Eric Goulder, MD, FACC
Heart Talk - June 2021
A Simple Four-Step Plan to Optimize Your Oral-Systemic Health
Heart-healthy and Stroke-free Living with Eric A. Goulder, MD, FACC
Your dental provider is a potentially lifesaving member of your chronic disease prevention team! Here is some powerful motivation to take excellent care of your teeth and gums: Doing so is one of the simplest – and most effective – ways to add years to your life, as a recent study of more than 5,600 older adults proves. The researchers tracked the participants for 17 years and reported that:
Never brushing at night elevated risk for death during the study period by 20 to 25 percent, compared to brushing every night.
Never flossing upped mortality risk by 30 percent, versus daily flossing.
Not seeing a dentist in the previous 12 months raised mortality risk by up to 50 percent, compared to getting dental care two or more times a year.
Another startling finding from the study: One major predictor of early death was missing teeth, even when other risk factors were taken into account. A subsequent study of these participants also found that older adults who neglected their teeth were up to 65 percent more likely to develop dementia than those with excellent oral health. Here are some proven tips that will help you combat bacterial villains and achieve a perfect 10 in oral-systemic wellness from Doug Thompson, DDS, FAAMM, ABAAHP, founder of the Wellness Dentistry Network, and Cris Duval, RDH, who has served as the BaleDoneen Method’s oral wellness liaison.
STEP 1. Partner with your dental provider and set goals to take your oral health to the next level of excellence.
With study after study linking poor oral health to higher risk for life-threatening conditions, says Dr. Thompson, “dentists and dental hygienists are increasingly attuned to the oral-systemic connection and our important role in chronic disease prevention. My colleagues and I like to say, ‘On a good day, we save a smile and on a great day, we’ll save a life.’ ” Patients are also taking a more active role in their oral care. Make the most of your next dental visit by preparing a list of your oral health goals, concerns and questions, such as these:
How do you rank my oral health on a scale of 1 to 10?
What are my risk factors for periodontal disease?
What needs to happen for the two of us to get my oral health to a 10?
Are you willing to partner/coach me on how to achieve my oral health goals?
How do you rank my overall health on a scale of 1 to 10 and are there any red flags in my medical history that stand out?
What needs to happen for the two of us to get my overall health to a 10?
STEP 2. Ask your dental provider to screen you for periodontal and endodontic disease and check you for high-risk oral bacteria.
Our landmark study could transform how dental providers diagnose and manage periodontal disease (PD), since the research shows it’s important to find out if patients have the high-risk bacteria that are now known to be a contributing cause of atherosclerosis. Dr. Thompson recommends that your exam include these three components:
X-rays to check for signs of endodontic disease and history of gum disease. Ask your dental provider if you are at risk for endodontic disease, which mainly affects people who are prone to tooth decay, says Dr. Thompson. “If you have a lot of fillings or other dental work, such as root canals, your dental provider may recommend that you be evaluated for endodontic disease with an imaging test called 3-D cone beam tomography [CBCT], which may require being referred to a specialist since not all general dentists have this equipment.” In a recent analysis of studies, CBCT was 96 percent accurate for finding periapical abscesses and other signs of endodontic disease, as compared to a 73 percent accuracy rate for conventional dental x-rays. Adds Dr. Thompson, “If you’ve never had a cavity in your life, it’s very unlikely that you’d need cone beam CT since your risk for endodontic disease would be extremely low.” Radiographs or x-rays are also used to evaluate past bone loss from gum disease helping to determine the severity of the current disease.
A periodontal exam. This painless exam involves using a thin instrument called a periodontal probe to measure the depths of the pockets between your teeth, with each of these measurements recorded on your dental chart. Pockets are spaces around each tooth where it connects to your gums, and the deeper the pockets, the greater the probability that you have PD. A healthy pocket typically measures 1-3 millimeters and a depth of 4 mm or more suggests concern and possibly gum disease. Having pockets that bleed during the exam is another common symptom. “Periodontal disease is now staged the same way cancer is, with stage one indicating early periodontitis and stage four indicating advanced periodontitis with substantial loss of bone support (very loose or missing teeth) and deep pockets of infection,” says Dr. Thompson.
An oral salivary test for high-risk periodontal bacteria. To find out which patients harbor dangerous oral bacteria, The BaleDoneen Method recommends using available diagnostic tests that measure oral pathogens through DNA analysis, including OralDNA, OraVital, Hain Diagnostics and FidaLab to name a few. Because people without gum disease can also harbor these dangerous bacteria, Duval recommends this painless oral testing for all dental patients: “I’ll even test children if one of their parents has a high load of oral pathogens, since the bacteria can spread easily between family members through kissing or sharing food. Dogs are another potential source of bacterial infection, so avoid letting your pet lick you or your kids on the face. Always wash your hands after handling objects your dog has licked or chewed, such as toys or food bowls.”
STEP 3. Disinfect your entire mouth daily.
In the study of older adults, those who brushed and flossed daily outlived people with neither habit, prompted Duval to strongly recommend both practices to her patients, as does the American Dental Association. However, a 2015 review of the scientific evidence published in the Journal of Clinical Periodontology concluded that “the majority of available studies fail to demonstrate that flossing is generally effective in plaque removal.” Dr. Thompson advises his patients to clean between their teeth with a water flosser device, such as Waterpik or Oral-B Water Flosser, instead of using dental floss, but adds that his recommendations for home care are personalized for each patient. “The most important thing is use a thorough daily method of removing bacteria from between the teeth that you’re comfortable with, whether it’s water flossing or using dental floss,” he says.
If you use dental floss, be sure to employ the proper technique: Avoid snapping the floss up and down, which irritates your gums and does a poor job of cleaning. Instead, glide it gently up and down in zigzag motion as you clean the tooth surface and under the gum, with the floss contoured in a C-shape to wrap around the tooth. Also be sure to floss the back surface of the very last teeth on each side of your lower and upper jaw. Use a clean section of floss for each tooth. Along with water or dental flossing, Dr. Thompson and Duval also recommend the following ways to safeguard your smile and overall wellness:
To reduce harmful bacteria in your mouth, don’t just brush your teeth and gums. Also brush your cheeks, the roof of your mouth and the vestibule (the area between the teeth, lips and cheeks).
Use a tongue scraper – not a toothbrush – to clean your tongue.
After dental or water flossing, also use dental picks (such as G.U.M. Soft-Picks) to efficiently remove debris between teeth that floss doesn’t reach.
Fight bacterial buildup by using a high pH (alkaline) toothpaste, such as CariFree or CloCYS. These companies also have high pH mouthwashes.
Choose dental products that contain xylitol, a compound with an antimicrobial effect. Xylitol products, such as toothpaste, chewing gum and lozenges, help prevent cavities and may reduce risk for gum disease. Warning: If you have pets, keep all xylitol products out of your pet’s reach— xylitol is extremely toxic or even fatal to dogs, even in small amounts.
Go to bed with a clean mouth. Since your mouth makes less saliva when you are sleeping to wash your teeth and gums, it’s particularly important to disinfect your mouth thoroughly at bedtime.
Avoid mouthwashes that contain sugar or alcohol.
STEP 4. Get a dental cleaning at least twice a year or as advised by your dental provider.
Doing so could actually save your life! In the study of older adults, those who hadn’t seen a dentist in the previous year had a 50 percent higher death rate than those who went multiple times a year. “One of our goals is to keep all of our patients in what I call the ‘safety zone,’ as opposed to the danger zone where gum disease and high-risk bacteria create a perfect storm of inflammatory responses that leave people susceptible to heart attacks and strokes,” says Duval.
To stay in the safety zone, it’s crucial to get dental checkups and any necessary treatments on the schedule advised by your dental provider. If you have gum disease, treatments include nonsurgical periodontal therapy, a daily program of self-care to follow at home, prescription mouthwashes, dental trays with antibacterial gel (PerioProtect), and in some cases, a short course of antibiotics. Regardless of which treatment is prescribed, the DNA testing should be repeated to make sure the treatment was successful, says Dr. Thompson: “Unlike gingivitis, which can be reversed, periodontitis is not curable, but with the right treatment, it can be halted and stabilized to prevent further damage, usually with three to six months of active treatment, followed by maintenance care to keep the disease from reactivating.”
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