Watch Your Mouth

By Ranit Mishori
Special to The Washington Post
Tuesday, August 19, 2008

The way to a person's heart is through his stomach, the adage goes. But researchers now think the way to a healthy heart might be through your gums and teeth.

Evidence suggests that the healthier they are, the stronger and less disease-prone the heart is. If you don't floss or brush, you might be setting yourself up not just for gum disease but also for heart disease.

The link between what's happening in your mouth and in the rest of your body goes further still: Gum disease might be a kind of early warning system, with poor oral health linked to diabetes, kidney disease, preterm labor, osteoporosis, Alzheimer's disease and even certain types of cancer.

"A lot of research studies are coming out that seem to suggest some possible link or associations" between oral infection and systemic disorders, says Sally Cram, a periodontist in the District and consumer adviser for the American Dental Association.

There's a certain logic, of course, to the idea that your mouth -- your body's key opening to the outside -- would be a harbinger of bodily health. Yet the connection is one that many people, even medical professionals, often overlook.

Patients tend to minimize oral health, treating mouth issues as merely "dental." Professionals echo this artificial dichotomy: Dentists and doctors don't really talk to each other; they don't attend the same conferences; they don't read the same journals.

But recent research indicating a link between their disciplines is attracting attention from both doctors and dentists. Several studies show a startling correlation between gum health and atherosclerosis, a condition underlying much heart disease: The worse a person's gum disease, the narrower that person's arteries due to a buildup of plaque. This holds even for young, healthy adults who have no other symptoms of heart disease.

Many questions remain about the nature of the body-mouth connection.

In gum disease (called gingivitis in the early stages, before it develops into full-blown periodontal disease), the tissue that surrounds the bones supporting the teeth become inflamed or infected. Often this results from the accumulation of bacteria in the plaque under the tissue holding the teeth. The bacteria release toxins and other chemicals that begin to destroy the bone. Scientists believe they circulate and cause damage elsewhere in the body; exactly how remains unclear.

"It is like setting up a garbage dump on the edge of a river. You wouldn't be surprised if the lake downstream ended up polluted with the garbage from the dump," Vincent J. Iacono said in 2005, when he was president of the American Academy of Periodontology.

When Maurizio Tonetti, chair of the University of Connecticut's Division of Periodontology, conducted a study looking into whether reversing the production of bacteria and toxins in the mouth would benefit patients who had atherosclerosis, the results were encouraging. He reported in the New England Journal of Medicine last year that patients who underwent an intensive, six-month program of treatment for gum disease emerged not only with healthier gums but also with improved endothelial function -- that is, better function of the lining of the blood vessels. No, this does not necessarily mean better vascular function overall, but the experts say that these findings merit further study.

As does a possible link between gum infections and preterm labor. Nearly 13 percent of births in the United States are considered preterm (occurring before 37 weeks of gestation), and of these, almost half occur without explanation. This has prompted researchers to look at the role of gum disease.

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