Those at risk. Getting on in years also ups the ante. A shift in hormones puts post-menopausal women at risk of osteoporosis, which may raise the chances of developing periodontal disease. Entering menopause with pre-existing gum disease may speed the destruction of jawbone, making implants and other repairs more challenging. Old age may bring arthritis and lessened dexterity with floss and toothbrush. But losing teeth is no longer a foregone conclusion, says Richard Price, spokesman for the American Dental Association, though visits to the dentist most likely need to increase. Transportation an issue? "Some dentists make house calls," he adds. Contact the local dental society.
Pregnancy may introduce pitfalls, too. "If you're thinking of becoming pregnant or if you are pregnant, be sure you have no oral infection," says Offenbacher. About half of expectant mothers develop gingivitis, due in part to hormones, making frequent dental visits important. Research suggests that having gum disease makes a pregnant woman several times more likely to deliver a preterm, low-birth-weight baby. High levels of prostaglandins, a labor-inducing chemical associated with severe gum disease, may be to blame. Insurance companies like Aetna and Cigna have begun covering extra cleanings for pregnant women and additional deep cleanings, known as scaling and root planing, for those with more severe gum disease. Pilot trials suggested deep cleanings in such women reduce premature birth and low birth weight. A larger 2006 trial found they're safe but have no clear benefit.
Aetna, Cigna, and others are also now offering stepped-up care for members who carry their dental coverage and have certain chronic diseases—and the insurers are reaping savings when they do so. In research conducted with the Columbia University College of Dental Medicine, Aetna saw a reduction in total medical costs of 9 percent for members with diabetes, 16 percent for those with coronary artery disease, and 11 percent for those with stroke or other cerebrovascular disease.
Certain dentists routinely test blood pressure and refer patients to a physician if they find clues of systemic disease, and there's growing interest in expanding that aspect of dentistry. "We want to see the dentist become much more active in the role of diagnosis and screening," says Daniel Meyer, senior vice president of science and professional affairs for the American Dental Association.
And some dentists are already forging ahead. Three years ago, Ron Schefdore, a dentist in Westmont, Ill., began testing adult patients' blood glucose, cholesterol, and C-reactive protein (a marker of inflammation) before and after eight-week treatment regimens for periodontal disease. Monitoring those numbers helps him refer patients to a physician if something's out of the normal range. Another tool that inspires Schefdore's patients to commit to better oral care: a closed-circuit television. He zooms the camera in so "they can see all the blood and the yuck," he explains. "It really motivates them!"