New Report Reveals How Our Mouths Are The Gateway To Our Health

Good oral health is essential to our health and wellbeing. Some of us follow thorough oral care regimes and visit the dentist regularly, while some of us are guilty of skipping routine check-ups or failing to follow thorough oral care regimes. However, a new report reviewing the dental state of the nation - Oral Care Matters: The Mouth - Our Body's Gateway highlights the urgent need for people to take care of their oral health. Increasingly a body of new scientific research is linking gum problems with other health conditions, including cardiovascular disease, heart attack, stroke and osteoporosis (i).

These latest findings are highlighted in a new report on oral health launched by the Simplyhealth Advisory Research Panel - ShARP - which is an independent body of experts set up to help communicate the latest studies and intelligence on a variety of important health areas. Simplyhealth - one of the UK's leading healthcare providers - has set up the innovative new information group.

Periodontal disease or gum disease affects the tissues that support the teeth (ii).  It's a worryingly common problem in the UK. Data shows that the vast majority of the adult population - 83% - show signs of gum disease, with the problem getting worse with age (iii). Despite 75% of adults (iii) brushing their teeth twice a day, two thirds of those examined had visible plaque on their teeth.

Periodontal disease is not just limited to bleeding gums or lost teeth. Studies have demonstrated an association between poor oral health and cardiovascular disease (iv). While it's not known exactly what the underlying mechanisms are, it's thought that gum inflammation might cause inflammatory effects elsewhere in the body, including the arteries (v). Researchers also think bacteria in periodontal pockets around the teeth could go on to circulate around the vascular system, where they play a part in the build-up of plaque in arteries. A number of clinical studies (vi) strongly suggest that there is a direct link between periodontal disease and cardiovascular disease.

Commenting on this latest research, Professor Seymour from ShARP notes:  "The value to the nation in early treatment and prevention of periodontal disease is potentially huge. The simple act of removing the inflammation in gum tissues can help reduce the risk of hypertension, coronary heart disease and stroke. That is why we are calling for the UK nation to start taking greater responsibility for their own oral health. This means following a thorough twice-daily five-minute oral care regime."

"In addition to this, the role of the dentist is pivotal. Providing basic periodontal screening (BPE) at least once a year as part of a co-ordinated and targeted national screening programme so that a thorough inspection of their periodontal tissues can be achieved is vital. Patients who suffer from osteoporosis should also undergo regular six-monthly dental inspections."

"It's clear from the ShARP's own survey that too many people simply don't take good enough care of their teeth. Diet choice is also hugely important, with evidence that foods rich in anti-oxidants and polyunsaturated fatty acids can significantly boost periodontal health. Dentists and oral healthcare professionals give dietary advice on preventing tooth decay, so they could similarly provide advice to patients on what to eat to help prevent periodontal disease."
"There is no doubt that periodontal disease represents a clear threat to public health. But with the appropriate action, including more thorough daily oral care regimes, national screening programmes and emphasising the need to maintain healthy gums, the nation's health could be dramatically improved."

Oral Care Matters: The Mouth - Our Body's Gateway
To find out more about the nation's oral health habits, research was commissioned on behalf of the Simplyhealth Advisory Research Panel to learn more about everyday dental care preferences, choices and even guilty secrets. A total of 2,000 people aged 25 to 65 across the UK were polled - 62% were female, 38% male.

Four out of 10 (39%) admitted they only brushed for between one and two minutes. Dentists recommend that people should brush their teeth for at least two minutes thoroughly, twice daily (vii). More than a quarter (28%) admitted going for two days or more without brushing - and more than one in 20 had gone for four days or longer without brushing. Nearly two thirds - 63% - admitted they had noticed blood in their spit after brushing their teeth - a symptom of gum disease. Nearly four out 10 (37%) said this was at least once a week, with 13% saying it was every day or almost every day. A quarter (25%) said they had bleeding gums once or twice a month.

Three quarters of those quizzed said they would aim to brush their teeth better and take better care of their dental health if they knew for certain that poor oral health was associated with serious health conditions. Nearly a quarter (22%) admitted they never cleaned between their teeth to remove bacteria and debris that a toothbrush can't reach. More than half (54%) said they did occasionally, and only 24% said they did it once a day.

The vast majority (92%) felt it was important to have regular check-ups at the dentist, however nearly a quarter (24%) admitted they hadn't visited a dentist in the last year for a check-up or any other work.
New Emerging Oral Care Problems:

Osteoporosis and periodontal disease

Another serious condition now thought to be linked with periodontal disease is osteoporosis - a loss of bone density, making bones more brittle and vulnerable to fractures. As many as one in three post-menopausal women over the age of 50 are thought to suffer from the problem (viii). Studies show that women with osteoporosis have fewer teeth than otherwise healthy people (ix, x). Similarly, oestrogen supplementation (xi) has been shown to reduce gum inflammation and periodontal tissue damage.

Dietary factors too have been researched for playing a part in oral health. Foods rich in antioxidants and polyunsaturated fatty acids - such as omega 3 - can have an anti-inflammatory action. Studies show that people with low levels of antioxidants have greater levels of periodontal disease and that when a patient's diet is supplemented with additional antioxidants, periodontal inflammation is reduced (xii).

(i) Bahekar AA, Singh s, Saha S, et al. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis. Am Heart J 2007, 154, 943-57; Bordic F, et al. Bone loss and teeth. Joint Bone Spine, 2005, 72, 215-21: Yoshihara A, et al. The relationship between bone mineral density and the number of remaining teeth in community dwelling older adults. J Oral Rehabilitation, 2005, 32, 735-40. Nicopoulou-Karayianni K, et al. Tooth loss and osteoporosis: the osteodent study. J Clin Periodontol, 2009, 36, 190-7.

(ii) The disease is caused by bacterial plaque, which if left undisturbed, will cause inflammation of these supporting tissues. If the inflammation is confined to the gingival tissues then this is known as gingivitis. When the inflammation spreads to other supporting structures then the condition is known as periodontitis. If left, then plaque triggers inflammation in the tissues which support the teeth, leading to bleeding gums and even lost teeth.

(iii) UK Adult Dental Health Survey (2009)

(iv) Bahekar AA, Singh s, Saha S, et al. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis. Am Heart J 2007, 154, 943-57.

(v) Taylor BA, Tolfer GH, Carey HM, et al. Full mouth tooth extraction lowers systemic inflammation and thrombotic markers of cardiovascular risk. J Dent 2006, 85, 74-8; The relatively small follow up period for the patients in these studies did not establish whether such a reduction in CRP levels was cardio-protective; Offenbacher S, Beck JD, Moss K, et al. results from the periodontitis and vascular event (PAVE) study: a pilot multi-centred, randomised control trial to study the effects of periodontal therapy in a secondary prevention model of cardiovascular disease. J Periodontol 2009, 80, 190-201. Amar S, Gokce N, Morgan S, et al. Periodontal disease is associated with brachial artery endothelial dysfunction and systemic inflammation. Arterioscer Thromb Vasc Biol 2003, 23, 1245-49.

(vi) Recognising the ability of mouth bacteria to cause unwanted blood clots; Professor Howard Jenkinson 2012; Bristol University

(vii) Practising dentist and periodontologist, Professor Robin Seymour

(viii) European Parliament Osteoporosis Interest group and EU Osteoporosis Consultation Panel, 2005. Osteoporosis in Europe: Indicators of Progress. Nyon, Switzerland, International Osteoporosis Foundation

(ix) Bordic F, et al. Bone loss and teeth. Joint Bone Spine, 2005, 72, 215-21: Yoshihara A, et al. The relationship between bone mineral density and the number of remaining teeth in community dwelling older adults. J Oral Rehabilitation, 2005, 32, 735-40.

(x) Nicopoulou-Karayianni K, et al. Tooth loss and osteoporosis: the osteodent study. J Clin Periodontol, 2009, 36, 190-7.

(xi) Reinhardt RA, et al. Influence of estrogen and osteopenia/osteoporosis on clinical parameters in postmenopausal women. J Periodontol, 1999, 70, 823-8; Miley DD, et al. Cross-sectional study of vitamin D and calcium supplementation; effects on chronic periodontitis. J Periodontol, 2009, 80, 1433-9

(xii) Chapple IL, Milward M, Dietrich T. The prevalence of inflammatory periodontitis is negatively associated with serum antioxidant concentration. J Nutr 2007, 137, 657-64

(xiii) CORDA, 2012.

(xiv) British Heart Foundation