Bad Breath? Maybe Bad Heart!

by Dr. Ben Record

CENTRAL —   We all worry about having bad breath.  But did you know bad breath can be a sign of serious health problems?

Gum or “periodontal” disease is one of the most common diseases in adults and responsible for most of the tooth loss in adults.

Symptoms of gum disease are bad breath, red and swollen gums, bleeding while brushing or flossing and loose teeth.  Chances are YOU have some form of gum disease.

More importantly, gum disease itself can be a sign or symptom of heart disease and many other diseases.   The correlations between diseases can be complex but in some cases, bacteria that cause gum disease can prolong and even worsen a disease, such as chronic respiratory diseases.  Treating one without the other could have potentially fatal outcomes. Recent research has focused on the impact periodontal disease has on overall health, not just oral health.  Understanding this complex interaction between gum disease and systemic conditions such as cardiovascular disease and diabetes mellitus has led to a new way of thinking about the importance of periodontal disease in overall healthy well being.

Periodontal Disease as an Integral Link to Systemic Disease.  According to the National Center for Health Statistics, 2009, eight of the Top 10 causes of death have a link to gum disease:

• Heart disease: 599,413

• Cancer: 567,628

• Chronic lower respiratory diseases: 137,353

• Stroke (cerebrovascular diseases): 128,842

• Alzheimer’s disease: 79,003

• Diabetes: 68,705

• Influenza and pneumonia: 53,692

• Nephritis, nephrotic syndrome, and nephrosis: 48,935

The bottom line is that health care practitioners should be alert to the presence of gum disease, because it may be a clue to something much more serious.

By improving overall oral health and management of your gum/periodontal disease, your general health will improve through shared approaches targeting common risk factors:

• Smoking

• Stress

• Nutritional deficiencies

• Medications

• Oral hygiene habits

Types of Periodontal Disease.  Periodontal diseases include two general categories based on whether there is attachment or bone loss: gingivitis and periodontitis.  And only a visit to your dentist and hygienist will confirm your diagnosis.

Looking briefly at both diseases:

• Gingivitis: Reversible form of the disease; involves inflammation of the gum tissues and no bone loss; and begins in childhood, peaks in early adulthood

• Periodontitis: Irreversible  (man-

ageable) form of the disease; gum tissues inflamed, recession may be evident; most cases peak in late adulthood; and bone loss can be detected radiographically

Gum disease is caused by a combination of bacteria and host response, and takes a team approach, which  includes you, your hygienist, and your dentist to develop the best game plan to minimize the effects.  If left untreated, tooth loss will occur and your options for restoring your smile may be limited, in addition to increased complications of your systemic health.

So, if you have heart disease, diabetes, history of strokes or other cardiovascular and pulmonary diseases, your gum disease may be a contributing factor towards worsening events and conversely, your diabetes and heart disease may be contributing to your red, swollen gums which could lead to tooth loss.

***

I completed a two-year residency in general practice/hospital dentistry at LSU’s Charity Hospital in New Orleans and served as program director of that residency for a little over six years.  One of our primary goals was to serve patients admitted to the hospital for all the medical/surgical specialties and also serve as the dentoalveolar trauma team for the emergency departments.  We also served as a referral clinic for acute care for the residencies at Tulane, Children’s Hospital, and many other state-run health clinics.  During my tenure, we treated many patients that were severely medically compromised, and it was certain that every patient also had unmet dental needs, many that were complicating their management of admitting diagnoses.

Educating the patient and their primary medical/surgical teams and co-treating the patients improved their outcomes in most cases.  Diabetes became more manageable, their diseased heart valves improved, diet, nutrition, sense of well-being improved and most times treatment of their dental disease (gum and cavities) prevented bigger problems long term.   We worked with cancer specialists to address pre-head and neck radiation or pre-chemotherapy; assisted orthopedics prior to joint replacements; cardiac surgeons before heart valve replacements; and medicine specialists initiating bisphosphonate therapy to name a few; but those are the extreme instances.  It is much closer to home when you realize that diabetes, hypertension (high blood pressure), coronary artery disease, Alzheimer’s, and chronic lung infections can be related to, complicated by and/or unmanageable due to gum disease.  Seeing this daily, we stressed to the medical/dental residents that every tooth is connected to a heart…a lung…a kidney…a brain!  Most importantly, we encouraged all specialties not to be too focused on “their area” and realize that “your disease your responsible for” MAY be connected to the mouth…and ours to an entire body.

Most physicians and dentists know there are correlations and connections. So I hoped to share my experiences with the public so they can ask questions of their health care providers.

At Record Dental Center, we strive to be your “mouth doctor” and not just a “tooth doctor”…and sometimes that means we need to listen to your heart.  Thank you.

(Drawing by American Academy of Periodontology)

References: Genco, Robert, Williams, Ray. Periodontal Health and Overall Health: A Clinician’s Guide. Yardley, Pa. Professional Audience Communications, Inc. 2010