Why Oral Hygiene Is Crucial to Your Overall Health

The inside of your mouth is the perfect place for bacteria to thrive: it's dark, warm, moist, and fed by the food and drinks you eat.

But experts say that when harmful bacteria build up around teeth and gums, you're at risk for periodontal (or gum) disease, which is an infection and inflammation of the gums and bone around the teeth.

Such conditions in the mouth can affect other parts of the body, said Kimberly Bray, a professor of dental hygiene at the University of Missouri-Kansas City.

For example, a growing but limited body of research has linked periodontal disease to a range of health conditions, including diabetes, heart disease, respiratory infections and dementia.

Exactly how oral bacteria affect overall health is still poorly understood, Dr. Bray said, because existing research is limited and none has established cause-and-effect relationships.

But experts say some conditions have more to do with oral health than others. Here's what we know.

According to the Centers for Disease Control and Prevention, about 47% of people in the United States age 30 and older have some form of periodontal disease.

In the early stages of gingivitis, the gums may be swollen, red, or tender, and bleed easily. If left untreated, gingivitis can escalate into periodontitis, a more serious disease in which gums recede, bone is lost, and teeth may become loose or even fall out.

Ananda P. Dasanayake, professor of epidemiology at the New York University School of Dentistry, said that in periodontitis, bacteria and their toxic byproducts enter the bloodstream from the gums and tooth surfaces and spread to different of organs.

This can happen when cleaning or flossing your teeth, or when you have a cut or wound in your mouth, he said.

Dr. Bray says if there is inflammation in the mouth and goes untreated, some of the proteins that cause the inflammation may spread throughout the body and potentially damage other organs.

Of all the links between oral health and disease, Dr. Bray says, the one with the most evidence is between periodontal disease and diabetes. The two conditions appear to have a bidirectional relationship, she added: Periodontal disease appears to increase the risk of diabetes, and vice versa.

Researchers don't yet know exactly how it works, but in a review published in 2017, they wrote that systemic inflammation caused by periodontal disease may worsen the body's ability to signal and respond to insulin.

In another study published in April, scientists found that diabetic patients who received periodontal disease treatment had a 12 to 14 percent reduction in overall medical costs.

“Treatment of periodontal disease can improve diabetes,” Dr. Dasanayake said.

Bacterial aspiration pneumonia can result if large numbers of bacteria in the mouth are inhaled and deposited in the lungs, said Dr. Frank Scannapieco, a professor of oral biology at the University at Buffalo School of Dentistry.

The phenomenon occurs primarily among hospitalized patients or older adults in nursing homes, and is a concern for those who are unable to floss or brush their own teeth, said Dr. Martina Bertolini, Assistant Professor of Dental Medicine.

Dr. Scannapico says preventive dental care (such as professional tooth cleaning) or periodontal treatment (such as antibiotic therapy) can reduce the risk of this type of pneumonia.

In a report released in 2020, an international expert panel concluded that there is a significant link between periodontitis and heart disease, stroke, plaque buildup in the arteries, and other cardiovascular diseases.

While researchers have not determined how poor oral health contributes to poorer heart health, some evidence suggests that periodontal bacteria in the mouth may enter the arteries of people with vascular disease, which may play a role in the development of the disease.

A 2012 statement from the American Heart Association noted that gum inflammation is linked to elevated levels of inflammatory proteins in the blood, which are linked to poor heart health.

Some studies also suggest that better oral hygiene habits are associated with lower rates of heart disease.

For example, in a study published in 2019, researchers reviewed the health records of nearly 250,000 healthy adults living in South Korea and found that over about 10 years, those who brushed their teeth regularly and had their teeth cleaned regularly were more likely to have cardiovascular events. are less likely than those with poorer dental hygiene, more cavities, tooth loss, or periodontitis.

Dr. Dasanayake said many studies and reviews have found a link between severe periodontal disease and premature, low-birth-weight babies. Although more research is needed to confirm this association.

In a 2019 review, researchers found that treating periodontal disease during pregnancy improved birth weight and reduced the risk of preterm birth and fetal or neonatal death.

In a 2009 study, researchers found that oral bacteria may be transmitted to the placenta, which can lead to chorioamnionitis, a serious infection of the placenta and amniotic fluid that can lead to premature labor and, if not passed, even Life-threatening complications go untreated.

Research also suggests that bacteria in the mouth may activate immune cells circulating in the blood, causing inflammation in the uterus that can damage placenta and fetal tissue.

Long-term studies have shown that periodontitis may cause premature birth in animals such as mice, and that treating these infections can prevent low birth weight and premature birth.

Dr. Scannapieco said researchers are increasingly interested in the role of oral health in dementia, particularly Alzheimer's disease.

“Bacteria found in the mouth have actually been found in the brain tissue of Alzheimer's patients,” he said, suggesting they may play a role in the disease.

In a recent review, scientists suggest that oral bacteria—particularly those associated with periodontitis—may directly affect the brain through “central nervous system infection,” or by inducing “chronic systemic infection” that reaches the brain. Inflammation affects the brain indirectly.

However, the review's authors wrote that there is no evidence that oral bacteria themselves may cause Alzheimer's disease. Instead, periodontal disease is just one of many “risk factors” for people who are susceptible to Alzheimer's disease or other forms of dementia.

Oral bacteria are also closely linked to many other diseases, including rheumatoid arthritis and osteoporosis, Dr. Bray said. Emerging research is beginning to link oral bacteria to kidney and liver disease, as well as colorectal and breast cancer.

But experts say more research is needed to confirm all of these links. Dr. Scannapico says we still don't know whether regular dental care and periodontal treatment can help prevent or improve any of the above conditions.

Dr. Scannapico says the best way to maintain good oral health is to follow classic dental care recommendations, including brushing twice a day and flossing daily.

“Not everyone really takes their oral health seriously and they only think about it when they have a toothache or some pain,” he added. But it's important to be as diligent and proactive about your oral health as you are about exercise, diet, or any other aspect of your health.

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