Sunday May 21, 2006
Floss ... it could save your life
Healthy teeth and gums give you more than a nice smile – they prevent unhealthy bacteria from growing in the mouth and causing problems in other parts of the body. TEE SHIAO EEK learns about the diseases that can originate from oral infections.
I WOKE up one morning with a throbbing pain in the back of my mouth. I gazed into the mirror, jaw gaping wide, and there it was: a recalcitrant wisdom tooth trying to push through a clearly swollen gum.
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Prof John Thomas...‘If you save the mouth, you save the host.’ |
I experienced a sudden sense of doom; not only was I terrified of dental procedures of any kind, I wondered whether this gum infection could increase my risk of delivering a premature, low-birth weight baby in a future pregnancy.
It is a fear that is not completely far-fetched. In recent times, scientists have made a connection between oral infections and several systemic problems, like cardiovascular disease, pregnancy problems, lung infections and the difficulty of controlling blood glucose in diabetics.
Prof John Thomas, from the Departments of Pathology and Periodontics in West Virginia University, was in town recently to convince dentists of this link.
If he is right, these findings have serious implications on our healthcare system – it means that more emphasis has to be placed on dental care, as the consequences are no longer merely cosmetic, but have an impact on overall health.
Bacteria-ridden body
Prof Thomas is fond of telling people that “we live in a microbial world”. He’s not saying this because he deals with microorganisms every day – as a microbiologist – and has begun seeing them everywhere.
What he means, literally, is that there are microbes all around us. They’ve been on this Earth far longer than we have, and they will be here long after we’re gone. In fact, bacteria, fungi, parasites and viruses are the unsung heroes that keep our ecosystems thriving.
For an example of an ecosystem that needs microbes to survive, look no further than your own body.
“There are four places in the body where we have huge numbers of bacteria,” says Prof Thomas, namely the mouth, gastrointestinal tract, female urogenital area and the skin. “People have more bacteria in those four reservoirs than they do in normal human cells.”
But lest you think that all this bacteria will make you sick, Prof Thomas clarifies that there are “beneficial bacteria”, which we need, and “unhealthy bacteria”, which cause problems.
For instance, there are over 700 kinds of bacteria in the mouth, which form a protective barrier screen that prevents unhealthy bacteria from colonising the mouth cavity.
“People – like you and me – have never been exposed to the fact that the mouth is an enormously important reservoir of good and bad things,” says Prof Thomas.
The important thing, he stresses, is to maintain a balance between the healthy and unhealthy bacteria. By keeping the normal barrier screen of healthy bacteria, we get along very well with them.“(But) then we start doing things that are not very good for us. We let the bacteria accumulate by not brushing and flossing our teeth, or using mouthwash. We change our diet to be hugely favoured towards bacteria, by eating sugar-containing foods. The sugars favour certain bacteria, which start to break down the barrier of healthy bacteria,” he explains.
“If you allow this to go on for a long period of time, the more deleterious is this change”, eventually causing caries and gum infections, he adds.
“But people don’t see it because these infections are chronic and take years to cause problems.”
He is not just talking about problems of the teeth. There’s more at stake here than just the mouth alone.
From mouth to body
“People think that organisms of the head and mouth have nothing to do with organisms of the rest of the body,” says a puzzled Prof Thomas.
“When I teach medical students, they only worry from the neck down. And when I teach dental students, they only worry from the neck up.”
He wonders why it hasn’t occurred to most people that the human body is a whole system. “The bacteria of the mouth are very closely related to the bacteria of the other places.”
Therefore, when there is an overgrowth of non-beneficial bacteria in the mouth, these bacteria could cause problems in other parts of the body as well.
“The mouth is a very important, if not the most important, part of the body relative to predicting and telling us that things are going badly,” Prof Thomas notes. “If these problems are left for a long period of time and not corrected, they could have serious consequences.”
By “serious consequences”, he doesn’t just mean gingivitis or caries, but other diseases of the body. “We know now that there are at least five diseases of the body that are directly related to poor oral health.”
Endocarditis (infection of the heart valves)
When a person has gingivitis, the gums become swollen and inflamed.
The non-beneficial bacteria that caused this infection “gains access to the internal system of the body through the opening of the inflamed gingiva, and are transmitted by blood throughout the body,” explains Prof Thomas.
These organisms will search out tissues that are very similar to the mouth, such as heart valve tissue.
“So these bacteria lodge in the heart valves. People walk around feeling rundown, weak, and poorly for three to six weeks up to three months. Then they begin to realise they have shortness of breath, and can’t do the same level of activity as before.”
The fatigue and weakness occurs because the infection has damaged the valves and the heart is now working harder to pump blood. Eventually, the heart may not be able to pump enough blood throughout the body, which means that heart failure has set in.
Premature delivery and low-birth weight babies
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We used to think that losing a tooth was no big deal. But now scientists believe that poor oral health and bacteria from the mouth can lead to other diseases of the body. |
“When bacteria in the mouth grow, they produce by-products and these by-products challenge a person’s immune system.”
The immune system then sends a signal throughout the body to get rid of these unhealthy bacteria.
Unfortunately, the body’s immune system is too effective, in a sense. “The body doesn’t care whether the bacteria is in the mouth or in the uterus, so the immune system tries to get rid of (all of) it,” says Prof Thomas.
The body is unable to discriminate between the bacteria and the growing foetus in the urogenital tract, so the consequence is that the body rejects the foetus as well. “So you get premature birth, and as a result of that, low-birth weight babies,” he says.
He adds that the link between oral bacteria and pregnancy problems is very significant. A woman who has gingivitis has a 2.5 to five times greater risk of delivering a premature and low-birth weight baby, which will increase problems in the newborn by almost 100-fold.
“This is a very serious problem among women of lower socio-economic status who have less access to dental care. Those circumstances won’t be changed and that risk won’t be decreased in the second pregnancy unless a woman does something about her oral hygiene.”
Diabetes
People with diabetes who have poor oral health face the risk of having their condition becoming more severe.
Prof Thomas explains that the bacteria associated with the regulation of insulin are bacteria that are also found in the mouth.
Again, if there is overgrowth of unhealthy bacteria, these bacteria mask the body’s recognition of what it should be doing.
“The bacteria acts as a red light to the signals of the body. The body doesn’t regulate diabetes properly, and the end result is that you amplify the disease,” he says.
“If you have low-level diabetes, (the bacteria) makes diabetes appear earlier. And you can’t control diabetes as easily in someone who has poor oral hygiene.”
In developed countries, fewer than one in five people with diabetes have poor oral health. However, in lower socio-economic regions, Prof Thomas speculates that practically every person with diabetes also has poor oral health.
He laments that this connection goes virtually unnoticed. “Does a doctor treating diabetes call up the dentist, or send his patient to the dentist?”
Risk of lung infections in hospitalised patients
Someone who has had poor oral health his entire life, say over a period of 50 years, could see the consequences coming full circle if he enters the hospital in the later part of his life and requires mechanical ventilation.
“In the intensive care units of hospitals, 50% of the patients will be mechanically ventilated. Of those 50%, those who are mechanically ventilated for longer than four days, increase their chances of dying by a percent a day,” Prof Thomas reveals this alarming fact.
He explains that mechanical ventilation involves the use of a tube that connects the ventilator to the patient’s lungs. “That tube acts as a meeting place for bacteria from the mouth to form a biofilm (see ‘Slimy bacteria’). After they’ve been there for four days, they begin to disperse.”
With the tube providing a handy connection, the bacteria go right into the lungs, causing lung infections that could be fatal.
In people who smoke, have diabetes, are overweight and have bad teeth, the potential risk of lung infection goes up about 50-fold.
Although hospitalised people on mechanical ventilators are usually from the elderly age group, their problems with oral hygiene started when they were in their late teens or early adulthood.
“It’s hard to make the connection between bad oral hygiene at 21 and death at 65. It’s hard to say to a family, ‘Your mum is not doing well because she had bad oral hygiene 30 years ago’,” says Prof Thomas.
“But that’s the reality. And what scares us is that we’re not sure how common this is.”
Think outside the mouth
“People don’t yet recognise that their oral cavity is a reflection of their general health,” says Prof Thomas.
“It’s no longer just oral diseases. Other diseases of the body are clearly associated with oral hygiene.”
However, poor oral health is a gradient. So should we only be worried if we have full-blown periodontal disease, or is even a mild case of plaque cause for concern?
Unfortunately, there is no “cut-off” point in the gradient, where you’re only at risk if you cross that point.
“It’s a combination of events over time. Clearly, gingivitis, periodontal disease and caries are the major players,” says Prof Thomas.
But this does not necessarily mean that if you have any of these three, you’ll definitely have a bad outcome. Neither does it mean that if you’ve just got a little plaque, you don’t have to worry.
“Generally, as you increase the opportunity for bacteria to change the balance, you are at greater risk,” Prof Thomas cautions.
Brush, floss and rinse
It’s really not too difficult to see what you should be doing now to prevent these problems.
“Just take care of your mouth,” Prof Thomas points out. “You have to brush, floss and use mouthwash. And see your dentist regularly.”
Although brushing and flossing have become routine for most people, the use of mouthwash as part of that routine has yet to become habitual.
“Mouthwash is a medication used for prevention; it is not simply a colouring reagent. Using mouthwash ... is such a simple, easy, beneficial way to change all the bad things that can occur,” he says.
However, some mouthwashes contain substances, namely alcohol, that may be restricted in certain cultures or religions.
Prof Thomas reassures those who are concerned about this that mouthwashes are for medicinal use. You can also look for an alcohol-free mouthwash, although be sure that it is still effective if it doesn’t contain alcohol.
This three-step oral care routine is so simple that you can’t push the burden of responsibility to your dentist or doctor anymore. “You should take responsibility for your own oral hygiene,” Prof Thomas advocates.
As he has emphasised, poor oral health has its roots during the early years of life, and builds up over the years. Whatever your age, you have to take care of the poor bacterial environment in your mouth now, or you’ll end up paying a much higher price for it later.
Of course, all the flossing and mouth-rinsing in the world isn’t going to save your life if you eat 10 fast food meals a week and drive without your seatbelt – but in the face of all the health advice that experts are bombarding us with, “brush, floss and rinse” isn’t so hard to do.
Related Stories:
Choosing a mouthwash
Where is our dental care?
Slimy bacteria
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