The Effect of Dental Issues on Your Health
It’s not enough to do your best; you must know
what to do, and then do your best.
—W. Edwards Deming
In this chapter, we are going to discuss how dental problems can affect your overall health. For example, poor gum health can ignite an area of inflammation and stimulate a reaction that can spread to affect other areas of the body and lead to serious chronic inflammatory health conditions. Poor oral health and the chronic body inflammation it creates can increase your risk for heart attack, stroke, diabetes, dementia, certain forms of cancer, Alzheimer’s, and preterm birth.
A healthy mouth will reduce the chance of inflammation in your gum tissues, which may prevent many of these distant problems that can ravage your health. If you have been diagnosed (or if you have a family history of) chronic inflammatory disease, especially diabetes or cardiovascular problems, please consider your mouth health and how it may be affecting your general health. You may want to have a saliva test to check the levels of mouth bacteria we know are implicated in a variety of chronic health problems. An ultrasonic scan can show plaque deposits in your carotid arteries, and a blood test can indicate the level of inflammation in your body. When these tests are combined, they can give a useful warning or indication of the presence of chronic inflammation, which could have a serious impact on your life now or in the future.
Many of my dental and medical friends were shocked when they took the aforementioned tests and discovered a number of unsuspected problems. These medical professionals took immediate action, because they realized the implications of plaque in their coronary arteries and the consequences of body inflammation. They understood the serious nature of these risks and how life-threatening medical events are often triggered by inflammation that can be initiated by certain kinds of harmful mouth bacteria.
TRANSMISSION OF DISEASE
Dentists have known for a long time that dental disease is a transmissible bacterial infection and that this transfer occurs from person to person, from tooth to tooth, and from teeth to toothbrushes, even after a single toothbrush use. It’s impossible to prevent the sharing and spread of mouth bacteria as they float in the saliva that moistens your mouth. Within the mouth, saliva is in contact with other nearby anatomical areas, such as the nose, pharynx, throat, and ears. You may brush your teeth thinking that you are cleaning away plaque from your mouth, but your newly brushed teeth will almost instantly become repopulated with the same oral bacteria that will immediately drop out of saliva or spread from confluent areas—places in contact with the mouth, but where a toothbrush cannot go.
The bacteria in your mouth are invisible, and they invisibly transfer in droplets of saliva. Mouth bacteria can generally be classified as healthy or unhealthy, which means you will share your personal variety of bacteria with the family or friends who live around you, and these bacteria will be potentially useful and protective or harmful and aggressive. For a hundred years, dentistry has focused on fixing teeth, and most people have believed that tooth damage is the result of a problem called plaque.
Dentists are skilled at repairing teeth and are well trained to restore the look of your smile and a tooth’s biting function. The hygienists’ role for decades has been to clean away the debris of infected plaque from around your gums and polish your teeth to make them shine. Dental professionals may try to help you by suggesting toothpastes or rinses known or proven to kill bacteria and strip plaque from the mouth, sometimes for up to twenty-four hours. These routinely accepted approaches focus on ridding the mouth of germs and plaque, but in the long term, killing or scraping away mouth bacteria indiscriminately will not help you develop a healthier mouth. Dental disease is a unique infection as it involves an intricate film called biofilm that covers all the mouth, teeth, and gum surfaces. The health of biofilm is maintained or improved by adjusting your mouth conditions to achieve balance in the mouth’s chemistry, physics, and biology. The kind of bacteria in your mouth are changed very slowly over time, which is why it is impossible for a dentist to make your mouth healthier at infrequent dental visits or by killing all the bacteria in your mouth. You alone have the power to control this complex situation and develop great oral health using good daily tooth care and habits that promote dental healing and mouth health. The good news is that I am going to teach you effective strategies that create healthy conditions in your mouth that will not only strengthen your teeth but will also help you to develop a healthier mouth biology, or ecosystem. These same strategies will protect your gums while your mouth health improves, but our ultimate goal is that your own healthy mouth ecosystem, supported by your own healthy saliva and your own immune system, will eventually be your primary defense against cavities and gum disease.
MY FIGHT WITH ACNE
The science of skin health has also changed over the past fifty years. My personal experience was the agony of following ineffective skin care advice as a teen. I had acne and a face covered in blemishes, and the teachers at my English boarding school told me that my skin was dirty and the solution was a good daily cleaning with soap and a scrubbing brush. I made painful efforts to scrub my skin and cure my problem, but as you can imagine, all the washing and scrubbing did not solve anything. In fact, the more I scrubbed, the worse my acne became. In addition, my skin felt tight, itchy, sore, and painful, and it was still covered in blemishes!
After years on this demoralizing merry-go-round, I was introduced to a simple three-part routine for delicate skin: a gentle liquid to clean my skin, another to balance my skin’s chemistry, and a final lotion that was protective and soothing. I don’t remember exactly, but I’d say it took less than two weeks for my problems to miraculously vanish and for my skin to feel comfortable and look fresh and healthy. How was it possible to improve years of bad skin without brushing or scrubbing? It was a long time before I could answer this question and only after I understood that, in the world of health, the goal should never be to strip or sterilize but to create the conditions that support health. Today, we know that skin must be hydrated, nourished, at an optimal level of acidity (pH), and protected by a film of healthy skin microbes and proteins.
I am forever grateful to the cosmetic Clinique consultant in the 1960s who in one afternoon helped me solve my skin problems and changed my approach to skin health for life. This kind lady with her simple outreach was the person who motivated me to think differently and help many dental patients escape a similar “brush and floss” agony and find a more effective solution for mouth health. The correct dental advice combined with specific oral care products can create the environment for quick and almost miraculous changes in mouth health, even after years of damage and disease. For thirty years, my friend and nutritional pharmacist Ben Fuchs has formulated products for skin care that respect the body’s biochemistry, and like him, I am convinced that our body is designed divinely to heal and renew itself on a moment-to-moment basis when it is given correct care and adequate nutritional support.
GUM DISEASE AND BODILY HEALTH
The links that connect our mouth and body health show us that oral health is far more precious than sweet breath or a shiny grin. We now know, for example, that bacteria from the mouth can travel in the blood to locations elsewhere in the body. In your bloodstream, these bacteria can cause damage to vital organs like the heart, heart valves, or surgically replaced joints, like a knee or hip. Oral bacteria can also create inflammation and ignite an inflammatory response that can ripple around the body, triggering problems that are not always recognized as coming from bacteria hidden under the gums. The bacteria that cause some of the most serious medical problems lurk in the gums, and from this location, they contribute to dangerous and even life-threatening health problems. There are about eleven kinds of these bacteria known to be involved in chronic inflammatory conditions, and they are collectively known as periodontal pathogens.
Periodontal disease is the name given to a gum infection that is triggered by specific periodontal bacteria. These health-threatening bacteria can multiply easily when they find a secluded place in your mouth where the oxygen supply is limited. Periodontal problems are usually painless, and there are rarely any symptoms or signs of swelling or bleeding. Hidden in a tiny space under the gums, these invisible periodontal pathogens can attack the gums and also cause widespread body inflammation; some bacteria may even gain entry and flow in the blood to other parts of the body. Most patients will be completely unaware of any problems, but their internal body defenses notice these attacks and will try to stop them. Periodontal pathogens are very resistant to the body’s internal defense system and also to most traditional dental therapies used against them. This creates a situation where there is an ongoing fight between these pathogens and your immune system, and this fight can continue for years, generated by pathogens in gum pockets around teeth. There is no sign of damage at first, but the longer the situation remains unresolved, the greater the body’s response. This is why the unusual inflammatory reaction from gum disease can lead to bone loss around teeth, the loss of gum attachment, and the eventual loosening of teeth. This inflammation can also be magnified if its effects travel around your body. The reaction becomes slowly exaggerated and amplified as it spreads, sometimes triggering debilitating or life-threatening health conditions like rheumatoid arthritis, cardiovascular disease, or dementia.
Most of us will have a few periodontal pathogens floating in our mouth, drifting in our salivary liquids. They should be in very small numbers in a healthy mouth—their presence is normal and will cause no harm. Periodontal bacteria only become problematic if they find a place to multiply. This is when their numbers will increase in saliva. For this to occur, the bacteria need to locate a dark space with limited oxygen. If they find such a space, they will seize the opportunity to lodge and flourish. This is why periodontal pathogens often become trapped under the gum between the tooth and the tooth socket, inside a space called a periodontal pocket. Measuring the levels of periodontal pathogens in your saliva is a good way to know if you may have a periodontal pocket somewhere in your mouth.
Because these bacteria are problematic only on occasion, they are classified under the umbrella name of opportunistic bacteria. In other words, they need a specific opportunity to multiply and cause harm. The extent of gum damage can be roughly illustrated by calculating the surface area in a mouth with multiple dental pockets. Healthy teeth should have no pockets, but if you had a pocket depth of 5 millimeters on one side of your teeth, this would be an open wound with a total length that is the distance around the mouth (approximately 762 millimeters). If your pockets were 5 millimeters deep, this would create a surface area of 3,810 square millimeters (which is equivalent to the surface of a 6-inch square). No doctor would ignore a festering 6-inch skin wound for years, yet many adults live with this undiagnosed problem in their gums, sometimes for decades.
When you have a mouth teeming with bad bacteria, no amount of brushing or flossing will get rid of them. In fact, I suggest that flossing may actually aggravate the problem and potentially create more pocket opportunities, open up wounds, and even push bacteria into the blood, which could increase the risk for an inflammatory response. I know this is the opposite of our generally accepted dental mantra, but this is why I do not think it is safe for anyone with an unhealthy mouth to floss. It’s important to note that flossing was born in an era before periodontal pathogens were understood or could be measured.
My belief is that flossing can actually increase someone’s risk for general health conditions that are influenced by poor oral health. These are all medical conditions, such as heart attack, stroke, high blood pressure, rheumatoid arthritis, insulin instability for diabetics, infertility-treatment failure, and preterm birth. This is why, if you want to floss, I suggest you first ensure your mouth is as healthy as possible and maybe take a salivary test to know your levels of opportunistic mouth pathogens before you begin. In addition, gum-disease pathogens have been implicated in the predisposition to certain kinds of cancer, digestive problems, and even dementia and Alzheimer’s. In the past, people believed that there was a connection between early tooth loss and dementia, and in 2017, a systematic review of studies on this subject by N. C. Foley and others confirmed an association between poor oral health and dementia more definitively.
Scientists at the Harvard School of Public Health showed recently that gum disease may be linked to pancreatic cancer. Pancreatic cancer affects more than thirty-three thousand Americans each year and kills more than thirty thousand, making it the fourth leading cause of death from cancer. The Harvard studies showed that men with gum disease were 63 percent more likely to develop pancreatic cancer than those without gum disease. In a group of nonsmoking men, those with gum disease were twice as likely as those with healthy gums to develop pancreatic cancer.
Chronic or recurrent sinus infections, middle-ear infections, respiratory problems, and even acid reflux may also be associated with poor oral health. Improving your mouth health will often help relieve the symptoms and recurrence of sinus and acid reflux problems, which is understandable when we think about how the ecosystem of the mouth contacts the ecosystem of these areas. New information is constantly being gathered about the associations between oral health and general health, so please stay informed and check my website, www.DrEllie.com, for the latest studies about these oral-systemic links.
CONDITIONS ASSOCIATED WITH DENTAL AND GUM DISEASE
•Cardiovascular disease
•Stroke and high blood pressure
•Preterm birth
•Cancer
•Diabetes
•Arthritis
•Dementia and Alzheimer’s
•Joint replacement failure or slow healing
•Infertility-treatment failure
•Chronic sinusitis
•Middle-ear infections in childhood
•Acid reflux symptoms
•Respiratory infection and pneumonia
•Crohn’s disease and irritable bowel syndrome
Heart Disease and Other Damage Caused by Oral Bacteria
Heart disease is largely preventable, but nearly one million Americans have a heart attack each year, with an increasing number occurring among younger people. Almost all doctors and cardiologists today view cardiac disease as the result of inflammatory damage. The main focus of preventive cardiac care is to eliminate or reduce every potential source of inflammation, yet oral health is often forgotten, or flossing is recommended, which I believe may put patients in harm’s way. This is why it seems essential for anyone who is at risk for heart disease or stroke to consider my strategies to improve their mouth health and take a salivary test to find out the levels of periodontal pathogens that may be lurking in their mouths.
Salivary testing identifies the number of periodontal pathogens in your saliva and scores the measured levels of each pathogen. A high titer suggests that specific bacteria are multiplying fiercely, which indicates a problem likely exists in the gums, and this could trigger inflammation elsewhere in the body. There are a variety of suggestions about how to control opportunistic pathogens, and of course, the popular ones are antibiotics, strong antiseptics, multiple and deeper cleanings, or killing the bacteria with trays full of peroxide (which are worn at night) for the rest of your life. Later, you will read about my strategy to control these pathogens by nurturing the healthy bacteria in your mouth. If you discover high concentrations of periodontal pathogens in your mouth, you must make a decision which approach to use and take action to stop gum problems before they ruin your general health.
Please realize that, if you accept the normally recommended products and treatments, your end goal will be to kill and mechanically remove biofilm from every surface in your mouth. In this situation, you will need to continue killing or removing biofilm and pathogens, possibly forever. The reason you will never gain control is that this treatment damages healthy bacteria at the same time. An alternative approach is to be considerate of healthy mouth bacteria and use strategies that change the ecology more slowly while nurturing useful and good bacteria. This takes time and relies on commitment by you and help from your immune system. By using a nurturing strategy, however, you should see improvements in your periodontal health within six months and be able to reach a stable state of mouth health within a few years, hopefully something you will be able to enjoy for the rest of your life.
Dentists know that, during a dental cleaning, or even while flossing, it is possible for mouth bacteria to be pushed through the gum and enter the bloodstream. Your immune system usually destroys invading bacteria, but certain strains may bypass these defenses. If you have a compromised immune system, you are at even greater risk.
Mouth bacteria can grow on damaged heart valves and cause a potentially lethal condition called endocarditis. Mouth bacteria have also been isolated from other places in the body: around the joints of artificial knees or hip replacements, in heart muscle, in the brain, and in the placentas of pregnant women. Mouth bacteria have even caused the fatal septicemia of an unborn baby and have been isolated from plaque deposits in coronary arteries following a heart attack. Everyone should take mouth health seriously, especially if you are contemplating a new hip or knee replacement, or you are going to have heart surgery, become pregnant, or are being treated for risk of stroke or high blood pressure.
In the past, scientists have had difficulty cultivating certain kinds of bacteria, and this made it difficult to know if periodontal pathogens caused coronary artery disease. It now appears that Porphyromonas gingivalis (P. gingivalis) is the primary bacteria that erodes gum tissues and enters the bloodstream to travel around the body. P. gingivalis have been found in joint tissues, heart plaque, and placenta. P. gingivalis has most recently been linked to a higher risk for esophageal squamous cell carcinoma, a type of pharyngeal cancer.
In 2012, UK researchers found that Streptococcus gordonii (S. gordonii) can masquerade as a human protein and blood-clotting factor called fibrinogen, which allowed these bacteria to attract platelets and cause clumping inside blood vessels. Microbiologists at the University of Rochester found aggressive strains of Streptococcus mutans (S. mutans), the bacteria of dental caries, or tooth decay, had invaded heart muscle, showing how bacteria from the mouth can wreak various kinds of havoc elsewhere in the body.
Gum Disease and Preterm Birth
There appears to be a strong relationship between gum disease and preterm births, and P. gingivalis has been found in the amniotic fluid and placenta in cases where babies were born prematurely. Marjorie K. Jeffcoat has investigated this very probable connection between poor oral health during pregnancy and the earlier delivery of babies, which can put babies at risk for many medical conditions, including respiratory problems, long-term disabilities, imperfect organ development, vision impairment, hearing loss, mental developmental disorders, and even death. Because mouth health is generally measured by visual examination—without any bacterial testing—there have been contradictory results in these research studies, some supporting and some negating this link. Dr. Jeffcoat’s large prospective study in 2001, published in The Journal of the American Dental Association, showed a significant association between preterm birth and periodontal disease when oral health was measured between the twenty-first and twenty-fourth weeks of pregnancy.
In a study published in The Lancet in 2008, researchers found less connection between dental care and preterm birth, yet other studies by Nestor J. Lopez in 2002 indicate that, when a mother has a dental cleaning during pregnancy, it could lower her risk of preterm birth. These studies seem to conflict with each other and with studies led by Bryan S. Michalowicz, published in The New England Journal of Medicine in 2006, which showed dental cleanings did not reduce the risk of preterm birth once the woman became pregnant. All the studies used traditional metrics for measuring disease and the old dental paradigm that assumes a dental cleaning, scaling, and root planing is beneficial. What we do know is that, if a mother enters pregnancy with good oral health, she will lower her chance for a premature birth by up to 84 percent and possibly more.
A study in 2014 by Dr. Kjersti Aagaard at Baylor Medical College in Texas has also shown that a mother’s mouth health will influence a newborn’s digestive microbiome before birth. The bacteria found in the placenta after birth matched the bacterial community found in the mother’s mouth, and this demonstrates how bacteria can travel from the mouth via the blood and reach the placenta. From the placenta, microbes can reach the baby either by crossing into the baby’s blood within the placenta or by passing into amniotic fluid, which is swallowed by the baby. The team also found that specific bacterial species were more common and others less common among women who had given birth prematurely—before thirty-seven weeks of pregnancy. Dr. Aagaard speculates that, if oral bacteria reach the placenta through the blood, then it is possible that bacteria from diseased and bleeding gums could colonize the placenta, potentially triggering premature birth.
This is why it seems essential for a pregnant mother to maintain healthy teeth and gums during pregnancy. Pregnancy is a time when the mouth becomes acidic, and this can easily upset a previously healthy mouth ecosystem. No one should ever accept bleeding gums as normal, especially during pregnancy. If this happens to you, I recommend you take a salivary test to find out your levels of periodontal pathogens so that you can take action and support your immune system to reestablish mouth health. You can learn more about periodontal pathogen testing at www.DrEllie.com.
SUPPORT FROM A DENTIST
Dr. Ron Phillips practiced dentistry for forty-three years, and during those years in private practice, he, like most dentists, believed that dental problems were caused by plaque on teeth. Forty years ago, plaque was viewed as the enemy, and this was why plaque needed to be destroyed. Dr. Ron will admit that his passion as a caring dentist was to kill and destroy plaque and mouth bacteria, because he believed the only good bacteria were dead ones. He did not have a hygienist, so he cleaned all of his patients’ teeth over those years, which made him extremely conscious of his patients’ mouth health. Despite a fastidious patient-training program and the fact that most of his patients were compliant with his brushing and flossing instructions, the vast number of them continued to have cavities, sensitivity, recession, enamel erosion or abrasion, gum infection and disease, and sometimes tooth or root fracture. In fact, Dr. Ron found these problems so common he eventually decided this state of poor oral health could be regarded as normal, especially as people age.
Dr. Ron and I met at a conference on heart disease. We were discussing how the blood that runs through our gums and teeth also travels around the rest of our body. We also discussed how inflammation from the mouth increases the chance of heart attacks and stroke. During this conversation, I explained my strategies to him, and he was sufficiently impressed to try them out for himself.
In his final year before retirement, Dr. Ron asked me to speak at his dental study club. He also told every patient in his practice about my method of oral care. He carefully explained the system to them. He soon noticed amazing results in the mouth health of his longtime patients. He reported shining teeth and greatly improved gum health.
Dr. Ron says that learning this kinder and more nurturing approach to mouth care was the most important thing he ever learned in dentistry, as its consequences far outweighed the benefits derived from implants, veneers, beautiful bridges, and other reconstructions he had done over his years as a clinician. This new approach allowed Dr. Ron to offer his patients a simple and effective method to reach a higher level of oral health. Dr. Ron urges other dentists to teach interested patients about these strategies and help them gain control over their dental problems. He says that, as a dentist, seeing such joy and empowerment will change your practice forever.
As we understand the link between mouth health and general health, the obvious problem is our inability to really know if our mouth is healthy. Visual observation or waiting for disease to develop can no longer be an acceptable method of mouth health evaluation. This also raises the importance of effective oral care and an evaluation of ineffective directions that many people have followed for years, often without any success. Perhaps the greatest confusion is in the minds of people who long ago understood the value of good bacteria—called probiotics—and their essential role in digestive health. I became a health seeker myself in the 1960s and learned the value of eating whole foods for health. I have avoided processed junk foods and toxic additives and have never consumed a can of soda in my life. I support the concern of health seekers about mercury in silver fillings, the toxicity from artificially fluoridating water, and the dangerous influences of some industries in their pursuit of profit.
The problem is that sometimes the truth is complicated, and we often don’t know whom to trust. You may fear silver fillings and want to remove them, but be warned that white ones and sealants contain BPA, which may present its own dangers to your health. You may be against fluoridation of water as I am, but if your teeth need mineral support, as many do, the ideal helper is a tiny amount of sodium fluoride applied regularly to the outer enamel surface. Without this help, it is very possible that you will end your adult years simply suffering from different problems associated with root canals, crowns, and even losing teeth—damage that could have been prevented with a tiny drop of fluoride on the outside of your teeth.
If you are someone who needs to improve your mouth health, I hope you will consider a new approach that is kinder and more respectful of your mouth. The recommendations I share may seem simple and even mundane to someone who has endured years of pain and suffering. On the other hand, why not try a few weeks on my system and see what happens at your next dental appointment? My suggestions may be simple, but if you are looking for a different outcome, I encourage you to give them a try.