What Your Mouth Says
February 2, 2012
A few weeks ago there was a large article in The Wall Street Journal entitled, “If Your Teeth Could Talk.” It was a basic review of some of the connections between oral and systemic health and also offered some newer research that I was unaware of.
I have written many times on the growing evidence linking periodontal (gum) disease with many systemic issues. The fact of the matter is the mouth is truly the gateway to the rest of the body. While some early signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalance and drug issues can show up in the mouth long before the person discovers that there is a “problem”, an unhealthy mouth also puts you at greater risk for things like heart disease, stroke, diabetes, and pregnancy complications.
A study done at New York University in 2009 reported that 93% of people who have periodontal disease are at risk for diabetes. The issue is inflammation and the fact that periodontal disease and diabetes exacerbate each other. Inflammation from periodontal disease, a chronic non-symptomatic disease, makes it more difficult for people with diabetes to control blood sugar levels. High blood sugar accelerates tooth decay and gum disease, which elevates inflammation. It is a vicious cycle.
However, more recent studies show that treating gum disease improves circulation, reduces inflammation and can even reduce the need for insulin in people with diabetes. The estimates are that six million Americans have diabetes and don’t know it. The risk of not treating either disease can have irreversible consequences.
If you have ever had a planned surgery you probably were asked about your dental health, how often you visit a dentist and asked to get “clearance” from your dentist prior to surgery. The reason for that is because the type and quantity of bacteria present in uncontrolled gum disease is much higher than in periodontally healthy individuals. Bacteria from the mouth can travel through the bloodstream and cause problems elsewhere. Far too often patients come to me a month before surgery and say they need to get their mouth in shape prior to their procedure….an often impossible task.
There are also an increasing number of people on medication and the number of medications they are taking. Many drugs, including but not limited to blood thinners, bisphosphonates (ex. Fosamax), blood pressure medications, antidepressants and chemotherapy drugs can all have effects on the mouth that can be devastating if not closely monitored.
This is all “real” stuff. I deal with these issues in the office every day. I use this analogy a lot, “Periodontal disease is like diabetes, it is not curable, but in most cases it is controllable.” For most patients, good home care combined with good professional care can control this disease. Just as in the lottery, “you can’t win if you don’t play”. However, the consequences for not playing the dental game are more risky.
If you didn’t take the survey last week that I discussed, go to the Facebook page below to take it. I will be reporting the results in the next couple of weeks. So far, not one respondent would give up their teeth for a million dollars. Would you?
Room For Improvement
September 2, 2011
Dentists play a key role in screening patients for many disorders relative to nutrition and in providing appropriate referrals into the health care system. Although the importance of integrating diet and nutrition guidance into dental care has been advocated for decades by educators, it continues to be ignored except by a handful of prevention-oriented practitioners.
Many of the world’s most significant health problems are linked to poor dietary practices, including over-nutrition and under-nutrition. Nutrition plays a fundamental role in health, and dental professionals have the opportunity to be a critical link between discovery and wellness.
There is a great deal of evidence linking oral infections, including periodontal disease, nutrition and immunological response. We have clear evidence linking oral disease with adverse pregnancy outcomes, diabetes, cardiovascular disease and stroke. In addition, obesity, which is an epidemic facing our country, is significantly affecting the incidence of diabetes, cardiovascular disease and overall lifespan. We know there are direct connections between these problems and oral disease. What is the role of the dentist? Should the dentist just be a tooth fixer?
As the body of data linking systemic health conditions and oral infection grows, the expanding understanding of the gene-nutrient reaction may result in more profound discoveries. As of now, many dentists fail to fully appreciate that the scientific bridge between oral disease and systemic health is often mediated by diet and nutrition.
The beneficiary of this profound evidence should be you, the dental patient. It should not only be the responsibility of the physician or specialized nutritionist to incorporate this information into practice. The dentist should be playing a key role.
For the most part, the dentist is the only one who examines the mouth. It used to be that the dentist only looked at the teeth and only fixed problems when they arose. By now, most dentists screen for periodontal, or gum, problems as well as oral cancer. The trend is to address these problems earlier than ever before.
People tend to have ingrained in their head that the dentist just looks at the teeth and treatment should be the same as 25 years ago. The fact of the matter is, things change. As I have said in numerous previous columns, there are no two dentists that practice identically. Each individual’s philosophy of care comes from personal experience, review of literature and the type and amount of continuing education taken. One thing we all hope is that our health care provider, dentist or physician, has our best interest in mind. There is room for improvement in the communication between all health care providers.
As science continues and evidence grows, preventative care and treatment will change with the times. It is the responsibility of all health care providers to work towards a more integrated health care system.
The Silent Epidemic
February 8, 2011
With more than 24 million diabetics and 57 million pre-diabetics in the United States, nearly a quarter of the nation’s population, there are a lot of people affected by diabetes. The most up to date research shows the connection between dental health and diabetes has never been more critical.
As an indication of our general health, the rapidly rising rate of diabetes should be ringing alarm bells everywhere. The litany of health implications from diabetes is a long and grisly list. It is the sixth leading cause of death in the U.S. That is probably vastly understated because as many as 65% of deaths from diabetes are attributed to heart attack and stroke. People with diabetes have about twice the overall risk of death as those who don’t have the disease.
Complications from diabetes cuts years off productive lives and interfere with the quality of those lives through a host of debilitating health effects. Heart disease and stroke rates are as much as four times higher among diabetics. Nearly three-quarters of diabetics have high blood pressure. Each year, diabetes causes blindness in as many as 24,000 Americans. It is the leading cause of kidney failure, nervous system disease, amputations – the list goes on.
This isn’t meant to be a scare tactic. These are simply the facts and, yes, they are sobering. But if you have diabetes or are pre-diabetic, you may want to brace yourself. Because we are going to talk straight about oral health and diabetes, two diseases that can twist each other into a tight downward spiral of amplifying negative health effects. Unless they are halted by your physician and your dentist working in tandem as a health care team, together with your commitment to hold up your end of the bargain, these effects can continue to compound.
The facts about the connections between oral health and diabetes are even more alarming than those about diabetes alone. Here are just a few:
Diabetics are twice as likely to develop gum disease. This is especially true if your diabetes is not under control. The gum disease then worsens your diabetes through an automatic response that your uses to fight the infection.
People with gum disease are 270% more likely to suffer a heart attack than those with healthy gums.
People who have diabetes and sever gum disease have a premature death rate nearly eight times higher than those who do not have periodontal disease.
Those who have gum disease and diabetes together are more than three time likely to die of combined heart and kidney failure.
In people who have type 2 diabetes, gum disease is a predictor of end-stage kidney disease.
In people who have pre-diabetes – blood glucose levels that are higher than normal but not in the diabetic range – gum disease makes it more likely that they will become diabetic.
Once established in a person who has diabetes, the chronic infection that causes gum disease makes it more difficult to control diabetes, and increases damage and complications in blood vessel disease.
It’s Just a Cleaning
October 28, 2010
This is a phrase we hear far too frequently when patients call to cancel their hygiene appointments at the last minute or just do not show up. When the patient is told that there are no open hygiene appointments for 4-6 months the response if often, “Oh, that’s okay, it’s just a cleaning.” However, this lack of concern for urgency is only partly to blame on the patient; most of the accountability falls in the lap of the dental staff, including the dentist.
If you read this column with any frequency, I am sure you are sick of hearing that 75% of the population has some form of periodontal (gum) disease. I am sure you are sick of hearing that periodontal disease has been linked to heart disease, stroke, pre-term, low birth-weight babies, diabetes, and possibly even some types of cancer. The problem is the dental staff is not discussing this enough with their patients.
Based on your level of periodontal health, there are different levels of frequency recommended for hygiene visits. Many people, and the bare minimum, should be seen every 6 months. For others, every 3 or 4 months is recommended. We have some patients where even more frequency is recommended. Regardless, if you put off your routine care by 1, 2 or even 6 months, that is a lot of time to have bacterial growth accumulate and put your body into a defensive mode due to increased inflammation.
Remember, gum disease is not only bad because it makes your breathe stink and your teeth fall out; it is bad for you systemically because of chronic inflammation. You may very well not notice an increase in inflammation, but your body does. There are measureable indicators of this.
If your goal is health, routine maintenance is essential. I tell my staff this all the time – without being a nag, educate, educate, educate. Believe me, if you only knew how bad chronic inflammation really was for you, you would most likely want to be seen more frequently than you are. Personally, I have a good family history when it comes to periodontal disease and I have good home care (although I am told there is room for improvement). My maintenance frequency is every 4 months.
The other, and understandably more selfish issue with regards to changes in your hygiene appointments, is what it does to the office schedule. Most dental offices have a 48-hour policy for changing appointments. This allows enough time to fill the schedule with people on a wait list. There are obviously good reasons why patients need to change an appointment. I do not consider many of the reasons that my staff report to me very good reasons to change a time that has been reserved for you for months. This goes back to the understanding of how important it is to stay on schedule with maintenance.
Some offices charge a fee for not cancelling an appointment within a certain period of time due to lost production and the need to pay staff for their time.
The goal of your dental office is to help you in keeping your teeth and aiding in a healthy body. Help yourself with regular and frequent visits.
Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry.
