Brush Your Teeth!

Brush Your Teeth!

We often tend to think of oral health and our overall health as two separate things. After all, we don’t see a physician when we have a toothache and we do not rush to a dentist in the event of a heart attack. However, oral health and systemic, particularly cardiovascular health are correlated more than we might think.

 Periodontal disease or gum disease is a condition where ongoing bacterial infection of the gums, the soft pink tissue around teeth, results in chronic inflammation. While inflammation is a healthy response by the human immune system and keeps harmful populations of pathogens in check, it also damages human tissue over time. Scientists have now established that individuals with periodontal disease or gum disease are more likely to have cardiovascular problems including heart attack, stroke, heart disease, and diabetes. Since tooth loss is also a result of gum disease, scientists in a recent study predict that an adult’s tooth number could be a predictor of risk for cardiovascular complications and for overall health.

 The typical adult human has 32 teeth. In 1997, 8,446 participants between the ages of 25 and 75 were asked complete a detailed questionnaire regarding their nutritional intake, education level, socioeconomic status, lifestyle and medical history. Their teeth were then counted by a nurse. Each participant was placed into categories of minimal, moderate, and advanced tooth loss. Nearly 14 years later, scientists followed up with the participants. They were able to gather current data from 7,862 of the original 8,446 participants. Some of the individuals are still living and some are not.

After performing an in-depth statistical analysis that was adjusted for covariates such as age and socioeconomic status based on the Framingham general cardiovascular risk profile and the Diabetes Risk Score, scientists found that individuals with moderate and advanced tooth loss surveyed in 1997 were at higher risk of cardiovascular complications. Individuals with moderate tooth loss had the highest rate of non-lethal coronary heart disease and acute heart attacks. On the other hand, individuals with advanced tooth loss had the highest rates of coronary heart disease and cardiovascular complications in general. Those with no remaining teeth were at less risk of incident coronary heart disease and cardiovascular heart disease but were at the greatest risk of diabetes mellitus and death.

            When number of missing teeth was included as a variable in assessing risk, the 13-year follow-up reflected a more accurate prediction of results for cardiovascular complications. Since cavities and periodontal disease are the most common causes of tooth loss, the authors suggest that advanced tooth loss is an accurate indicator of ongoing inflammation. Previous studies have suggested that tooth loss may not be a good predictor of death in general but that it is an accurate predictor of mortality due to cardiovascular disease. The study strengthens that prediction. While some limitations to this correlation are that people often have teeth extracted for orthodontic reasons. For example, most people have their wisdom teeth removed for reasons that are not related to cavities or gum disease. It is not uncommon for additional teeth to be extracted to avoid tooth crowding in people with small mouths. For this reason, people with less than 5 missing teeth were considered to have minimal tooth loss. Subjects with moderate tooth loss are likely to have acute gum disease but this may also be a result of extraction for aesthetic reasons and decay. Those with advanced tooth loss most likely suffer from chronic periodontitis. Another potential problem with the 1997 survey is that the nurse counting the teeth was not trained to differentiate natural teeth from prosthetic teeth such as implants and bridges. However, with such a large cohort of participants this possible error should be negligible.

Health professionals are moving toward whole person health where instead of a patients’ health being compartmentalized, the big picture is assessed. For example, dentists in the past mostly performed tooth-by-tooth dentistry. That is, they simply fixed a their patient’s immediate problems such as cavities or chipped teeth.  Today, dentists are being educated to consider the health of the person attached to the tooth in treatment planning. The results of this study suggests that tooth counts could be incorporated into risk assessments by family practice doctors as one of the first steps in preventing cardiovascular problems. Further, it demonstrates the importance of oral health to overall health. In a society where cardiovascular issues are a leading cause of death, it is important to shed light on this integration of health. Who would have thought that along with monitoring your cholesterol and eating healthy, brushing your teeth and flossing can help prevent cardiovascular problems?