Is your oral health vital to your general health?
How can you improve your oral health through good lifestyles, habits and regular visits to your doctor and dentist?
Helen, a 57-year-old lady, presented with frequent migraines. She described herself as having a sweet tooth, and craving sugar and carbohydrates since childhood. She had gained excessive weight that had reached obesity levels. She had been on various diets over the years, with no success, and she had progressed to having high blood pressure, prediabetes, and abnormal blood fat. She had recently fitted two stents because of the narrowing of her coronary arteries, which helped her angina symptoms.
Interestingly, Helen had a long history of gum disease – lasting most of her adult life. This started with tooth pain, bleeding gums, and an awareness of bad breath. She had also received 17 silver (mercury) dental fillings. And she had had multiple courses of antibiotics for gum infection and repeated abscesses.
We will find out how Helen got on later.
In this blog, I will cover oral microbes, their role in gum and systemic disease, and what you can do, in terms of lifestyles, habits, and medical and dental care, to prevent oral disease and associated metabolic and vascular disease.
People with periodontal disease, a serious oral problem, seem 2 to 3 times more likely to have a heart attack or stroke. However, many people with heart disease have healthy gums, and not everyone with gum disease develops heart disease. Correlation is not causation, but a healthy mouth will at least help you to keep your teeth!
Let’s delve a bit deeper into oral health.
Your oral microbiome is your second largest microbial community after your gut. The average person has 300-700 different species in their mouth – predominantly bacteria, protozoa, viruses, and fungi. Different areas of the mouth are occupied by different microbes. Your oral microbes stay constant despite the daily influx of microbes in food, air or via direct contact with other people. But the damage to the microbiome can interfere with your oral and systemic health.
Gum disease is very common among the general population, affecting over 50% of people over 30, with 10% severe cases. People assume gum disease is a purely dental problem, but gum disease sufferers are more likely to have a heart attack. Studies have confirmed that gum disease increases your risk of vascular disease, obesity, diabetes, dementia, colorectal cancer, rheumatoid arthritis, and Parkinson’s disease.
How does poor oral hygiene progress?
You were born with beautiful pink (this varies between ethnic groups) gums of soft connective tissue, which covers the bone that supports your teeth. The gums wrap tightly around your teeth to block any potential space (pockets) that can promote bacterial growth.
Gum disease presents with tooth pain, bleeding gums while brushing or flossing, and bad breath. In the early stages, known as gingivitis, the gums become red and swollen. If left unattended, gum disease can progress to the formation of plaque, which contains bacteria, which irritate the gums and causes inflammation and recurrent infection. You can arrest this early with good mouth care and plaque removal through regular and effective tooth brushing and flossing.
If you don’t, the bacteria ferment sugar to produce lactic acid, which can melt the tooth enamel, causing holes and dental cares. Plaque breaks the seal between the gums and the teeth, causing small spaces or pockets. When the infected plaque gains access to the deep connective tissue, this results in periodontitis, the advanced form of gum disease that causes receding gums, meaning the teeth eventually become loose and fall out.
Plaque can also die off to form a solid calcified coating called tartar. The long-term effects of periodontal disease can cause jawbone loss, affecting whether dental implants can be used in the future.
Minor cases of gum disease, as we have seen, can usually respond to good oral hygiene. The advanced disease requires regular visits to the dentist or hygienist for thorough cleaning (scaling) to remove any hardened plaque (tartar) and to prevent plaque building up.
The infection spreads from the mouth via the bloodstream
Risk factors for gum disease include poor oral hygiene, a diet high in sugar, a dry mouth (through stress, dehydration, and autoimmune conditions), medications such as birth control pills, diuretics, anticholinergic drugs or sleeping pills, smoking and lack of sleep.
Studies show that people with poor oral health (gum disease or tooth loss) have a higher heart attack or stroke rates than those with good oral health. The infection spreads from the mouth via the bloodstream, infecting cholesterol plaque in blood vessels. Antibiotic treatment does not reduce cardiovascular risk. It is not the bacteria but the immune response that triggers vascular damage.
Therefore, periodontal disease increases the body’s inflammation burden, and low-grade chronic inflammation, as we know, is the common factor in all metabolic conditions, including heart disease.
One study revealed a graded association between tooth loss on the one hand – and cardiovascular death, all-cause mortality, and stable coronary heart disease on the other.
Another study confirmed the regression of carotid artery intimal thickness (the beneficial reduction in arterial blockage) six months after treatment for severe periodontal disease.
What about Helen?
Helen’s BMI was in the obesity range at 31.4; her blood pressure was high at 145/95, and her waist size was high at 44 inches. She has a dark patch (acanthosis nigricans) in her right armpit, a common sign of metabolic disease. Her liver was enlarged and probably fatty. Routine blood tests revealed high total cholesterol at 5.9, high LDL (bad guy) at 4.9 and a low HDL (good guy) at 0.93, high triglyceride at 4.4, a high uric acid level at 425, HbA1C (a marker of blood sugar control over the last 3 months) was high at 39, hs-CRP (inflammation marker) high at 2.7.
Despite having the stents fitted, Helen’s risk of suffering an acute vascular event was still high. She had a high tendency to form blood clots, reflected in high fibrinogen at 5.2, together with small sticky cholesterol particles. These together increased her chance of indeed developing those clots, and were one to block a heart artery, which could result in a heart attack.
Helen realised the importance of working diligently to reduce her periodontal disease while lowering her risk of vascular disease. Now that she was fully aware of her genetic make-up and biochemistry (including her sweet tooth), she could take steps to successfully burn significant fat and lose weight. This has reduced her risk of making clots, an immediate threat to her health. Her blood pressure, blood sugar and lipid profiles have improved greatly with minimal medication. Above all, she has become more relaxed, and much happier and has reached a higher level of physical and mental functioning with a positive impact on her quality of life.
But, looking back, the bottom line is that her oral health had certainly not helped her systemic health.
Do YOU have gum disease?
Gum disease presents with tooth pain, bleeding gums, and bad breath. Medical tests for the condition include urine organic acid test, DNA health and DNA Smile, and vascular risk profile.
You can alleviate your risk by reducing your sugar intake, also through dental hygiene – brushing your teeth twice daily and cleaning the interdental spaces by flossing or using interdental brushes – and by stimulating saliva flow by chewing your food thoroughly and chewing gum. Incidentally, use food and toothpaste that contains arginine to balance oral acidity, your oral microbes process nitrite in fruits and vegetables to nitric oxide, which control blood pressure.
Food high in arginine includes meat, fish, nuts, seeds, milk, and dairy products.
More broadly, rebalancing your lifestyle will help greatly – stop smoking, eat a balanced diet, enjoy restful sleep at night, reduce stress levels, and enjoy more sunshine.
By now, my friends, you know that a healthy diet means real food with high fibre, avoiding sweets, processed carbs, fast food, and snacks (crisps, biscuits, and chocolates.) Enjoy plenty of fruits and vegetables rich in nitrite that controls blood pressure and chlorophyll, the natural antimicrobial to clear pathogenic bacteria.
Finally, please avoid over-the-counter antiseptic mouthwash like Chlorhexidine. This can wipe out beneficial bacteria, causing a serious shift in your oral microbiome, resulting in mouth acidity and lower nitrites, negatively affecting your blood pressure.
So, you can see, my friends, that poor dental health can have far-reaching consequences, but the solution is relatively straightforward. Certainly, in minor cases, better oral hygiene can resolve the problems, whilst more advanced cases may need professional intervention. Even though Helen’s situation was serious – the two stents, the risk of clots and heart attacks – she was able to turn her health around.
How is YOUR oral health?
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