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Your mouth can signal your overall health

POSTED: December 16, 2008 5:00 a.m.
For The Times/

Dr. R.D. Nickels, right, and his assistant, Veronica Chacon, work with a patient recently at the Good News Clinic. Researchers now are linking overall health to the condition of patients' teeth and gums.

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It has been said that the eyes are the windows to the soul. But is your mouth the window to the rest of your body?

Increasingly, researchers are discovering that the condition of your teeth and gums can be an indicator of your overall health.

For example, patients who have severe gum disease, or periodontitis, are much more likely to have a buildup of plaque in their arteries.

But it would be a leap of logic to say that if you don’t brush your teeth, you’ll have a heart attack. Scientists still are trying to explain the connection between the two diseases.

"We don’t know if it’s cause-and-effect, or if they stem from the same pathophysiological process," said Dr. Bernardine King, a cardiologist with the Gainesville Heart Group.

In other words, there could be a common factor that’s causing both problems.

But cardiologists long have known that gum disease can cause bacteria to get into the bloodstream, and sometimes those bacteria can get lodged in a defective heart valve. This is why people with heart defects usually have been advised to take preventive antibiotics before having a dental procedure.

King said she is intrigued by a growing body of research on the role of inflammation in heart disease. It turns out that a major cause of inflammation is chronic infection. King said it is certainly possible that ongoing gum disease could be putting people at risk for heart attacks.

This emerging research is beginning to break down the artificial barrier between doctors and dentists. The old view, held by both patients and health professionals, was that the teeth were separate from the rest of the body. Treatments performed on teeth were considered cosmetic and not related to the patient’s medical condition.

But King said most cardiologists no longer feel that way.

"When we treat the heart, we look at the whole patient (including the teeth)," she said.

And when a dentist has a concern about a patient’s health, doctors are more likely to listen.

"We do communicate with dentists as much as possible," said King.

Dr. Heather Perry, a periodontist in Gainesville, said progress has been made, but she would like to see more sharing of information between dentists and physicians.

"There’s not a lot of back and forth," she said.

One reason is that it’s difficult for the two professions to swap data; their record-keeping systems are not compatible.

But that may change at Good News Clinics. The free clinic in Gainesville is unique in that it offers needy patients both dental and medical care under one roof.

"At Good News, you have access in the same building (to physicians), so that makes referrals easier," said Dr. Richard Bennett, a Gainesville dentist who has a private practice and also volunteers at Good News.

Cheryl Christian, executive director of Good News Clinics, said this proximity will allow the clinic to try something no other local provider can do.

"We’re working with a group at Georgia Tech that’s working on a program that could import dental records into medical records," she said. "There’s currently no software like that."

Good News has another advantage: All services are free, so the clinic never has to deal with insurance companies.

Many people who do have insurance coverage have had to contend with sometimes ridiculous rules about what’s considered "medically necessary."

Most medical insurance policies won’t cover anything related to the teeth, so even if a patient has a severely abscessed tooth that could spread infection to other parts of the body if not treated, they may be denied coverage.

"Insurance companies almost see teeth as a luxury," said Perry.

But the teeth are connected to the body by blood vessels and nerves, just like any other part of the anatomy.

Bennett said he wishes the insurance industry would acknowledge this reality.

"Sometimes we see patients who don’t heal as well after a procedure, and we begin to think they may be diabetic," he said.

Studies have revealed a strong correlation between gum disease and diabetes.

"Often the severity of your periodontal disease is related to the severity of your diabetes," said Perry. "If you can control one, you can control the other."

Diabetic patients are susceptible to infections, so it may not be surprising that they would have a higher risk for gum disease. But new research has shown unexpected connections between oral health and other systemic conditions.

For instance, pregnant women who have gum disease are more likely to have low-birth-weight babies and to go into labor prematurely.

Again, Perry warns that poor oral health doesn’t necessarily cause these pregnancy complications. "It could be that both conditions are related to the patient just not taking good care of herself," she said.

Regardless of the cause, an astute doctor should take a look at their patient’s mouth. If the condition of the teeth indicates that the patient is probably not brushing, it’s likely that he or she has other health issues, such as smoking, poor diet or lack of exercise.

Perry believes a more holistic approach is gradually evolving, both in dentistry and medicine.

"I do think people are recognizing the connection," she said.



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