I work as a dental assistant in the summers and winters and what stands out to me the most when I talk to patients is that they don’t floss, at least not a regular basis. Often patients think feel that toothpaste, mouthwash, or a water pick will do the job, but the dentist I work for says that those methods are like having a nasty rotten mushy apple stay on a counter top then spraying it with an antibacterial spray. Of course the millions of bacteria on the top of the mushy rotten apple will die, but you still have a nasty mess on the counter top with countless living bacteria underneath the surface. Then what is the solution then to cleaning a counter top or a tooth? Just physically wipe it off. It requires a wet rag to wipe off the mushy apple off the counter or some floss to clear out the plaque and food between teeth and under the surface of the gums. The biofilm of the early plaque is quite loosely attached to the teeth and just need some gentle physical force such as brushing and flossing can remove it. Why does the dentist tell me to stress the importance of flossing to patients? If patients don’t floss they will develop gingivitis (inflammatory gum disease), and more severe cases will develop into periodontitis (inflammatory disease of the gum and surrounding bone structure). The dentist stresses flossing so much to prevent, periodontitis is the leading cause for adult tooth loss. [Source of information from this paragraph came from Clayton Wainwright, DDS.]
However the dentist also stresses gum and surrounding bone hygiene for the health of internal organs and overall systemic health. That’s right; a health smile leads to an overall healthier body. The gums and jaw has constant blood circulation, just like your ear for example. If you get a chronic ear infection, it is quite obvious to get to the doctor clear the infection. The infection is sending harmful pathogens and inflammatory cytokines into your circulatory system. However if you have a chronic gum and surrounding bone infection it might not be as obvious to quickly go to the dentist clear the infection. Like the ear or any chronic infection, it is important to clear periodontal infection as soon as possible. In fact, the dentist receives many patients from general surgeons who will not operate on the patient until after all the oral infections are dealt with. [Source from Dr. Wainwright]
The link between oral health and system health is a current hot area of research, and one fine example is the correlation between periodontitis and stroke. The basic flow chart is that microbes cause dental caries and periodontal disease; which lead to bacteremia (bacteria in the blood) and systemic inflammation; which lead to atherosclerosis and thrombosis; which lead to coronary heart disease and cardiovascular disease, such as stroke. Several of these negative inflammatory cytokines connected to periodontal disease are such as IL-1 and TNF. Animal studies have shown that inducing periodontal disease in rabbits leads to the accumulation of coronary artery disease. In addition, several human studies such as the NHANESIII or a study in the Annals of Neurology demonstrate that periodontitis (not gingivitis) had a correlation with increased risk of stroke. Although more large scale studies are needed, the current evidence supports that periodontitis can increase the chance of having a stroke. [Sources from Ray Wagner MD, MS, FAAP; and articles found on http://d2l.ltc.arizona.edu/d2l/orgTools/ouHome/ouHome.asp?ou=167152 and http://d2l.ltc.arizona.edu/d2l/orgTools/ouHome/ouHome.asp?ou=167152]
Preventing periodontitis is quite easy with proper dental hygiene and regular trips to see the dentist. What is sad is that now around 75% of Americans adults are affected by some stage of periodontitis and the future adults don’t look so great with early childhood carries, aka ECC or child tooth decay, being the leading chronic disease among school aged children. So when I tell the patients at the dental office that flossing necessary to keep your teeth, I can also now tell them that flossing can help prevent stroke and other cardiovascular diseases. Any thoughts?
Geoff, you seem to know more than the average person about this specific area related to oral hygiene. I never found oral physiology interesting, but I found this post pretty insightful. I tried to search briefly on a pretty random question. How do animals, especially those that live longer than a decade, maintain their teeth. If they cannot floss or brush, then why aren't animals predisposed to these chronic infections and disease that humans seem so prone to aquiring?
ReplyDeleteBesides that, I looked up some surface level information about how chewing tobacco affects systemic function all because of the effects it has on the vasculature of the gums. Apparently, it can cause dysfunction slowly through and around areas of the mouth and neck. Specifically, the pre-cancerous sign appears as white lesions caused by leukoplakia.
Does your dentist ever see patients that frequently use tobacco or other oral drugs that negatively affect the mouth?
I was just curious, is something like gingivitis or periodontitis reversible? I see toothpaste and mouthwash commercials stressing that their product can prevent these symptoms, but do any have the ability to restore the teeth and gums to their desired state once it is lost, or would you say early prevention methods such as flossing and dentist visits are the best method of treatment?
ReplyDeleteThis seems pretty interesting, and to the above comment I would think that periodontitis can be reversed, as in the infection can be treated, but the bone loss is permanent. These statements about the periodontitis and its correlation to stroke and cardiovascular disease are intriguing, however I would say they're pretty bold statements. I mean, isn't that the same as saying that any prolonged infection without treatment is going to cause deleterious affects. I'm not saying that it's not true, but telling patients that if they don't floss they're going to have a stroke might be a little premature. It would be nice to see a epidemiologic study of the stroke victims in the U.S, and to see if they had any oral or gum infections at the time.
ReplyDeleteThis is an interesting topic. I’ve heard about gum and tooth decay leading to systemic infections but I didn’t know they had proven it could cause heart disease. I wonder if there is any data on the statistics of people who’s heart disease could be tied back to gum and tooth decay?
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