tag:theconversation.com,2011:/global/topics/periodontal-disease-2918/articlesPeriodontal disease – The Conversation2023-12-19T23:42:53Ztag:theconversation.com,2011:article/2198782023-12-19T23:42:53Z2023-12-19T23:42:53ZOral health is health: Better access to dental care may have potential benefits beyond Canadians’ mouths<figure><img src="https://images.theconversation.com/files/566686/original/file-20231219-15-3hv10x.jpg?ixlib=rb-1.1.0&rect=688%2C22%2C4303%2C2964&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Because oral health is linked to overall health, dental care needs to be viewed as an integral part of health care. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/oral-health-is-health-better-access-to-dental-care-may-have-potential-benefits-beyond-canadians-mouths" width="100%" height="400"></iframe>
<p>Oral diseases, particularly dental decay and periodontal (gum) diseases, are largely preventable, yet are some of the <a href="https://www.who.int/data/gho/data/themes/oral-health-data-portal">most common non-communicable diseases around the world</a>. Pain due to untreated dental decay impacts eating and sleep quality, among other essential functions. Indeed, the agonizing nature of dental pain earned it the title of “<a href="https://doi.org/10.1038/sj.bdj.4809302">the hell of all diseases</a>” more than 200 years ago.</p>
<p>But pain is only the most obvious of the many ways oral health is linked to overall health.</p>
<h2>Access to dental care</h2>
<p>The federal government recently launched the long-anticipated <a href="https://www.canada.ca/en/services/benefits/dental/dental-care-plan.html">Canada Dental Care Plan</a> (CDCP) to improve access to dental care for the almost <a href="https://www.canada.ca/en/health-canada/news/2023/12/the-canadian-dental-care-plan.html">nine million Canadians</a> who lack dental insurance.</p>
<p>The program comes in light of the increasing barriers to dental care with the most recent data from Statistics Canada showing that <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/231106/dq231106a-eng.htm">one in four Canadians avoid seeing a dental professional due to costs</a>. While this burden affects mostly low-income families, seniors and people living with disabilities, it also places a huge toll on the population as a whole.</p>
<p>On top of the time lost from school or work due to dental problems, many without the means to access dental care end up seeking care in hospital emergency departments, unnecessarily costing the health-care system billions of dollars.</p>
<p>The CDCP is an important milestone that could eventually get many Canadians the dental care they need and deserve. Meanwhile, this investment in oral health is a reminder of the importance of a healthy mouth, what makes it fundamental to overall health, and notably, how the potential impact of improving access to dental care for those who need it most may extend beyond the mouth.</p>
<h2>Oral health is integral for overall health</h2>
<p>The <a href="https://www.who.int/health-topics/oral-health#tab=tab_1">World Health Organization</a> (WHO) defines oral health as “the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompassing psychosocial dimensions such as self-confidence, well-being, and the ability to socialize and work without pain, discomfort and embarrassment.”</p>
<p>A healthy, disease-free mouth is key to quality of life and well-being. Being fundamental to various essential functions, the lack of oral health connects it to a number of chronic diseases in several ways.</p>
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Read more:
<a href="https://theconversation.com/filling-the-gaps-why-canada-still-needs-a-public-dental-health-plan-despite-decades-of-medicare-181306">Filling the gaps: Why Canada still needs a public dental health plan despite decades of medicare</a>
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<p>The most <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf?sequence=1">recent WHO report</a> shows that dental decay and gum diseases affect almost 25 per cent of Canadian adults — a higher figure than that observed in the United States. Importantly, both conditions are among the most common causes of tooth loss in adults globally, thereby impacting the ability to eat, the quality of nutrition and, in seniors, <a href="https://doi.org/10.1111/jgs.16377">contributing to frailty</a> and <a href="https://doi.org/10.1111/jgs.13190">declining cognitive health</a>.</p>
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<figcaption><span class="caption">Prime Minister Justin Trudeau making an announcement about applying for the federal dental benefit, at one of Western University’s dental clinics in December 2022.</span></figcaption>
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<p>Severe gum disease in particular is an inflammatory condition that is linked to several other chronic conditions through <a href="https://doi.org/10.1038/s41577-020-00488-6">exacerbating inflammatory reactions</a> in other organs and body systems and that may arguably contribute to some <a href="https://doi.org/10.1016/j.amjcard.2016.05.036">heart</a> and <a href="https://doi.org/10.1111/nep.13225">kidney diseases</a>, among others.</p>
<p>Importantly, there is <a href="https://doi.org/10.1038/sj.bdj.2017.544">a bidirectional relationship between gum diseases and diabetes</a>, where severe inflammation of the gums and supporting bone can aggravate the risk and complications of diabetes, and vice versa.</p>
<p>The consequences of an unhealthy mouth also extend to an individual’s social interactions. For example, those experiencing poor esthetics due to crooked, broken or stained teeth are more likely to be <a href="https://doi.org/10.1016/j.ssmph.2015.11.001">stigmatized and blamed for their dental appearance</a>. In severe cases, they may potentially have <a href="https://www.thestar.com/news/why-is-he-out-of-work/article_711c362f-333c-5580-97ae-7f4646eb092d.html">fewer opportunities for employment</a>.</p>
<p>Observations such as these bring to mind the 19th century’s French naturalist and father of paleontology, Georges Cuvier who famously said, “<a href="https://wellcomecollection.org/articles/W3LpDykAACgAEVFi">Show me your teeth and I will tell you who you are</a>.” </p>
<p>Cuvier’s statement at the time intended to describe how teeth where distinctive of populations according to diets and environmental impacts. Nevertheless, it is not hard to see its relevance to the appearance and health of the mouth and teeth and their impact on how one is perceived in today’s society.</p>
<h2>Children’s health and dental care</h2>
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<img alt="A boy being examined. by a dental care worker out of shot" src="https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566687/original/file-20231219-23-k1u7se.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Canadian kindergarteners in need of dental treatment are found to score lower on physical, cognitive, social and emotional development scales than those without dental problems.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Certainly, oral diseases affect all age groups and children are no exception. Recent reports show that almost <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf?sequence=1">39 per cent of Canadian children</a> under nine years old have dental decay. Just like in adults, the impact of dental decay on children extends to poor nutrition, and affects sleep and development.</p>
<p>For example, Canadian kindergarteners in need of dental treatment were found to <a href="https://doi.org/10.1186/s12887-019-1868-x">score lower on physical, cognitive, social and emotional development scales</a> than those without dental problems. On top of this, researchers found the treatment of severely decayed teeth to be by far <a href="https://publications.gc.ca/collections/collection_2014/icis-cihi/H118-94-2013-eng.pdf">the most common reason for children aged one to five years old to receive general anesthesia to undergo surgery</a>.</p>
<h2>Dental care and chronic conditions</h2>
<p>The connection between oral health and overall health is evident in myriad ways, and so is the need to improve oral health and access to dental care in Canada. It also raises the question of whether dental care can help alleviate chronic conditions beyond the mouth. </p>
<p>The <a href="https://doi.org/10.1038/s41467-022-35337-8">scientific evidence on that varies</a>, and largely depends on the chronic condition in question. For example, patients with diabetes are among those who can benefit the most from having better access to dental care. Treating gum diseases can help subside body inflammation and <a href="https://doi.org/10.1002%2F14651858.CD004714.pub4">reduce the risk and complications of diabetes by helping the body regulate blood glucose levels</a>. </p>
<p>Notably, Canada ranks <a href="https://iris.who.int/bitstream/handle/10665/373542/9789240070820-eng.pdf">fourth out of 29 countries</a> in the Region of the Americas in its rate of lip and oral cavity cancer. Many dentists are trained to spot the signs of oral cancer and can help in its early detection, which can be lifesaving.</p>
<p>As we learn more on the impact of dental treatment on chronic disease management, we know that facilitating access to dental care can have promising results on several fronts. In addition to saving costs for individuals and our health-care system, it would enhance the population’s oral health and potentially help in the management of some chronic diseases, such as diabetes. </p>
<p>Importantly, it can reduce the pervasive and inequitable burden of oral diseases. </p>
<p>Indeed, investing in better access to dental care may bring us closer to a healthy smile and beyond, for every Canadian.</p><img src="https://counter.theconversation.com/content/219878/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Noha Aziz-Ezzat Gomaa receives or has received funding from the Canadian Institutes of Health Research, the Schulich School of Medicine & Dentistry at Western University, and the Children's Health Foundation. She is affiliated with various national and provincial dental professional associations.</span></em></p>In addition to saving costs for individuals and our health-care system, facilitating access to dental care would enhance the population’s oral health and potentially help in managing chronic diseases.Noha A. Gomaa, Assistant Professor, Dental Public Health and Oral Medicine, Schulich School of Medicine & Dentistry, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772192022-02-25T02:16:57Z2022-02-25T02:16:57ZHow to brush your teeth properly, according to a dentist<figure><img src="https://images.theconversation.com/files/447715/original/file-20220222-26-ghb9dy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5599%2C4073&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Most of us brush our teeth on autopilot. So let’s stop and ask: are you doing it properly? For a full two minutes? Do you use the correct type of brush and toothpaste? </p>
<p>Did you know you’re supposed to spit, not rinse after brushing?</p>
<p>And brushing soon after eating acidic foods, like citrus, can damage your teeth? </p>
<p>Here, I answer five questions commonly asked at the dentist.</p>
<h2>1. Am I brushing correctly?</h2>
<p>For starters, make sure you’re brushing both teeth and gums at least twice a day.</p>
<p>Brushing removes dental plaque, the grey-white bacterial mass that sticks to the tooth and gum surface.</p>
<p>If left undisturbed for at least a day, plaque bacteria <a href="https://journals.asm.org/doi/10.1128/mSystems.00360-19">multiply and begin to mature</a>. </p>
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<a href="https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447984/original/file-20220223-27-1vxn8z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Plaque can cause damage to the tooth enamel and the dentine underneath.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Mature plaque forms an architecturally complex mass with its own sewerage system. </p>
<p>Plaque feeds on the food we eat, particularly carbohydrates (sweet and savoury) to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/prd.12361">reinforce and build</a> a complex structure that releases <a href="https://link.springer.com/chapter/10.1007/978-3-030-31772-0_3#citeas">acids</a> and gassy, smelly by-products (plaque sewage). </p>
<p>Mature plaque on your teeth and gum surfaces can lead to cavities (holes in our teeth) and gum disease.</p>
<p>Cavities form in our teeth when the mineral in our enamel and eventually, dentine, <a href="https://link.springer.com/chapter/10.1007/978-3-030-31772-0_3#citeas">dissolves to neutralise plaque acids</a>. Over time, the tooth softens and caves in. </p>
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<p>Every time you brush, you stop plaque bacteria from feeding on your food, multiplying and maturing. Mature plaque mixed with mineral in your saliva forms <a href="https://journals.sagepub.com/doi/full/10.1177/154411130201300506">calculus or tartar</a>.</p>
<p>Calculus can only be removed completely by a dentist or hygienist using special tools.</p>
<p>Not brushing before bed is <a href="https://link.springer.com/article/10.1007/s40368-019-00463-3">especially risky</a>; saliva flow reduces and food stuck between your teeth ferments, creating a perfect petri dish for plaque growth. This is where flossing or using tapered <a href="https://www.ada.org.au/Dental-Health-Week-2017/Oral-Health-for-Busy-Lives/Flossing">interdental cleaners</a> can help. </p>
<p>Make sure you clean the teeth at the back of your mouth, and don’t rush. The Australian Dental Association recommends brushing for <a href="https://www.teeth.org.au/brushing-teeth">two minutes</a> morning and night.
Watch this video for some handy tips on how to brush your teeth.</p>
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<h2>2. How do I look after my gums and prevent bad breath?</h2>
<p>Bad breath can be caused by <a href="https://pubmed.ncbi.nlm.nih.gov/31610030/">gum disease</a>.</p>
<p>After <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/prd.12296">two to three weeks of poor brushing</a>, the mature plaque causes the gums to swell, redden and bleed easily. </p>
<p>This is because the gum’s blood vessels leak <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/prd.12296">immune fighting cells to try and destroy the plaque</a>. </p>
<p>But the plaque’s defence system repels the attack. Everything your body throws at it bounces off and starts to break down the bone that holds your teeth in your head. </p>
<p>This process is known as advanced gum disease or periodontal disease. It happens slowly and painlessly. As the gums recede, teeth appear elongated.</p>
<p>Untreated, your teeth may become painful, loosen and even fall out.</p>
<p>This is why it’s important to have a regular dental check-up and to brush and floss frequently. </p>
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<h2>3. What kind of toothbrush should I use?</h2>
<p>The Australian Dental Association <a href="https://www.ada.org.au/Dental-Health-Week/Oral-Health-for-Busy-Lives/Brushing-and-flossing">recommends</a> using a toothbrush with a small head and soft bristles.</p>
<p>Some of us are magnificent manual tooth brushers, but many would <a href="https://www.cochrane.org/CD002281/ORAL_poweredelectric-toothbrushes-compared-to-manual-toothbrushes-for-maintaining-oral-health">benefit by using an electric toothbrush</a>. </p>
<p>Why? The same reason we ditched the broom for a vacuum cleaner. </p>
<p>It’s faster, efficient and does a better job – as long as you hover over the surfaces you need to clean. Aim for teeth as well as gums. </p>
<p>Electric toothbrushes come with <a href="https://www.choice.com.au/health-and-body/dentists-and-dental-care/dental-products/review-and-compare/electric-toothbrushes">various features</a> to suit different budgets and needs. </p>
<p>For instance, some have an in-built warning signal to prevent you from brushing so hard you abrade (wear away) your teeth and gums. </p>
<h2>4. When should I delay brushing?</h2>
<p>Generally, wait at least 30 minutes after vomiting or consuming <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jerd.12706">acidic foods and beverages</a>.</p>
<p>If in doubt, check the food label as there are many <a href="https://adavb.org/publicassets/3a66cf22-4d5b-e911-a2b6-ff21181505bd/Fact-Sheet_Oral-Health_Dental-Erosion.pdf">different acids in our diet</a>.</p>
<p>Acids soften the enamel and dentine like soaking dirty saucepans in the sink. </p>
<p>And if we don’t give our saliva enough time to mop up the acids, the softened tooth surface scratches away when we brush. </p>
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<span class="caption">If we don’t give our saliva enough time to mop up the acids before brushing, the acids soften the tooth surface.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>5. What kind of toothpaste should I use?</h2>
<p>Keep it simple. Select a toothpaste that contains <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007868.pub3/full">fluoride</a>. </p>
<p><a href="https://www.teeth.org.au/dental-fluoride">Fluoride</a> fills and reinforces the microscopic gaps in our teeth to create an acid-resistant barrier.</p>
<p>It also forms a non-stick surface to <a href="https://link.springer.com/chapter/10.1007/978-3-030-31772-0_3#citeas">prevent plaque from attaching and maturing</a>. </p>
<p>Do spit and not rinse at the end; avoiding rinsing means you get a fluoride treatment each time you brush. </p>
<p>What about whitening toothpastes? Whitening toothpastes can have strong abrasives that wear the tooth surface to cause sensitivity. </p>
<p>Most stain particles in our natural teeth hide in microscopic gaps in enamel. </p>
<p>The most efficient and least destructive way of removing these stains is by <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jerd.12519">using peroxide-based</a> whitening products.</p>
<p>Talk to your dentist about <a href="https://www.ada.org.au/getattachment/Your-Dental-Health/Resources-for-Professionals/Resources-for-Adults-31-64/Teeth-whitening-the-best-result-for-your-smile/Teeth-whitening,-getting-the-best-result-for-your-smile.pdf.aspx">options</a> and be wary of home remedies or gimmicks. And remember, whitening will not change the colour of dentures, crowns, veneers or fillings.</p><img src="https://counter.theconversation.com/content/177219/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arosha Weerakoon is a self-employed dentist in private practice. She has received funding from Colgate to conduct research on how collagen and mineral characteristics in teeth change as we age. She is a member of the Australian Dental Association and a Fellow of the Royal Australasian College of Dental Surgeons.</span></em></p>Do you brush for two minutes, with the correct type of brush and toothpaste? Did you know you’re supposed to spit, not rinse after brushing? And that brushing at the wrong time can cause damage?Arosha Weerakoon, Lecturer, General Dentist & PhD Candidate, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/634962016-08-10T13:40:02Z2016-08-10T13:40:02ZThe flossing flap: Mind your dentist, and floss every night<figure><img src="https://images.theconversation.com/files/133421/original/image-20160808-18023-xsqp1c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While flossing may not be fun, it is still good for you.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-282691796/stock-photo-happy-young-woman-flossing-teeth.html?src=0CtD3jD8TDcPzg3O_HavUA-1-1">From www.shuttertock.com</a></span></figcaption></figure><p>“To floss or not to floss?” has become a big question in the past week. News reports have conflicted, leading to confusion. </p>
<p>First came a <a href="http://bigstory.ap.org/article/f7e66079d9ba4b4985d7af350619a9e3/medical-benefits-dental-floss-unproven">story from the Associated Press</a> on Aug. 2 that the Departments of Agriculture and Health and Human Services had <a href="http://www.nytimes.com/2016/08/03/health/flossing-teeth-cavities.html?_r=0">dropped recommendations for flossing</a> because no studies provided evidence that flossing actually promotes oral health.</p>
<p>Then came a joint announcement from HHS and the American Dental Association on Aug. 4. The ADA said that “the bottom line for dentists and patients is that a <a href="http://www.ada.org/en/press-room/news-releases/2016-archive/august/statement-from-the-american-dental-association-about-interdental-cleaners">lack of strong evidence</a> doesn’t equate to a lack of effectiveness.”
HHS said in a statement to the dental group that flossing is “an important <a href="http://www.ada.org/en/press-room/news-releases/2016-archive/august/statement-from-the-american-dental-association-about-interdental-cleaners">oral hygiene practice</a>.”</p>
<p>As with many questions related to health and medicine, experts may not always agree. As a hospital dentist practicing in an academic setting, I have personally observed the detrimental health effects of poor flossing habits. While there may not be studies yet that substantiate the health benefits of flossing, I see the benefits every day.</p>
<h2>Brushing up on the basics</h2>
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<img alt="" src="https://images.theconversation.com/files/133422/original/image-20160808-18053-16x8ztl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/133422/original/image-20160808-18053-16x8ztl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133422/original/image-20160808-18053-16x8ztl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133422/original/image-20160808-18053-16x8ztl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133422/original/image-20160808-18053-16x8ztl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133422/original/image-20160808-18053-16x8ztl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133422/original/image-20160808-18053-16x8ztl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Flossing daily is still ideal.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-289517327/stock-photo-close-up-of-toothbrush-and-dental-floss.html?src=qf8SscYMZgEuxz1QWLQKiQ-1-0">From www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Let’s start with dental basics. </p>
<p>Flossing reduces plaque, the sticky film that collects at the gumline as a result of eating. This plaque layer harbors lots of bacteria. The ADA estimates that more than <a href="http://www.ada.org/en/publications/ada-news/2016-archive/august/association-responds-to-news-story-challenging-benefits-of-dental-floss-use">500 species of bacteria</a> can thrive in this plaque. Some are good, but some are bad. </p>
<p>An overgrowth of bacteria can be responsible for common problems such as gingival inflammation, bleeding, tenderness, and bad breath. </p>
<p>Flossing, if practiced consistently and correctly, can help prevent some of these consequences. I believe it prevents the development of <a href="http://www.healthline.com/health/gingivitis">gingivitis</a> and subsequent periodontitis. Gingivitis is the inflammation that develops at the gumline when plaque accumulates around the tooth. If left undertreated, it can progress to periodontitis, or gum disease with associated bone loss. </p>
<p>Without flossing and regular dental cleaning visits, periodontal disease may cause early tooth loss. It is also directly linked to chronic systemic illnesses such as low birth weight babies, diabetes and heart disease. Treatment for these types of periodontal diseases can be painful, time-consuming and financially draining. No one wants this, trust me. Gingivitis leads to tooth loss, and tooth loss leads to poor health.</p>
<h2>Evidence is one thing, experience another</h2>
<p>Based on my clinical experience, I believe flossing helps to prevent decay. How? Decay that may occur between your teeth starts just below your contact point, where neighboring teeth meet. Flossing helps to mechanically disrupt the plaque that may build between teeth. If there is no disruption, the bacteria will break down the tooth surface to cause a cavity. </p>
<p>The <a href="http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/heart-disease-prevention/faq-20057986">link between periodontal disease</a> and heart disease has only become more obvious within the last two decades. This does not mean that bacteria in your mouth causes heart disease; it means that some studies have suggested a link. </p>
<p>What is that possible link? Your mouth has lots of bacteria and your gums have lots of blood vessels. Any disruption or accumulation of plaque may cause bacteria to enter your circulatory system. Bacteria can then travel anywhere, such as to the valves of your heart, or even to your brain. </p>
<p>Ultimately, an endocarditis or encephalitis could develop, causing risk to your health. The inflammatory reaction caused by bacteria is the <a href="http://www.webmd.com/heart-disease/features/periodontal-disease-heart-health">ultimate link</a> between gum disease and these chronic conditions. </p>
<h2>You can’t fool your dentist</h2>
<p>A visual inspection can tell your story. Your dentist and hygienist can tell if you have been compliant with your daily brushing and flossing. Patients who are not compliant with flossing usually have obvious redness and tenderness during probing and manipulation of the gumline. This can make a routine dentist visit more painful and uncomfortable than it should be.</p>
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<img alt="" src="https://images.theconversation.com/files/133423/original/image-20160808-18030-16w20f0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/133423/original/image-20160808-18030-16w20f0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133423/original/image-20160808-18030-16w20f0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133423/original/image-20160808-18030-16w20f0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133423/original/image-20160808-18030-16w20f0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133423/original/image-20160808-18030-16w20f0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133423/original/image-20160808-18030-16w20f0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Your teeth tell the story. Via Shutt.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-127690178/stock-photo-medical-treatment-at-the-dentist-office.html?src=dOxqbJLxaZ744UbcWfcpYw-1-24">From www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Good oral hygiene practices of brushing and flossing keep your gums healthy and in turn keeps you healthy. Always brush and floss every day.
Otherwise, be prepared for the cavities, gum disease, and the possible <a href="http://www.health.harvard.edu/blog/treating-gum-disease-may-lessen-burden-heart-disease-diabetes-conditions-201407237293">progression into diabetes</a> and other chronic conditions. </p>
<p>So, if you are at the bathroom sink tonight talking yourself out of flossing because there is no evidence, talk yourself into it instead. Pick up the floss, make your dentist proud.</p><img src="https://counter.theconversation.com/content/63496/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Rezk does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Millions smiled last week when it was reported that there’s no evidence to support the flossing of teeth. A dentist sees it differently and suggests we continue the practice.Julie Rezk, Assistant professor of dentistry, Vanderbilt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/58582012-05-01T20:46:17Z2012-05-01T20:46:17ZHow much is general health affected by oral health?<figure><img src="https://images.theconversation.com/files/10181/original/4w7yktn9-1335843726.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Oral diseases are a significant burden on many people.</span> <span class="attribution"><span class="source">Tess Heder</span></span></figcaption></figure><p>Bad oral health can have a significant negative impact on people’s quality of life. It can also affect other diseases that they may be suffering. But whether oral ill-health causes general health problems depends on what disease you’re talking about.</p>
<p><a href="http://www.ada.org.au/app_cmslib/media/lib/0609/m16793_v1_nacoh%20oral%20health%20care.pdf">People with untreated</a> oral and dental diseases can experience severe pain, loss of sleep, inability to eat certain foods, time off work or school and embarrassment about their appearance. </p>
<p>These diseases can accelerate the progress and severity of other illnesses, which makes it even more important that we do all we can to ensure everyone has access to affordable dental care.</p>
<h2>Periodontal disease</h2>
<p>The oral disease most frequently associated with medical conditions is chronic periodontal disease, which is the result of inflammation of the tissues surrounding the tooth affecting the gum, the ligaments and the bone. It’s caused by a bacterial infection and other factors, such as smoking. </p>
<p>In its <a href="http://www.nidcr.nih.gov/datastatistics/surgeongeneral/report/executivesummary.htm">most severe forms</a>, periodontal disease can cause loss of the bone that supports the tooth, resulting in the tooth becoming loose. It can even cause tooth loss.</p>
<p>The strength of the relationship between periodontal disease and general health varies with the medical condition under investigation. The strongest evidence for such a link is between periodontal disease and diabetes.</p>
<h2>Periodontal disease and diabetes</h2>
<p><a href="http://www.joponline.org/doi/abs/10.1902/jop.1996.67.10s.1041">Epidemiological studies</a> have confirmed that patients with diabetes (both type 1 and type 2) are more susceptible to periodontal disease. The <a href="http://onlinelibrary.wiley.com/doi/10.1034/j.1600-0757.2001.22250103.x/abstract;jsessionid=EC5216EBFDC5EE1F9D979A6E64DD32D0.d03t04?userIsAuthenticated=false&deniedAccessCustomisedMessage=">extent of the risk</a> relates to the duration and control of their diabetes – periodontal disease is likely to increase markedly when diabetes is poorly controlled.</p>
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<img alt="" src="https://images.theconversation.com/files/10176/original/hrnyn5jh-1335838651.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/10176/original/hrnyn5jh-1335838651.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=442&fit=crop&dpr=1 600w, https://images.theconversation.com/files/10176/original/hrnyn5jh-1335838651.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=442&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/10176/original/hrnyn5jh-1335838651.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=442&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/10176/original/hrnyn5jh-1335838651.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=555&fit=crop&dpr=1 754w, https://images.theconversation.com/files/10176/original/hrnyn5jh-1335838651.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=555&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/10176/original/hrnyn5jh-1335838651.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=555&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Periodontal disease can result in your teeth falling out.</span>
<span class="attribution"><span class="source">Woodleywonderworks/Flickr</span></span>
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<p>Diabetes, in turn, leads to more <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0757.2005.00138.x/full">rapid and severe progression</a> of destructive periodontitis, <a href="http://www.jdcjournal.com/article/S1056-8727(05)00048-6/abstract">increasing the risk</a> of greater severity at least twofold. It essentially <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0757.1994.tb00025.x/abstract">doubles the rate</a> of periodontal disease progression.</p>
<p>Essentially, <a href="http://www.nidcr.nih.gov/datastatistics/surgeongeneral/report/executivesummary.htm">research</a> suggests the relationship between periodontal disease and diabetes goes both ways – not only do people with diabetes have more severe periodontal disease, but periodontal disease may make it more difficult for people who have diabetes to control the condition. </p>
<h2>Periodontitis and heart disease</h2>
<p>The relationship between cardiovascular disease and periodontal disease has been more difficult to elucidate. Many studies <a href="http://www.ncbi.nlm.nih.gov/pubmed/18807098">found an association</a>, but others have not. A recent <a href="http://www.ncbi.nlm.nih.gov/pubmed/19805772">review and meta-analysis of seven studies</a> for the US Preventive Services Task Force found that the presence of periodontal disease was a weak but independent risk factor for heart disease.</p>
<p>So the important question of whether periodontal disease causes heart disease has yet to be determined. </p>
<p>This issue was recently <a href="http://circ.ahajournals.org/content/early/2012/04/18/CIR.0b013e31825719f3">addressed in a statement</a> by the American Heart Association. The statement said there’s good evidence that periodontal disease and stroke, heart disease and peripheral vascular disease occur in the same people but that there’s no evidence periodontal disease causes these problems or that treating periodontal disease prevents them.</p>
<h2>Other diseases</h2>
<p>A 2008 <a href="http://www.ncbi.nlm.nih.gov/pubmed/18724863">meta-analysis</a> concluded periodontitis had an effect on general health but issues of both the criteria for periodontal disease and confounding (diseases having the same risk factors as periodontal disease) need to be resolved. </p>
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<img alt="" src="https://images.theconversation.com/files/10175/original/2m8szbrw-1335838502.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/10175/original/2m8szbrw-1335838502.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=465&fit=crop&dpr=1 600w, https://images.theconversation.com/files/10175/original/2m8szbrw-1335838502.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=465&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/10175/original/2m8szbrw-1335838502.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=465&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/10175/original/2m8szbrw-1335838502.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=584&fit=crop&dpr=1 754w, https://images.theconversation.com/files/10175/original/2m8szbrw-1335838502.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=584&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/10175/original/2m8szbrw-1335838502.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=584&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Researchers don’t know whether there are causal links between bad oral health and general health.</span>
<span class="attribution"><span class="source">Black Glenn/Flickr</span></span>
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<p>The association between pregnant women with periodontal disease and adverse pregnancy outcomes has been demonstrated in a number of studies. But <a href="http://www.bmj.com/content/341/bmj.c7017.full">results</a> from a number of randomised controlled trials of periodontal treatment during pregnancy have not been successful in improving pregnancy outcomes. </p>
<p>Other diseases where chronic infection may be an important factor have also been associated with periodontal disease. They include rheumatoid arthritis, stroke, chronic kidney disease and obesity.</p>
<h2>Causation and correlation</h2>
<p>In all these health problems, issues of confounding (many of the risk factors for periodontal disease are the same as those for other diseases) or co-morbidity (diseases sharing underlying risk factors or occurring in people with similar susceptibility) need to be clarified before causation can be determined.</p>
<p>Well-designed, large-scale longitudinal studies are required to determine whether causal links exist, the strengths of these links and whether treatment can reduce risks. </p>
<p>Meanwhile, oral diseases are a <a href="http://www.arcpoh.adelaide.edu.au/project/distribution/nsaoh_pdf%20files/nsaoh_report.pdf">significant burden for many people</a> particularly those who have difficulty gaining access to dental care because of financial constraints, location or disability.</p>
<p>Even though the nature of the relationship between oral health and general health remains to be clarified, the burden of bad oral health is significant for many Australians. It results in pain, discomfort, and loss of self-esteem as well as time lost from school and work. This makes it a major health issue in its own right, and one that requires attention and action from governments.</p><img src="https://counter.theconversation.com/content/5858/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kaye Roberts-Thomson receives funding from the NHMRC. She is the director of ARCPOH. Some researchers at the centre receive funding from Colgate Oral Care.</span></em></p>Bad oral health can have a significant negative impact on people’s quality of life. It can also affect other diseases that they may be suffering. But whether oral ill-health causes general health problems…Kaye Roberts-Thomson, Director of the Australian Research Centre for Population Oral Health, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.