As far back as about 400 B.C., Hippocrates, the “Father of Medicine,” suggested pulling teeth as a cure for arthritis. More than 2,000 years later, researchers correlate poor dental health to a host of chronic diseases and conditions, including rheumatoid arthritis, heart disease, diabetes, childhood obesity, certain types of cancer, brain degeneration, respiratory disease, and problems during pregnancy.
“Dentistry and medicine are critically linked to one another,” says Dr. Maggie Tauber, a pediatric dentist who practices in Glastonbury. “The teeth are not separate from the rest of the body. First and foremost, we always consider the person as a whole.”
While the correlation between oral health and overall health is clear, “What we don’t understand is cause and effect,” says Dr. Patricia Diaz, associate professor in the Department of Oral Health and Diagnostic Sciences at the UConn School of Dental Medicine in Farmington.
Dentists know that if we don’t brush our teeth at least twice a day and floss daily, we’re at increased risk of cavities and gingivitis, a bacterial infection of the gums. Left untreated, the inflammation continues and we develop gum disease, or periodontitis, which affects the gums, ligaments and bone which anchors the tooth. Gum disease is characterized by bleeding, inflamed and receding gums, deepening pockets around the tooth and tooth loosening.
But here’s the thing — oral bacteria doesn’t stay in the mouth; it travels. For example, Diaz says, oral bacteria is sometimes found in the placenta of stillborn babies and in the brains of Alzheimer’s patients.
Worldwide, oral infections are among the most common causes of inflammation-induced diseases. In a study published in April 2019 involving 755 participants, those with oral infections in childhood were more likely to be at risk for heart disease and stroke, according to the study published in JAMA Network Open.
Researchers reviewed oral exams conducted when the children in the study were an average age of 8 years old and, following up 27 years later, found that the children with all four signs of oral infections (bleeding, cavities, fillings or pockets around the teeth) were 95 percent more likely to develop thickening of the artery walls than those with none. Even the kids who only had one sign of oral infection were 87 percent more likely to develop artery damage, the study reported.
Prevention begins in babies
Since extensive research shows that dental problems begin in childhood, the American Academy of Pediatrics (AAP) and the American Dental Association (ADA) recommend that babies have their first dental appointment when they get their first tooth or no later than 12 months.
“The visit is a preventative visit,” says Dr. Monica Cipes, a West Hartford-based pediatric dentist. Dentists talk to parents about feeding practices, show them how to care for their baby’s teeth and gums, intercept any habits that could harm their child’s oral health and teach them about injury prevention in toddlers, she says. Dentists advise parents to floss their children’s teeth as soon as they have two teeth touching.
While most parents know that soda and candy contribute to tooth decay, the ADA and AAP recommend that parents limit their children’s juice intake to four ounces a day. Juice drinks and 100-percent juice are not essential for a healthy diet and put children at increased risk for cavities and obesity, according to the AAP. Sweetened sports drinks are just as bad for children’s teeth as soda and juice.
“The more frequently you eat or drink, the more likely you are to get cavities” and develop obesity, Cipes adds.
Research shows that, in some cases, dental health problems can be a sign of an underlying disease. For example, research shows that Vitamin C deficiency in children causes bleeding and swollen gums.
Tauber had a patient who, before being adopted from China, had many broken bones. After looking at the child’s teeth, Tauber suspected the child had a fragile bone disease called osteogenesis imperfecta, and directed the girl’s mom to talk to her pediatrician. A specialist confirmed the dentist’s hunch.
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Spotting emerging health problems
When dentists examine patients, they’re not just checking the teeth and gums. A full oral exam involves looking for abnormalities in the back of the tongue, evaluating the cranial nerves, looking at the eyes, skin and hair of patients, says Dr. Stuart Lazaroff, a general dentist in North Haven.
“We’re looking for growths, white or red lesions, anything that’s growing that shouldn’t be there,” he says. Dentists often see signs of oral cancer before patients have been diagnosed. Lazaroff scans all visible skin and has found cancer on patients’ ears and a patient’s leg.
“You can see all kinds of diseases by looking in the mouth and get ahead of things,” he says. “It’s not just important to go to the dentist to make sure your teeth are OK.”
Health insurance companies recognize the value of early detection, and recently two dental codes were added for insurance reimbursement to check patients’ blood sugar levels, says Dr. Margaret Drozdowski Maule, a general dentist who practices in New Britain.
More than 7 million adults in the U.S. have undiagnosed diabetes, and 84 million have prediabetes, according to the American Diabetes Association. A simple finger-prick blood test called a hemoglobin A1C reveals someone’s average blood glucose level over the past three months. If it’s higher than 5.6, it suggests the person could be pre-diabetic; an A1C of 6.5 or higher indicates the person has diabetes.
Uncontrolled diabetes goes hand-in-hand with gum disease, Maule says. She had a patient who had trouble keeping her blood sugar from spiking and had a dental abscess in her mouth, but once she was able to bring her blood glucose levels within a normal range, the abscess improved.
Research suggests that oral health impacts the body’s ability to control sugar levels, says Dr. Effie Ioannidou, a professor of periodontology and director of the Dental Clinical Research Center at the UConn School of Dental Medicine.
“We have solid evidence that patients with diabetes tend to have a higher prevalence of oral diseases,” she says. “We find that if we take care of oral infections in diabetic patients, we may be able to help their glucose control.”
Another finger-prick test allows dentists to check what a diabetic’s blood glucose level is at that moment. If someone’s blood glucose exceeds normal levels at the time of surgery, then surgery is not recommended because patients won’t heal as well, Maule says. (Those with diagnosed diabetes can lower their glucose level quickly by giving themselves insulin.)
Surgical patients with diagnosed diabetes and without diabetes who have elevated blood glucose levels risk increased surgical-site infections, heart attack, stroke and death, research shows.
Another reason for screening for diabetes is that it helps identify people who are diabetic or prediabetic who don’t know it. Screening for diabetes during regular dental visits led to the diagnosis of diabetes in 12 percent and prediabetes in 23 percent of 1,022 patients enrolled in a study published in the Journal of the American Dental Association.
The mouth-body connection
Dentists look for diseases and seek patients’ medical history and medications because they can impact oral health.
For example, radiation treatments to the head and neck can cause the salivary glands to produce less saliva, and some medications cause dry mouth, increasing the risk for tooth decay, Maule says. Knowing this, dentists may apply fluoride to the teeth, prescribe a high-fluoride toothpaste or suggest patients chew sugar-free gum to stimulate saliva.
Pregnant women are encouraged to see their dentist. Those who get regular dental care are less likely to go into preterm labor, research shows. Bacteria from inflamed gums of those with gum disease can get into the bloodstream and reach the fetus, causing premature labor and babies to be born with low birth weights, research published in the Journal of Natural Science, Biology and Medicine suggests.
For dementia patients, their failing memory may result in less brushing and flossing, causing tooth decay and gum disease. Or, oral bacteria from those with periodontitis may reach the brain and contribute to dementia. Either way, Diaz says, people with gum disease for at least a decade had a 70 percent higher risk for Alzheimer’s disease than those without it, according to a 2017 study.
Dental inflammation has also been linked to kidney disease and some types of cancer, especially colorectal cancer, Ioannidou says.
It’s clear that flossing and brushing benefit more than our smiles.
“If you control oral bacteria, you’re going to control oral disease,” Diaz says. “And you may even have an impact on preventing systemic disease.”