By R.J. Ignelzi
June 12, 2007

DAN TREVAN / Union-Tribune
As part of a healthy gum routine,
dental hygienist Terrie Vorono cleans
patient Bob Coy's teeth.
Once again, Mom was right.

For years she hounded you to brush and floss regularly to help keep your teeth and gums healthy. Little did she or anyone else know then that following her oral hygiene advice may also protect you from serious illness and disease.

There's growing evidence that gum or periodontal disease may put you at increased risk for heart attacks, stroke, diabetes and some cancers.

In March, a study published in the New England Journal of Medicine found that treating severe gum disease can improve the function of blood vessel walls, improving heart health.

The April issue of the Journal of Periodontology published studies that found periodontal bacteria in the arteries of people with heart disease and in the placentas of pregnant women with high blood pressure. Another study in that journal found that gum disease may predispose some people to developing early signs of diabetes.

And earlier this year, a Harvard School of Public Health study of more than 50,000 men showed that those who had gum disease had double the risk of getting pancreatic cancer than those without gum disease.

“Although the cause and effect of periodontal disease linked to other diseases is not absolutely proven, the data is starting to pile up,” says Dr. David Richards, a Hillcrest periodontist who emphasized that it's more important than ever to “take aggressive action against periodontal disease.”

An estimated 80 percent of American adults have some form of periodontal disease, according to the National Institute of Dental and Craniofacial Research at the National Institutes of Health.

The main cause of gum disease is bacteria, which is found in plaque, a sticky, colorless film that constantly forms on the teeth and tongue. Daily brushing, flossing, tongue scraping and other forms of interdental cleaning usually remove plaque to keep the gums healthy.

But it doesn't take long for sloppy brushing and haphazard flossing to lead to gingivitis, the early stage of periodontal disease. Characterized by swollen and bleeding gums, it's reversible with professional treatment and diligent home oral care.

Left untreated, however, gingivitis can develop into periodontitis, advanced gum disease. As tartar and plaque continue to build up, pockets form between the teeth and gums and the gums may begin to recede. As the pockets become deeper, the disease destroys more gum tissue and progresses to the bone, which can eventually cause teeth to become loose or fall out.

The dentist, periodontist or dental hygienist can remove plaque through deep cleanings called scaling and root planing. If inflammation and deep pockets remain after cleaning and medication, it may be necessary to do flap surgery, which involves lifting back the gums and removing the tartar. Your periodontist may also suggest bone and tissue grafts to help replace or encourage new growth of bone or gum tissue destroyed by the disease.

About three of every 10 adults over age 65 have lost all of their teeth because of cavities and gum disease, according to the U.S. Centers for Disease Control and Prevention.

“A lot of people go untreated for periodontal disease because most of the time it doesn't hurt. By the time they feel or notice anything, it's too late. The bacteria has already eaten away at the bone and tissue,” says Dr. Irvin Silverstein, a La Mesa periodontist. “If periodontal disease hurt as much as an infected finger, they'd get themselves treated early.”

A number of studies indicate that the unchecked inflammation and bacteria in the mouth may be at the root of many problems throughout the body. The bacteria in plaque produce toxins that trigger an immune response and the release of chemicals called cytokines to wall off and kill the bacteria. The problem is, when too many cytokines are released, inflammation increases, damaging tissues in all areas of the body and causing increased blood pressure levels, high cholesterol levels and increased blood clotting, which can lead to potentially fatal heart attacks and strokes.

“Inflammation is a very important phenomenon in the spectrum of all kinds of diseases,” Richards says. “The inflammatory messengers sent out by diseased gums are taken by the bloodstream to distant sites in the body and can affect overall health.”

Some researchers also believe that when periodontal bacteria travel from the mouth through the bloodstream, they may lodge in the blood vessel walls, triggering inflammation and causing the walls to thicken. A thickened blood vessel wall can increase a person's risk of heart disease and heart attack.

To save your teeth and your general health, stopping periodontal disease before it starts is critical, periodontists say, because you're never cured.

“Just like with diabetes, you will always be stuck with periodontal disease once you have it. But, you can manage it,” Richards says. “You will have to be more vigilant (about oral hygiene) than the next person who doesn't have any deep pockets. And you may need to get your teeth cleaned four times a year and use special mouth rinses. But, if you work at it, you can control it.”

Staff librarian Beth Wood contributed to this article.

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