Good dental care has widespread health consequences

It has long been understood that brushing and flossing twice a day helps to maintain healthy teeth and gums, but what about the rest of the body?

The American Dental Association, or ADA, is increasingly becoming more aware of research pointing to the fact that good oral health is “important for overall health, and vice versa.”

Dental literature has highlighted medical and dental patient treatments that address the interface between pathologies in the oral cavity and systemic conditions. Dentistry has even coined the phrase “periodontal medicine” to describe the relationship between systemic conditions and periodontal, or gum, diseases.

Periodontal disease is an infectious disease that is linked to the nation’s No. 1 killer, heart disease, and is a silent, non-painful disease that often progresses unnoticed. Similarly, systemic conditions can promote the development of periodontal or tooth diseases.

There are several other areas in dental research focused around periodontal medicine and the number of effects connecting periodontal disease or oral infections to systemic infections in addition to cardiovascular disease — for instance, diabetic complications and preterm delivery and low birth weight in babies. Fortunately, that is why a visit to the medical doctor will routinely include a dental history.

The notion that oral-systemic health has an effect on overall health is not a new one. Once put on the back burner, in recent years it is gaining in popularity once again.

“More than 2,000 years ago, Hippocrates suggested that arthritis could be cured by the removal of infected teeth,” said Dr Michael Glick, DMD, of the American Dental Association.

He also said that countless articles have discussed periodontal disease and its association with heart disease, stroke, pneumonia, pre term births, low-birth-weight babies, osteopenia, osteoporosis and diabetes.

“Although the focal infection theory fell out of vogue during the 1920s and 1930s, there is a renewed interest in the effect of oral infections on the development and exacerbation of systemic diseases. Particularly, the association between periodontal disease and general health has been elucidated and discussed both in the professional literature and the lay press. This connection has popularized the terms “oral-systemic” and “periodontal medicine.”

What Glick and others now ask is what does this mean to the dental community? What is the role of dentists in the future as health care providers?

“Should oral care providers screen patients for common medical conditions? Should dentists start to check patients’ blood pressure, cholesterol and plasma glucose to screen for heart disease and diabetes mellitus? ”he asked in his article “Exploring our role as health care provider: the oral-medical connection."

Performance of patient assessments and clinical examinations are part of dental hygienists’ educational preparation and standards of care.

Dental professionals conclude that oral health examinations are one of, if not the most, important services they provide. The good news about periodontal disease is that it is preventable. Proactive care that includes regular check-ups and thoroughly brushing and flossing is a patient’s best way to stay on top of their oral health.

With that said, even a dentist or dental hygienist wouldn’t be aware a patient has periodontal disease without doing a thorough and proper examination, which includes a clinical examination that measures the periodontal pocket depths beneath the gums, exposing and evaluating dental X-rays to see if bone has been lost and if there is bone loss — where it is occurring, and development of a plan of treatment.

For local Registered Dental Hygienist Anne Green, RDH, establishing the oral-medical connection is something that gets done at the beginning of each visit and continues on as the visit ensues.

“We always ask them if there are any changes in their health or if they are on any medications,” said Green. “And we try to motivate them to brush — well, everybody brushes – but to floss. It takes 30 seconds to floss, and if you know it could possibly help your heart, isn’t that worth it?”

Oftentimes, Green said, patients will mention things like high blood pressure and that gives the hygienists another way to start a conversation.

“You use whatever you can. Whatever they throw out there, you try to make it click and motivate people.”

Other tips for a healthy mouth and gums include brushing, flossing, visiting the dentist and dental hygienist at least once every six months, and avoiding smoking and using tobacco. It is recommended that people change their toothbrush at least every three months, or sooner if the toothbrush looks worn.

Green said most people are really surprised to hear of research that is starting to make a correlation between heart disease and other ailments, and periodontal disease.

For many dental professionals, making those connections is the first step. Although many of the articles and research conducted fall short of showing a clear “cause and effect” relationship between, for example, treatment of periodontal disease and healthier, higher weight babies, it does show a correlation between pregnant women with existing periodontitis possibly having a higher risk of pre-term and /or lower birth weight babies.

Studies on cardiovascular disease have shown that periodontal therapy does in fact, have a positive effect on heart disease inflammation markers. And studies have proven that people with diabetes and smokers are at a higher risk of developing periodontal disease.

According to the association, more studies are needed to see the affect of treating periodontitis on the affect of other conditions.

“Well-controlled, blinded clinical studies are required to establish a cause-and-effect relationship and to determine if, or how, treating periodontal disease may affect systemic health.”

But for people like Green, who have seen all types of patients with all types of levels of knowledge about their health and heart, the proof is in the pudding.

“Of all the physicians I have treated over the years, the cardiologists are the ones who make the time in their schedule to get their teeth cleaned.”

With the average dental cleaning visit hovering around more than $100, and emergency room visits costing everyone in the long run, this news does not bode well for the many Delawareans who already struggle with finding money to visit the dentist, which only exacerbates a vicious cycle of poverty and disease. As Coastal Point reported in September 2008, a 12-year-old Maryland boy, Deamonte Driver, died from complications from a tooth abscess in February 2007 after his mother spent months trying to find someone willing to treat him. That case has sparked a push for reform in the availability of dental care not only in Maryland but nationwide.

And for low-income Delawareans, there are options for oral health care.

At the present time, Sussex Smiles, the Sussex County dental clinic for adults ages 18-64 that closed its doors this past fall, is referring would-be patients to Delmarva Rural Ministries in Dover, at (302) 678-3652, which provides dental care to low-income residents.

For low-income children, the Delaware Healthy Children Program (DHCP), the low-cost health insurance program for Delaware’s uninsured children, includes dental services that include preventive, diagnostic and restorative dental procedures. For more information, visit http://dhss. delaware.gov.