treated differently and may need a more aggressive preventive protocol to help ward off progression of disease. In addition, an otherwise healthy person who presents with a sudden increase in gum inflammation should possibly be evaluated by their physician to rule out any systemic causes if there is not a simple explanation for the change.

The connection between oral health and systemic health is well-established and ever-evolving. One thing we know for certain – we are living longer, but with more chronic diseases and medication than ever before. It is exciting that there are so many things on the horizon when it comes to detection, prevention, and treatment.

Among the tools being researched to help determine the particular disease path that a person is on are salivary biomarkers. Although not routinely available yet, this precision approach to the prevention and treatment of periodontal disease accounts for variability in a person’s genes, environment, and lifestyle. Because it is more personalized to the individual, it results in more accurate treatment planning as well as improved outcomes for the patient.

Considering the aging population, periodontal (gum) disease has the potential to become the most prevalent dental disease in the near future. It is more important than ever for dentists to take the time to develop and incorporate a comprehensive periodontal examination and treatment protocol for adults.

As with most diseases, delaying the treatment of periodontal disease until the advanced stages results in treatment that is more expensive, more complex, and less predictable. Most early to moderate stage disease can be treated in a general dental office if the inflammation is easy to control and the patient doesn’t have numerous systemic issues. Otherwise, it may be in the patient’s best interest to be referred to a like-minded periodontist.

When half of the US population is still affected with periodontal disease, despite decades of research and treatments, something is still missing. That missing key is a more collaborative approach involving, dentists, periodontists and physicians.

….and remember, just because it doesn’t hurt doesn’t mean there isn’t a problem. To be continued.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

The connection between oral health and systemic health is well-established and ever-evolving. One thing we know for certain; we are living longer, but with more chronic diseases and medication than ever before.

Gum Disease in an Aging Population

The latest statistics are alarming. Forty-seven percent of US adults who are age 30 or older – an estimated 64.7 million Americans – have either mild gum disease (8.7%), moderate gum disease (30%) or severe gum disease (8.5%). As the population ages, the prevalence rises with 70% of individuals over the age of 65 exhibiting some level of gum disease. And, since we are on statistics, by 2030, it is estimated that the number of people over 70 years of age will have doubled from 35 million to 71 million.

So, as we age, our risk of developing disease increases. Interestingly, there is also a direct correlation between the regions of the US with the greatest concentration of gum disease and those that have a high incidence of cardiovascular disease and diabetes. Although a direct cause-and-effect link is still in the process of being established between gum disease (periodontitis) and other systemic diseases, inflammation is often a common denominator. And it is always important to remember that the mouth is the gateway to the rest of the body.

We used to think that if people didn’t brush their teeth well, or didn’t visit a dentist often, they would automatically get gum disease. However, there are patients who have poor home care who never develop gum disease, and there are also patients who have great home care, visit a dentist regularly, and continue to experience breakdown from gum disease – albeit at a slower rate than they would if they had poor habits.

We now know that managing gum disease and other chronic inflammatory diseases like cardiovascular disease, diabetes, respiratory disease and arthritis are more patient specific based on an individual’s “inflammatory mediators”. These are molecules released by immune cells and are largely responsible for individual responses to disease susceptibility and progression. This is why probiotics are likely to play a significant role in treatment of chronic inflammation in the future.

As we wait for research development for different ways to combat chronic inflammation, it is without dispute that people should do all they can to minimize inflammation in the mouth. The mouth is very accessible and with proper training, coaching and monitoring, a healthy mouth is better for your whole body.

Although some may say that the associations between gum and systemic diseases are statistical by nature, not causal, the data is fairly strong that there is a link between gum disease and cardiovascular disease – such as heart infarction and stroke.  This supports diagnosing and treating oral infections, including lifelong professional maintenance and good home care.

Remember – just because it doesn’t hurt doesn’t mean there isn’t a problem. More next week.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

In an online report I recently read by Men’s Health Magazine, they listed 9 “healthy” habits that they claim are a waste of time. Three of them had to do with oral health. Let’s take a look.

Does Everyone Need a Dental Visit Every Six Months?

The first on the waste of time list was to see your dentist twice per year. I have seen this reported somewhere else in the media recently. According to Men’s Health, close to 30 studies have apparently found no conclusive evidence supporting a need to see a dentist every 6 months. They went on to say, “If your teeth and gums are healthy, once per year is enough to catch developing problems.”

I absolutely agree. There are definitely people who only need to see a dentist/hygienist once per year. Most dentists use a classification system to rate a patient’s periodontal (gum) health. Type I patients are the ones that only need to see a dentist once per year. They are healthy, they have good homecare habits and are low risk for disease. In the average dental practice, I would say this is about 10-15% of the population.

Type II patients are those with gingivitis and should be seen twice per year. This group makes up about 50% of the typical dental patient population. Many of these patients could move into the Type I group if they had better homecare habits and technique.

Type III & IV patients are the remaining 30-35% of the population who should be seen every 3 or 4 months, and in some cases even more frequently. Because of genetics and/or bad habits, this group has active disease and is at high-risk for problems.

Let’s also not forget the other 50% of the population who don’t even visit a dentist once per year. While I think there are people who can be healthy and see a dentist once per year, it is irresponsible to make it seem that it pertains to everyone. The only one who can determine how healthy you are is your dentist. It should be up to you and the dentist you trust.

The #7 waste of time reported was to use a hard toothbrush. According to the report, a soft one cleans your teeth just as well and is less damaging to your teeth and gums. This is old news and is true.

The next one shocked me. The #8 waste of time – brushing and flossing twice per day. According to Men’s Health, everyone only needs to visit the dentist once per year and brush and floss one time per day. They recommend brushing for at least 2 minutes before you go to bed and flossing one time per day. They also mentioned that people who did not floss frequently (whatever that means) are 3 times more likely to develop stomach cancer. I am assuming the author is relating lack of flossing to getting periodontal (gum) disease. More recent research is showing that, “Risk factors for precancerous lesions and gastric cancer are being identified, one of which may be periodontal disease”. Although lack of flossing does not automatically cause gum disease, poor oral health is clearly a risk factor for other health problems.

Here’s the bottom line:

1. Establish a relationship with a dentist you are comfortable with and trust. Determine with that person how frequently you should be seen.
2. Use a good quality soft electric toothbrush. Get instructions on proper use from your hygienist.
3. Brush at least twice per day, preferably at least 30 minutes after meals. Floss at night before you brush.

It is as simple as that.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Every once in a while someone will say, “There must be a lot less cavities today than there were years ago because of improved home care, fluoride, etc., right?” The answer is, yes there are, but there is still way too much decay. Poor diet and home care are the two most common culprits leading to decay.  When and what you eat and drink is important. Improvement in home care means changing what is being done now, and requires discipline.

Yesterday, I went into one of my hygienist’s rooms to check her patient, a 13-year-old boy, and asked the hygienist how his home care was, because his gums were bright red. She said to me, “Jack, why don’t you tell the doctor how often you told me you brush your teeth.” The boy answered, “About once a week.” ONCE A WEEK?!?! Add to the that he is in braces too, which makes it even more important to keep the teeth clean.

It’s important sometimes to step back and review the basics, so here they are. At a minimum, you should brush with a fluoride toothpaste at least twice a day for two minutes. A good electric toothbrush is preferable to a manual toothbrush. When I say “good”, I mean one that sits on charger, and not one that takes AA batteries. There are two major brands out there. I prefer the one that starts with an “O”.

Plaque Removal and Fluoride in a Daily Home-Care Routine

It amazes me how many people don’t floss their teeth. I have heard every excuse in the book; “My fingers are too big”, “I don’t have the time”, “It’s too hard”, “My dog ate the floss”. Just like anything else, it is always hard to start a new ritual. There are so many different kinds of floss and gadgets to help floss that there is something out there for everyone. And if you can’t seem to make it work, use a water pik.

Bacteria, which accumulates on and between the teeth, forms that white film called plaque. Plaque contains billions of colonized bacteria. The right kind of bacteria, along with the wrong king of diet and the wrong genetics can produce cavities. Plaque that is not removed with thorough daily brushing and flossing can harden and turn into calculus (tartar). These colonized bacteria can then lead to tissue inflammation (gingivitis), the early stage of periodontal (gum) disease.

Brushing your teeth helps get rid of most of the plaque, except for the stuff that accumulates between the teeth. That is what floss is for. I know it sounds gross but if you want to know what your breath smells like, floss a few teeth and then smell the floss. That should turn you into an avid flosser.

The routine should be, floss, brush, rinse. The whole event should be around five minutes. Believe me, you have five minutes. Flossing first allows the fluoride from the toothpaste to contact a cleaner tooth surface between the teeth. I prefer a non-alcohol based rinse as alcohol is drying and creates a better environment for bacteria to thrive.

One important thing about flossing; proper flossing is not popping the floss between the teeth and shooting it right back up. The proper way to floss is to get the floss between the contact of the teeth, slide the floss gently under the gum tissue around one tooth, “shoe-shine” the side of the tooth, gently move the floss over the papilla (the little piece of gum between the teeth), “shoe-shine“ the side of the other tooth and then bring the floss up. At your next dental visit, ask your hygienist to evaluate your flossing skills to make sure you are doing it correctly.

You have the 5 minutes twice a day.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.