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Flossing Protects Far More than the Teeth and Gums
Flossing Protects Far More than the Teeth and Gums
By Jane E. Brody

Published: January 19, 1999

I suspect that my most egregious lapse in healthful living is widely shared: Knowing that I might lose my teeth in the coming decades is not enough to get me to floss every night. I do endure thrice-yearly periodontal cleanings and admonishments to do a better job on a daily basis, but still that 18-inch strip of string does not always find its proper mark before the day is done. Even watching the misery my husband suffered in adjusting to dentures was not enough to sustain a nightly habit of flossing.

But I have recently learned that there is a lot more than tooth preservation to worry about. Recent findings indicate that periodontal disease may precipitate or aggravate health problems elsewhere in the body. Perhaps the emerging information about the relationship between periodontal disease and these serious, and sometimes fatal, ailments will motivate more of us, including yours truly, to pay more attention to the health of the gums and bone that support our teeth.

Infections Go Bodywide

More than 400 species of bacteria live in the human mouth, where some can infect the gums and underlying bone that support the teeth. Gingivitis, an infection that sometimes renders the gums tender and susceptible to bleeding when they are irritated, is generally the first stage of periodontitis, a disease that afflicts millions of Americans. As many as half of high school students have gingivitis. Gradually, as infected gums pull away from the teeth, ever-deepening pockets form that allow the infection to spread and eat away the underlying bone, causing teeth to loosen in their sockets. About 15 percent of American adults have advanced periodontitis and are in danger of losing their teeth. In fact, most adults over 60 in this country have lost all their teeth, primarily due to periodontal disease.

But, recent studies show that teeth are not the only organs endangered by this oral disease. Infections in tissues of the mouth are easily spread into the bloodstream. Even brushing, flossing and chewing can prompt a bodywide invasion when periodontal disease is advanced.

”People think of gum disease in terms of their teeth, but they don’t think about the fact that gum disease is a serious infection that can release bacteria into the bloodstream,” said Dr. Robert Genco, editor of the Journal of Periodontology and professor of oral biology at the State University of New York at Buffalo. ”The end result could mean additional health risks for people whose health is already affected by other diseases — or lead to serious complications like heart disease.”

Serious Consequences

A century ago, a spurious link between periodontal disease and rheumatoid arthritis prompted dentists to extract all of a person’s teeth in hopes of curing the arthritis. This mistaken belief virtually halted for many decades any serious research into the relationship between periodontitis and other diseases. But its recent revival is yielding some frightening links to such problems as heart disease and strokes, diabetes, pneumonia and premature births.

HEART DISEASE — All other things being equal, people with periodontal disease are one and a half to two times as likely to suffer a fatal heart attack and nearly three times as likely to suffer a stroke as those without this oral disease. The association with heart disease is especially strong in people under 50. Studies have indicated that chronic oral infections can foster the development of clogged arteries and blood clots. Substances produced by oral bacteria that enter the bloodstream can precipitate a chain of reactions that result in a build-up of arterial deposits. And several common oral bacteria can initiate the formation of blood clots and disrupt cardiac function.

DIABETES — It has long been known that diabetes predisposes people to bacterial infections, including infections of oral tissues. But recent studies strongly indicate that periodontitis can make diabetes worse. Diabetic patients with severe periodontitis have greater difficulty maintaining normal blood sugar levels, and treatment of periodontitis often results in a reduced need for insulin. Experts now urge that periodontal inflammation be treated and eliminated in all people with diabetes, especially since such treatment may reduce the risk of injury to the retina and arteries that is a common consequence of diabetes.

PNEUMONIA — Bacterial pneumonia results when bacteria that live in the mouth and throat are inhaled into the lungs where immune defenses fail to wipe them out. Several agents that cause pneumonia can thrive in infected oral tissues of people with periodontal disease. And, other respiratory diseases, like chronic bronchitis and emphysema, may be worsened by oral infections when the invading bacteria are inhaled.

PREMATURE BIRTH — It has long been known that infections of the pelvic organs can precipitate premature labor and the birth of small babies. Infections lead to high levels of substances like prostaglandin E-2 that can induce labor. There is increasing evidence that oral infections, too, can induce premature labor. Periodontal bacteria produce molecules that also prompt the release of labor-inducing substances like prostaglandin. One small study found that mothers of prematurely born small babies were seven times more likely to have advanced periodontal disease as mothers whose babies were normal weight at birth, even though all mothers in the study were not otherwise at risk of having a premature baby. What is needed is a study to determine whether treatment of periodontal disease in pregnant women can reduce the risk of premature birth.

INFECTIONS — People with artificial joints and heart valves are at increased risk of suffering a serious infection when periodontal bacteria enter the bloodstream. For those with artificial heart valves, the infection can be fatal unless promptly and thoroughly treated with antibiotics. This is why dentists routinely prescribe antibiotics to such patients before initiating dental work.

What You Can Do

Of course, prevention is always the best bet. It starts with building and protecting one’s bones. This means having enough calcium in the diet to maximize bone development before age 30, when gradual bone loss begins. People with osteoporosis lose bone in the mouth as well as the hips and spine, and postmenopausal women who do not take hormone replacement have a greatly increased risk of periodontal disease.

Prevention also means establishing a routine of daily brushing and flossing and a professional periodontal cleaning at least once a year — or more often, if your mouth readily forms dental plaque. Keep in mind that early stages of periodontal disease often produce no symptoms.

The American Academy of Periodontology provides information about the link between gum disease and other diseases through a toll-free number, (800) 356-7736, and on its Web site — — where an academy periodontist will answer questions.

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