Dr. Pooja Maney, diplomate of the American Board of Periodontology and assistant professor of periodontics at the LSU Health Sciences Center, estimates periodontitis (gum disease) affects 15 to 20 percent of the population. It also is linked to cardiovascular disease, stroke, diabetes and low birth weight in babies whose mothers have periodontitis. Dr. Maney explains the role of dental health in total wellness and how to maintain healthy teeth and gums.
Q: Can you explain the connection between periodontitis and cardiovascular disease?
A: Periodontitis is an inflammatory condition, so when oral hygiene is poor, the plaque buildup in the gums and teeth leads to inflammation of the gums, and that produces a lot of pro-inflammatory factors known as cytokines. They are released into the bloodstream and actually trigger the liver to release c-reactive proteins, which are inflammatory proteins. So it predisposes the body to different systemic conditions, and there are direct and indirect mechanisms as to how periodontitis can affect the cardiovascular system.
Q: What are these mechanisms?
A: One is bacteria gets directly into the bloodstream and starts colonizing along the blood vessels. They contribute to forming plaques that produce atherosclerosis of the blood vessels. The other way is all these inflammatory mediators like the c-reactive proteins actually go through the blood vessels and increase inflammation along the blood vessels, which makes them more prone to forming the plaques.
Q: What is the link between periodontitis and other diseases?
A: Periodontitis, cardiovascular disease and stroke go hand in hand. For diabetes, most of the evidence points toward the fact that people with uncontrolled diabetes develop a severe type of periodontitis, because diabetes affects the immune system. So the relationship is more toward diabetes producing periodontitis, and it is a significant risk factor for periodontitis. The other thing is low-birth weight babies being born to women who have periodontitis. Inflammatory mediators enter the fetal placenta and the maternal blood stream, and they can induce labor early, so there are pre-term babies as well as low birth weight babies being born.
Q: How often should you see a dentist to maintain healthy teeth and gums?
A: Visit the dentist for a cleaning every six months and brush teeth for at least two minutes twice daily. Flossing every day is very important. Gum disease starts between the teeth. Periodontitis doesn't hurt, so people neglect it until it is too late. We see patients come in with a lot of bone loss and gum inflammation and bleeding gums. The process happens over a lot of years, so they can save money if they come in for checkups every six months.
Q: Is there any advantage to using an ultrasonic toothbrush instead of a manual toothbrush?
A: There is no difference overall. A few studies indicate ultrasonic toothbrushes can be better for people who aren't doing a good job with a manual toothbrush. With a manuel toothbrush, the technique matters, so the advantage (of an ultrasonic toothbrush) is you don't have to use a technique — you just hold the brush where your tooth and gum meet.
Q: Is there anything else you want people to be aware of regarding oral health?
A: People need to look at oral hygiene as part of their overall health and not just dental health. And of course, dental health is really important, because if you don't have your teeth, you won't be able to chew, which leads to problems like malnutrition, not to mention low confidence. There is definitely a connection to oral and systemic health.