To dream of losing a tooth supposedly indicates anxiety. While some may scoff at dream interpretations, the truth is we should be very worried about our oral health because it’s linked with serious, even deadly, disease.
Tooth decay is the most prevalent health problem in Australia but its lurking relative, periodontitis, may be silently wiping us out because of its links with heart disease, arthritis and other chronic illness.
The chronic inflammatory oral disease is now the fifth most prevalent health problem among Australians. It is so harmful that researchers in Melbourne are poised to start clinical trials into a vaccine to arrest the periodontitis problem plaguing the population.
One in five Australian adults may have a form of periodontitis. The British Medical Journal recently called periodontitis a major public health problem which affects almost half of adults in Britain, causing tooth loss, disability and poor nutritional status and impacting on quality of life.
“There’s a strong link between very poor oral health and poor general health – not just an epidemiological link but a plausible, biological link between periodontitis and systemic diseases such as cardiovascular disease, arthritis and oral cancer,” says Oral Health Cooperative Research Centre chief executive, University of Melbourne Laureate Professor Eric Reynolds.
Periodontitis is a slow-building, chronic disease in which dangerous bacteria embed themselves in plaque under the gum and attack the immune system, causing tooth loss. The bacteria can also enter the bloodstream, where it can snake around our bodies causing havoc.
The economic cost of oral disease is a “staggering” $8 billion, says Reynolds.
“We are only treating the tip of the iceberg with periodontitis because many people unfortunately think teeth are expendable,” Reynolds says.
“People need to know that oral disease is increasing their risk of heart attack, cancer, arthritis and other chronic inflammatory diseases.”
Researchers at the centre are working with a biotech company to begin clinical trials into a vaccine for periodontitis after identifying and targeting a destructive keystone pathogenic bacterium, Porphyromonas gingivalis.
P. gingivalis can cause blood clots once in the bloodstream and can trigger heart attacks in animals.
“We’ve shown in animal models that we can prevent P. gingivalis establishing and producing periodontitis, so we’re now scaling up for phase one clinical trials,” Reynolds says.
“The more I get to know about P. gingivalis, it’s a pathogen that I really don’t want in my mouth.”
While children are at low risk of periodontitis because it takes years to become entrenched, it can present as we approach adulthood and Reynolds urges people to teach their children to floss and don’t stop.
“If you do that every day, starting in childhood, these deep pockets may not develop and you won’t get periodontitis because it is a preventable disease. And when you realise it increases the risk of other diseases that can kill you, it’s really a practice that I suggest we should by teaching everyone to do at an early age.”
The Royal Australasian College of Physicians updated its position statement on oral health in children and young people last year with a call for more awareness among health practitioners to identify children in need of better oral health care. It also supports universal dental care for children.
Oral health appears to worsen as children reach the 15-24 age group, with 64.4 per cent of them experiencing some sort of tooth decay and 18.5 per cent of them missing at least one tooth as a result of dental disease, according to an Australian Institute of Health and Welfare report.
Associate Professor Sharon Goldfeld, who led the college statement with the support of the Royal Australasian College of Dental Surgeons, says the strongest predictor of adult dental disease is childhood dental disease.
‘‘We’re seeing a higher rate in disadvantaged children,” Goldfeld says.
“We’re seeing more caries in poorer children – fundamentally, for whatever reason, we cover the rest of the entire system except for teeth yet the burden of dental care is really quite substantial both for children and for adults. And there is very real connection to the rest of their health.”
Periodontitis or gingivitis?
Gingivitis starts when plaque builds up between teeth and gums. Gums can become red and swollen. Gingivitis is common because “you have to have really good oral hygiene to stop some plaque building up in between the teeth and the gums”, says Professor Eric Reynolds, of the Oral Health CRC. Brushing teeth and flossing daily is key to keeping it at bay.
Periodontitis builds up over many years due to poor oral hygiene and lack of regular effective flossing. People may not even experience pain after bacteria have built up in pockets between the gum and teeth as they become “long in the tooth”, or as the pockets deepen and allow nasty bacteria to embed and eventually cause bone and tooth loss by disrupting the immune system. “If you brush your gums and they bleed or they bleed when you eat, that’s a sign that you may have periodontal disease,” Reynolds says.