Watch Your Mouth

Observational studies show rates of preterm birth are higher for women with severe gum disease than those with milder or no such disease. A recent review in the journal American Family Physician noted that studies of nearly 15,000 women in "identified 24 studies demonstrating a positive relationship between periodontitis and preterm birth, low birth weight, or both."

Gum disease may also be implicated in a "small, but significant" increase in overall cancer risk for men, according to a recent study in The Lancet Oncology. The authors linked gum disease to a higher chance of lung, kidney, pancreatic and blood cancers. A similar pattern is emerging for kidney disease and Alzheimer's. But as with heart disease and preterm labor, the question of what causes what has not been definitely answered.

In diabetes, however, the body-mouth connection is clear-cut. Diabetics who have uncontrolled gum disease, Cram said, "have a much harder time [than other diabetics] controlling their blood sugar levels." The reverse, she noted, is also true: People with uncontrolled diabetes are about "three to four times at greater risk of developing periodontal disease." The cycle is very hard to break.

'Smiles for Life'

You would think that physicians would be telling their diabetic patients to make regular dental visits to head off gum disease and that dentists would be advising patients who develop persistent gum disease to be tested for diabetes. But neither group of practitioners has been especially good at making the connection.

Similarly, despite growing evidence of a link between preterm labor and gum disease, only 22 to 34 percent of U.S. women consult a dentist during pregnancy, according to a 2001 report in the Journal of the American Dental Association; other studies also show lower use of dental services during pregnancy. Among women who develop mouth problems during pregnancy, only 50 percent seek help; many of the rest worry that mouth treatment may be harmful to their babies.

Experts such as Caswell A. Evans, director of the National Oral Health Initiative, think it is past time for patients to reconsider how they think about the dentist vis-a-vis the doctor. We minimize many mouth ailments, he says, shrugging off "blood on [our] toothbrush." And dental patients need to get past thinking of their dentist primarily as a cosmetic practitioner -- a whitener and straightener of teeth -- or a "fireman" to be called only when there's extreme tooth pain.

Regular visits to a dentist can make the mouth an early warning system for a variety of problems. Sores or fungus in the mouth, for example, are often the very first indications of infection by HIV, the virus that causes AIDS, or of cancer. Osteoporosis, a disease of the bones, could show up in a routine dental X-ray before you notice its impact on your hips or spine.

For their part, dentists and doctors are beginning to realize they might help their patients by joining forces.

"There's a desperate need for more collaboration between the two specialties," emphasizes Alan Douglass, an associate professor of family medicine at the University of Connecticut School of Medicine. That's why Douglass and his colleagues created a national oral health curriculum aimed at doctors, " Smiles for Life."

Doctors, Douglass says, "need to serve as an entry point into the dental-care system."

Meanwhile, Evans is urging his fellow dentists to consider the whole person and be "cognizant of their medical needs" as well as their dental ones.

One thing both groups agree on is the power of prevention, which means brushing, flossing and having regular professional cleaning.

Doctors can also help identify at-risk patients. The good news is that if you catch gum disease in its early stages, Cram says, "you can reverse it" with procedures such as scaling and root cleaning.

So, take care of your mouth. Your heart, your brain and your kidneys may thank you for it. As Evans puts it: "Oral health is not an out-of-body experience."

Ranit Mishori is a family physician and faculty member in the Department of Family Medicine at the Georgetown University School of Medicine. Comments:health@washpost.com.