Smile for the dentist

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Poor dental health in baby boomers can mean more than an unattractive smile. It can cause periodontal disease, a serious oral infection that in turn can lead to cardiovascular disease, stroke, respiratory illness, diabetes and a host of other serious illnesses. People who have gum disease are more than twice as likely to have cardiovascular disease than people with healthy mouth tissue, according to the American Academy of Periodontology. But nearly 80 percent of adults have some form of periodontitis, a chronic bacterial infection of the gums and bone surrounding the teeth, according to the National Institutes of Health. The condition begins when bacteria in plaque Š the sticky, colorless film that constantly forms on the teeth Š causes gums to become inflamed. The condition is painless and may not have any symptoms until it's advanced. Gum tissue should fit snugly around the tooth, like a turtleneck sweater. If the gums have receded, it creates "pockets" around the teeth, which can fill with bacteria. Red, puffy gums are a sign of gingivitis, the mildest, most treatable form of periodontal disease. "But by the time gums recede, it means you've already lost some jawbone," says Roger Cooper, a periodontist who teaches at the Arizona School of Dentistry and Oral Health in Mesa, Ariz. Periodontitis is unrelated to cavities, which are caused by different bacteria. Systemwide disease There are several theories about the link between gum disease and cardiovascular disease. When gum disease is left untreated, it causes chronic inflammation throughout the body, Cooper says, which may cause arteries to swell. Another possibility is that bacteria in the mouth get into the bloodstream, induce blood to coagulate more quickly and make the lining of arteries firmer, both of which make conditions ideal for plaque to form in arteries. Bacterial respiratory infections are thought to be acquired by inhaling fine droplets of bacteria-laden saliva into the lungs. This can cause infections or worsen existing lung conditions. The inflammation and systemic distress caused by periodontitis also is linked to increased incidence of stroke, pre-eclampsia, low-birthweight babies, diabetes, pancreatic cancer, oral cancer and complications in organ transplant survival. Treating gum disease Everyone gets sticky mouth plaque. Daily brushing and flossing are two important ways to get rid of it. But there's another crucial step. "You can't do it alone Š you need professional cleaning," Cooper says. "It's best to do it every three to four months because that's how long it takes for colonized bacteria to start destroying bone." Often, patients don't even know they have gum disease. After diagnosis, the first treatment is scaling and planing, in which all of the tartar is scrupulously removed from above and below the gum line. This is the most important step, says Edward Mazer, a periodontist with Southwest Dental Group in Tempe, Ariz. "Even when the gums are very inflamed and swollen and bloody, patients respond incredibly well to initial therapy because the inflammation is taken away. The body is great Šit will heal," he says. After scaling and planing, patients must commit to a careful regimen of brushing, flossing and using over-the-counter non-alcohol rinses. Mazer also discusses proper nutrition and stress control, both of which are key to oral health. Then Mazer will assess whether surgery to repair the tissue is necessary. "If they come back and their home care is not 100 percent, then I don't do surgery," he says. "You might think what I do is more important than what they do, but in long-term respects, it's not. Without their commitment, I'll have to redo the surgery and people lose their teeth five years later." Mazer says that when the gum pockets are 5 to 7 millimeters, he will perform a procedure called osseous surgery, in which he recontours the bone to reduce the pockets. After treatment, it's crucial that patients follow up with cleanings in the office every three to four months, Mazer says. Factors in gum disease Periodontal disease is caused when bacteria in the gums multiply and create inflammation, which can lead to tooth loss. Skipping dentist cleanings can lead to gum disease, as well as several other factors: n Smoking: Cigarettes, pipes and oral tobacco slows the delivery of oxygen and nutrients to the gum tissue and delays healing, meaning even a small amount of bacteria can quickly become a periodontal disease. Smokers are more likely to have a severe disease than non-smokers, and they are more susceptible to treatment failure. n Genetics: Up to 30 percent of people may be genetically more susceptible to gum disease. Also, some inherited conditions, such as Down syndrome and Marfan syndrome, are linked to a higher likelihood of periodontal disease. n Stress: People who have high levels of chronic stress produce more of the hormone cortisol, which has been linked to gum disease. n Medications: One reason baby boomers are more susceptible to gum disease is that they are more likely to take medication. Hundreds of common medications, including antihistamines, diuretics, painkillers, blood-pressure medications and antidepressants, can cause side effects such as dry mouth, soft-tissue changes and overgrowth of gum tissue. Dry mouth leaves the mouth without enough saliva to wash away food and neutralize plaque, increasing the chances of tooth decay. n Diabetes: Periodontal disease and diabetes make an unfortunate circle. Diabetics have a higher risk for developing infections, including periodontal diseases. An infection can impair the ability to process or utilize insulin, which may cause diabetes to be more difficult to control and infection to be more severe. n Poor nutrition: People who consume less than recommended calcium and vitamin C have slightly higher rates of periodontal disease. This is probably related to the tissue's ability to heal itself. Source: American Academy of Periodontology, www.perio.org