It’s More Than Just a Pretty Smile

Contrary to what the media would ask us to believe, our teeth are more than just the components of a dazzling smile. They, along with the entire mouth, act as the first indicators of general health and well-being. In 2000, former U.S. Surgeon General Dr. David Satcher described a “silent epidemic” in his report on the status of oral health in America. Defining oral health as “more than healthy teeth,” Satcher included the mouth and gums, hard and soft palates, tongue, lips, chewing muscles, and the jaws in his findings. These muscles and tissues enable us to speak, smile, chew, swallow and taste; in short, they enable us to enjoy life, communicate and nourish our bodies. Oral wellness was further defined as being free of oral pain, lesions, oral cancer and oral birth defects. The conclusions were clear — good general health and good oral health are inseparable.

Even more significant for women is research that indicates oral health may be more problematic for us. Naturopathic physician, author and researcher Tori Hudson, ND, cites in a 2006 report that genetic and hormonal factors may cause women to have “more frequent and intensified responses to oral bacteria.” That finding is bolstered by several studies linking oral bacteria to periodontal disease, which is related to systemic diseases of the body. Hudson goes on to report that oral hygiene practices, hormonal influences, pregnancy and menopause influence women’s oral health in a substantial way. Although it’s true that advances over the past 50 years in oral care ensure that most middle class Americans will retain sound, healthy teeth over their lifetime, it’s estimated that more than 100 million Americans lack dental insurance and may not receive the care necessary to promote sound oral health. In the 2005 King County Smile Survey, dental decay is described as a preventable disease that affects children’s ability to eat, sleep and learn. Gum and tissue disease can lead to tooth loss and social stigma, and oral clefts are one of the most common birth defects in the United States, occurring in about 1 per 1,000 births. According to the American Dental Association (ADA), dental caries (cavities) are the most common disease in children — 5 times more common than asthma. Parents are now encouraged to bring children for a pediatric dental examination by the age of one year, and primary care physicians are assisting pediatric dentists in promoting good oral wellness plans for their patients. Pregnancy and hormonal changes can present challenges for women hoping to maintain good oral health. “The hormonal changes that occur with pregnancy can increase inflammation of the gums and plaque accumulation. Clinical studies have reported 30 percent to as much as 100 percent incidence of gingivitis,” states Hudson. “Other changes can occur during pregnancy as well. This includes bad breath related to the acidic environment due to morning sickness, and caries activity if vomiting is involved. Increased tooth decay during pregnancy may also be related to nutrition changes and a decline in oral health care due to restraints on time.” Additionally, chronic dental issues in pregnant women can contribute to low birth weight and premature births. If, as Satcher reports, “We know that the mouth reflects general health and well-being,” what can be done to ensure good oral health throughout life?

WHAT CONSTITUTES GOOD ORAL HEALTH?

Seattle dentist Mary Sebek, DDS, defines good oral health in her patients simply. “Patients present healthy teeth that have little or no wear, no decay in the grooves or between teeth and the periodontium (gums) are an appropriate color, with no bleeding or puffiness,” she explains. “Oral tissues often reflect the health of a person and a well-trained eye can differentiate between a person with a systemic infection and a healthy individual.”

Oral health is often an indicator for other health conditions, many of which are chronic or life-threatening. Oral conditions can be used to diagnose HIV infections and research has shown some correlation between oral health and type-2 diabetes, stroke, heart disease, and cancer. “A normal part of every dental oral exam should be the oral cancer screening,” Dr. Sebek continues. “It allows a dentist to actively check all areas of the mouth for any abnormality. Ninety-five percent of all oral cancers are squamous cell carcinomas; therefore, it is crucial to check for any small red, white or ulcerative lesions.” Oral cancer is as common as leukemia, according to the ADA, and claims more lives than cervical cancer or melanoma. A disturbing trend is the recent rise of cases found in women and nonsmokers; 25 percent of oral cancers occur in people who don’t smoke and have no other risk factors.

CHALLENGES TO MAINTAINING GOOD ORAL HEALT

HIn King County, children from low-income families are twice as likely to have untreated dental disease. This translates into days missed at school, increased pain and discomfort, and compromised general health. But poor oral wellness doesn’t just affect children; nearly 25 percent of Americans between the ages of 65 and 74 have moderate to severe periodontal disease and one in five have untreated dental cavities. Complicating this problem is the fact that most older Americans lose their dental health benefits upon retirement. The ADA reports that poor Americans suffer the worst oral health and that racial and ethnic groups experience a “disproportionate” level of oral health problems. Patients with chronic diseases or disabilities also have a higher risk of complications due to poor oral health, and women face fluctuating hormone levels throughout life that can contribute to oral tissue inflammation.

If plaque isn’t removed from the teeth, the gums become colonized by bacteria — leading to inflammation, puffiness and often, bleeding. The ADA recommends that women get adequate calcium and seek assistance in controlling inflammation of the gums during pregnancy. Sebek agrees, adding, “As with pregnancy, a difficult problem also occurs during pre-menopause/menopause. As estrogen levels fluctuate, saliva flow is decreased — this leads to a breaking down of the salivary barrier and the tissues dry out. Plaque becomes stickier and more difficult to remove, and inflammation is often the result.” Systemic diseases such as Sjörgren’s syndrome can also be indicated by decreased saliva flow, and some medications taken for chronic illnesses such as high blood pressure can have the same effect. “It’s important to seek treatment,” Sebek cautions. “Every time a patient closes her teeth together and clenches, swallows or eats, she introduces a vast quantity of bacteria into her bloodstream.” Dental decay is an infectious disease — and many times, remains hidden from view until pain causes a patient to seek help. Decay is often visible on the top or occlusal surfaces of the teeth but not between the teeth. Sebek cautions that this is the area where major destruction can occur if not treated early. “It’s easy to diagnose decay and restore the tooth to an ideal form in the early stages,” she says. Appropriate care of the teeth and gums includes brushing at least twice a day, flossing (especially if the patient snacks on sticky or sweet foods during the day), and eating a balanced, nutritious diet. Studies by the ADA indicate that the more starch- or sugar-based foods consumed, the higher the level of tooth decay. Chewing sugarless gum has been shown to increase saliva, and rinsing with warm saltwater can be effective in healing small lesions in the mouth or on the gums. Smoking is a major contributor to all oral cancers; the ADA strongly recommends avoiding the use of tobacco in any form as the primary way to prevent oral cancer.

WAYS TO IMPROVE ORAL HEALTH

The Surgeon General’s report suggests that water fluoridation, dental sealants, proper diet, cessation of smoking and regular professional care are the most effective means to insuring good oral health. King County has a range of dental providers, including private practices, community and public health clinics, Children’s Hospital & Regional Medical Center and the University of Washington Dental Clinic. School-based dental sealant programs were introduced in 1986, and 75 percent of the population have access to fluoridated water. The Children’s Health Initiative, funded by private donations and taxpayer dollars, hopes to enroll more than 3,000 children in a comprehensive health plan — one that will include oral health strategies administered by the Washington Dental Service. When it comes to oral wellness, health care professionals believe that early intervention is necessary to ensure good lifelong habits.