Derita Malcom had a recent revelation—one profound enough that her two adolescent kids hear about it every night. "I preach: 'Take care of your teeth,'" she explains. Removing her upper denture before bed, Malcom, 49, tells her kids, "Look at mama's teeth" and the damage caused by gum disease. "I had such a fear of the dentist that I really neglected my mouth," says the elementary school secretary from Chesterfield, Va. The consequences are not limited to her mouth.
Malcom's diabetes may have been harder to manage because of her long neglect of oral health. Before she underwent a series of dental procedures last year, Malcom's A1c level, which reflects blood sugar control, was far above the safe range. Now, since she has a new dedication to home care and is nearing the end of her dental work, Malcom's sugars are closer to normal. "I didn't make the connection that it could improve my diabetes," she says. She's not alone.
Three in four American adults have at least mild periodontal (gum) disease, or gingivitis. More severe disease, or chronic periodontitis, may affect as many as 30 percent. Regardless of severity, gum problems can be quite stealthy; pain is minimal and bleeding or reddened gums may be the only sign. Yet disregarding oral health could have serious overall repercussions. Recent research suggests that uncorrected gum issues make blood sugar more difficult for diabetics to control. Diabetes, in turn, can cause or worsen gum disease. "It's a two-way street," says Susan Karabin, president of the American Academy of Periodontology. The underlying mechanisms are not fully understood, but gum disease involves chronic inflammation—which can trigger insulin resistance, a hallmark of diabetes—and also bacterial infection. "Periodontal disease creates the wound that allows [oral bacteria] to gain access to the rest of the body," explains Steven Offenbacher, director of the Center for Oral & Systemic Diseases at the University of North Carolina.
People with gum disease may also be more likely to have a heart attack, stroke, or thickening of the arteries. Again, the culprits may be inflammation, a major factor in cardiovascular disease, and chronic low-level infection. Oral bacteria have been found in arterial plaque and can induce a process that leads to blood clots.
The flip side, says Karabin, is that "a healthy mouth means a healthy body." Research published last year in the New England Journal of Medicine found that blood vessel function improved significantly in patients given intensive treatment for severe periodontitis, compared with those who had only basic plaque removal and polishing.
Cliff Sloan is quite literally taking such findings to heart. After the Chevy Chase, Md., resident had a heart attack eight years ago, his internist prescribed medication, maintenance of healthy habits—Sloan, now 50, was already a runner with a healthy diet—and an aggressive approach to oral health, including treatment for receding gums. Since then, Sloan, the publisher of the Web magazine Slate, has alternated every three months between visits to his regular dentist and intensive cleanings by a periodontist, or gum disease specialist. "The stakes are just too high" to ignore the apparent connection, says Sloan.
Chronic disease is not the only state that warrants extra attention to oral health. Infection control is critical to surgical patients, for example, and a dentist's or periodontist's sign-off is not infrequently required before patients proceed to the or, especially for heart or orthopedic procedures. Hormonal and developmental changes, too, can boost a person's risk of oral problems. Adolescents often have gingivitis due to a combination of raging hormones, orthodontia, and lax oral hygiene. Add an unhealthful habit—a study in the Journal of the American Medical Association this month found an increase in gum disease in young adults who were heavy users of marijuana—and the odds of oral health problems worsen still.
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!"