Dental Associates of North Virginia

Northern Virginia Health & Life Magazine: October 2009
"Word of Mouth"

The next time you brush your teeth, consider this: It’s harder than you think to remove plaque, and most people have some form of gum disease. If you’re one of them, you could be facing larger health problems in the future.

“The mouth is not a separate entity—it’s related to the entire body,” explains Beverly Fink, RDH, director of dental hygiene for Dental Associates of Northern Virginia and the president and founder of PerioAdvocates. Studies have shown a relationship between gum disease and its impact on your overall health: When gums bleed, the bacteria travel through the bloodstream and can cause problems in other areas of the body, including heart valves and arteries of the heart and in the lungs. These bacteria can also contribute to such complications of pregnancy as preterm deliveries and low-birthweight babies. There is a strong relationship between untreated periodontal disease, diabetes, and unstable blood sugars.

Given this new research, the approach to dental hygiene services has changed dramatically. In the past, hygienists were trained to simply clean teeth. But today’s standard of care requires hygienists to provide periodontal exams to identify gum disease as early as possible. Probing and charting of the gums identifies areas of bone loss and infection that can contribute to loss of teeth. Periodontal disease affects nearly 80 percent of the adult population. Fortunately, when detected early, it can be treated nonsurgically in a very conservative way and patients can expect excellent outcomes.

One of the first signs that you may be at risk is seeing a pink streak of blood while you are brushing or flossing. You shouldn’t panic, but you shouldn’t dismiss it either, explains Dental Associates’ Steven Fuchs, DDS. “If any other part of the body bleeds, it’s a big deal, but if your gums bleed, many people don’t get very concerned.” In fact, bleeding gums are a sign of infection. The body’s response to infection is inflammation, and the mouth is one of the biggest sources of inflammation in the body. In medical research today, scientists are studying inflammation and finding that many common diseases are related to the inflammatory process. Flossing can greatly reduce inflammation and bleeding in the mouth and promote a healthier body

An Ounce of Prevention

In the battle to keep cavities and gum disease at bay, hygienists must partner with their patients; regular hygiene visits are central to optimal dental health. “X-rays help dentists see in between teeth where both cavities and bone loss are often found,” says Fink. “At Dental Associates, our hygiene department has been highly trained to provide preventative hygiene services that help patients keep their teeth for a lifetime. Our hygienists teach patients to routinely expect a report that includes both their cavity status and their periodontal status. A patient should clearly understand if they are healthy, diseased, or stable as far as gum disease goes.”

A standard “cleaning” is no longer considered a universal treatment appropriate for all patients. A cleaning—in conjunction with good daily homecare—helps to keep a healthy mouth healthy, explains Fink. But patients with active gum disease require more than that. “You would be offered conservative periodontal therapy,” she says, “and once you have been treated, the approach to managing gum disease is periodontal maintenance procedures. A six-month checkup across the board is not appropriate for every patient, even if insurance companies would have you believe that. Those with gum disease need more frequent care to control the bacteria that damage the bone that holds teeth in place. In each case, 80 percent of the success we see will depend upon the patient’s involvement in effective daily homecare.

“Hygienists are valuable educators,” Fink continues. “We teach our patients with a hands-on approach. We don’t just talk about it; we show our patients how to care for their teeth and gums, then put the tools in their hands so they can show us that they are able to successfully use them at home. This type of coaching makes home care much more successful. If you are spending the time to do the work, it only makes sense that patients are able to get the most out of the time they invest.”

Plaque forms both on the teeth and under the gums and returns every 24 hours. Many patients mistakenly think that there is no need to use dental floss because they don’t trap food between their teeth. In fact, when teeth are aligned properly, food does not generally get trapped. The reason dentists and hygienists ask patients to floss is to remove bacterial plaque from between teeth and from under the gums where it hides. Remember, it’s bacteria that cause infection, which destroys bone and causes people to lose teeth. As with cavities, most gum disease starts between teeth.

“A tooth has five sides to it,” say Fuchs. “With brushing—if you do it properly—you may get three of the sides cleaned. But that means you’re leaving 40 percent untouched if you are not cleaning in between the teeth, the other two areas of the tooth that require cleaning. That 40 percent is where most problems arise—in between the teeth is where most people get cavities and bone loss.” But remember, too, that floss cleans these in-between areas effectively only if you are healthy periodontally (based upon the results of a current periodontal exam). If you have had periodontal disease, floss may not access deeply enough to remove the problematic bacteria, so consult your hygienist for other options and ideas. Flossing is great for keeping healthy patients healthy, but it is not the only effective oral hygiene aid that works. Many people with more advanced bone loss will benefit from an oral irrigator or other aids, such as small pointed bushes or toothpicks that, with proper instruction, can clean between teeth more effectively. Your hygienist can be a big source of education and options on these issues.

Common Culprits

The good news about gum disease is that it’s controllable once a patient is treated and he or she engages in an effective homecare routine. What’s unfortunate is that, to some degree, it’s contagious. Before you share a straw with your spouse or take a bite of your child’s pizza, consider this: If one member of the family has untreated gum disease, the rest of the family can be at risk. “Bacteria can travel back and forth,” cautions Fink. “Patients need to understand that cavities and periodontal disease can spread between family members. Bacteria that cause cavities are usually first introduced to a young child through the feeding process.” The family dog isn’t an innocent party, either. Dogs are commonly affected by periodontal disease, says Fink (check it out with your vet).

Even if you’re not sharing your food and you don’t have a dog licking your kids’ faces, the medications you’re taking can be solving one health problem while contributing to another. Both prescription and over the counter medications can cause dryness in the mouth that makes it even easier for cavities and gum disease to form.

Super Smiles

Regardless of the cause of cavities or gum disease, early detection and consistent treatment are crucial for optimal health. A super smile can lend itself to self-confidence. “From a psychological point of view, if you look good, you feel good,” says Fuchs. “While most people are quick to smile, some people talk with their hands in front of their faces because they don’t want people looking at their teeth. We can help people with that! People have never lived this long, and they certainly have never lived this long and had teeth. Today, we’re helping people keep their teeth for a lifetime. It’s a very rewarding experience!”