If you listen to a pain in your tooth, you may think it is crying for help from a dentist. But it may really be trying to tell you there's something wrong elsewhere. Dentists, researchers and, slowly, physicians are increasingly taking note of links between oral health and diseases such as sinusitis, sleep apnea and even cardiovascular diseases.
"There are a lot of links between dental health and overall health," says Dr. Glenn Schmidt, a dentist at Riverbend Dental Clinic (8025 Maple St., 861-9044). "There's a correlation between gum disease and heart disease. [Researchers] are finding that people with advanced gum disease have a higher incidence of coronary problems and heart disease." The theory is that bacteria in the plaque that forms in the mouth enters the body's system and travels through the arteries, forming plaque there also. "People are three or four times more likely to have heart disease if they have gum disease," the dentist says. "There's a very, very high correlation between coronary problems and advanced gum disease."
Dr. Richard Malone, a cardiologist at Ochsner Foundation Hospital, says although scientists have found similarities in plaque bacterias from the mouth and arteries, they still don't have the full picture of how the two interact. "If we knew the specific association of the plaques, doctors could begin to treat," he says. "That final part of the circle has not been completed yet. There are multiple types of bacteria now playing some part." Currently cardiologists look for periodontal disease as a risk factor for people whose arteriosclerosis cannot be explained otherwise.
Studies now are underway to determine the efficacy of treating the problem systemically with antibiotics, but Malone says the research won't be completed for another year or two. The results could back up previous studies that indicate antibiotics could be helpful. "There have been at least two studies that indicated treating the bacteria systemically with antibiotics is effective, but both involved a small number of patients," he says. "The larger trials may confirm the results. We may have something then that will alter treatment plans."
In the meantime, doctors have found that routine dental X-rays may help them prevent patients from suffering deadly heart attacks. The standard panoramic X-rays, or radiographs, dentists take in their offices include an image of the cartoid arteries on each side of the neck that carry blood between the heart and the brain. University of Buffalo School of Dental Medicine researchers say the radiographs show calcification that has formed in the artery, a major predictor of heart attacks and strokes. Those researchers say that plaque in the cartoid arteries doubles a person's risk for heart attack or stroke.
To capitalize on such information, Dr. Eric Hovland, dean of the Louisiana State University School of Dentistry, says dental education now includes lectures by physicians to make students more aware of other areas affected by dental health. "We've done well with educating dentists about the importance of total health and patients about the importance of dental health," he says. "One thing we're not doing a good job at is having our physicians become more aware of oral health." Small children, for example, generally visit pediatricians regularly, yet cavities go undetected, he says. "More children are affected by oral caries (small cavities) than any other disease," Hovland says. "Pediatricians who see a child should be aware of that ... spot the problems and send them to the dentist for sealants."
Interestingly, research studies also indicate a possible correlation between periodontal disease in pregnant women and low birth weights in their babies. "There is some preliminary data showing that some low birth weight babies may be associated to oral health, especially periodontal disease," Hovland says. "I think you'll see more of an alignment between dentists and physicians in the future."
One of the problems with preventing or treating gum disease, Riverbend's Schmidt says, is that it doesn't always have visible symptoms until it is quite advanced.
"Lots of people don't know they have it," he says. "There are certain signs of gum disease -- halitosis, gums that are bleeding, teeth that are loose -- but that is when it has gotten bad. It can even cause a low-grade fever where you just have a general malaise. Physicians, in general, don't correlate gum disease with a lot of health problems. Gum problems often don't give you any pain. It's like a silent killer of bone and gum tissue."
To be fair, it's not always that easy. Sometimes a patient will feel pain in a certain place, but the problem is not specifically related to the teeth. Referred pain, which is felt in the jaw, or in front, behind or on the opposite side of the source of the problem, can serve as a red herring for some conditions. Molar pain, for instance, can indicate a sinus infection instead of a decayed tooth. Because some molar roots actually are in or against the sinus cavities, the swelling and pressure associated with sinusitis can press against the tooth's nerve and cause pain. Dental pains also can come from angina, spasms caused by a deficient flow of blood to the heart muscle, and can serve as a signal to an imminent heart attack, Hovland says.
Detecting problems also can work conversely, the dentist says. Sometimes headache pain can be caused by a misalignment of the jaw or from fillings or crowns that are too high, keeping the teeth from meeting properly. Sleep apnea also can have adverse effects on oral health.
"People that have sleep apnea oftentimes are mouth breathers (when they sleep)," says Schmidt. "Being a mouth breather tends to cause gum problems, tends to cause breathing problems, airway dysfunction and, in some cases, the sleep apnea can cause high blood pressure, which leads to strokes." Often the apnea results from the jaw dropping back when a person sleeps on his back and compressing the airway. Dentists can help solve the problem by constructing an appliance that holds the jaw in place. In some cases, Schmidt says, the condition requires surgical correction because it can cause the adenoids and tonsils to become enlarged. "Mouth breathing also has a relevance to in dentistry in that it can cause the dental arch, the skeletal component, to actually become distorted. It can cause the palate to close in and you get cross-bite and can't swallow right. It also increases chances of a person developing allergies and chronic sinusitis." Treatment sometimes requires both a dentist and an ear, nose and throat specialist.
As with anything having to do with health, smoking also is detrimental or tooth and gum health and people who smoke not only have a higher incidence of gum disease, but more severe cases. Chewing tobacco is "almost suicide," Schmidt says, because of the risk of oral cancer, which makes up 5 percent of all cancer cases. "It's almost suicide to chew tobacco," he says. "Oral cancer can be very nasty. Dentists are usually the primary people to diagnose oral cancers. When undetected, it often leads to very disfiguring results if the lesion grows to a point where they have to literally cut out parts of the jaw and tongue and reconstruct them. If you get someone not to chew tobacco or to quit chewing it, you're literally saving a life."
Medications taken for non-dental problems also can affect oral health. Some pharmaceuticals can decrease the salivary flow (commonly called dry mouth), causing a higher incidence of decay.
There is good news in all of this. At least trips to the dentist are no longer something to be dreaded. Advances in technology, tools, techniques and even amalgams used to make fillings have made the experience virtually pain-free, and an emphasis among dentists on decreasing anxiety-ridden patients with everything from laughing gas to movies and headphones is slowly dispelling past generations' notions that dentistry hurts. Also, improved education, prevention measures and fluoridation programs have resulted in fewer dental problems for the current generation.
"The demand for dental services is at an absolute all-time high," says LSU's Hovland. "Sixty-five percent of individuals 2 years and older visited the dentist last year. Oral health is becoming a really big component of self-esteem." The result has been an increase in orthodontics overall, with adults making up 40 percent of braces wearers. Cosmetic procedures such as replacing silver fillings with porcelain, teeth bleaching, veneering and other procedures also are increasing.
Where the statistics about dental health and dentist visits have not improved are among the poor and those in areas where services are scarce, Hovland says, referring to a report issued recently by the U.S. surgeon general.
With all the education dental health and the improvement in patient outcomes and comfort, why do people put off going to the dentist until they no longer can ignore the pain?
"People are great procrastinators," Schmidt surmises. "Generally, cavities are one of the few things in the body that doesn't kill you, but it doesn't get better. One of the things you find with tooth pain is that generally it's periodic and might hurt for a while and then go away. When the pain becomes constant, it's pretty much a given that you'll have to have a root canal or extract the tooth."
Luckily, dentists today deaden the gum before they inject anesthesia to do such work. Improved radiographs allow better X-ray pictures using less radiation, better light and magnification equipment helps the dentist be more precise in repair work, lasers provide less pain and bleeding during soft-tissue surgeries, and the materials used to make crowns and fillings are strong and look natural (or better).
Dentists today may not give patients sugar-laden lollipops at the end of a visit like they did in past generations, but they don't send them away crying either. More important, they can detect problems outside the mouth that could save your life.
- Dr. Glen Schmidt at Riverbend Dental Clinic puts patients at ease with music, a movie and virtually pain-free techniques.