By Linda Rosenbaum
Most Canadians know that maintaining good oral hygiene keeps teeth free from cavities and prevents gum disease. But they get failing grades on proper brushing and flossing, and poor daily practices not only wreak havoc in the mouth, they may also contribute to heart disease and stroke, pneumonia and low-birth weight babies.
Whether it’s cavities, gum disease (gingivitis) or the possibility of heart disease, “the culprit is inflammation caused by bacteria,” says Dr. Bruce Ward, Vancouver dentist and past-president of the B.C. Dental Association. “Inflamed gums are the body’s response to irritation from not cleaning. Evidence is telling us that better oral hygiene and less inflammation leads to better overall health.”
To rid our mouths of bacteria, we have to brush and floss correctly. That’s not what most of us are doing. “I bet 30% of my patients floss regularly, 20% occasionally, and the rest do it right before they walk in the door,” Ward says. Flossing is essential, he adds, “because “80% of decay happens between our teeth. The only thing that helps that is flossing.”
Dr. Barry Dolman, Montreal dentist and president of the Ordre des dentists du Québec, has similar concerns. “I tell my patients ‘floss is free.’ You don’t need an appointment, parking spot or membership to a gym.”
He’s concerned about incorrect brushing, too. “Most of my patients don’t reach at least 40% of their teeth when brushing,” he says. “Of the 28 teeth in their mouth, 11 never get touched.” As for the ones they do brush? “They’ll be lucky to hit three out of the five sides of each tooth.” Areas most commonly missed are the inside of lower molars and outside of upper molars.
Our mouths are teeming with bacteria — most of them harmless. Normally, brushing, flossing and the body’s natural defences keep them in check. But with poor oral care, certain bacteria lead to tooth decay, gingivitis on the gums, and periodontitis, progressive loss of bone around the teeth.
Jaclyn Gieni, a Vancouver dental hygienist, uses a “disclosing solution” to teach her patients to brush correctly. She applies a vegetable-based solution to their teeth with a cotton swab, and if there is plaque present, the area turns pink. “Because of the colour, they see spots they’ve missed while brushing.” She then teaches them how to reach these areas and get the plaque off.
But Gieni says even the best brushers and scrapers in the world still get tartar, hardened deposits that develop when plaque isn’t removed. That’s why she recommends regular visits to a dental hygienist for professional cleaning. “Depending on the condition of your teeth and gums, at least twice a year,” she says. “You can reverse gingivitis, but not periodontal disease. If you’ve lost bone attachment to your teeth, you can’t get it back.”
An increasingly large body of evidence is showing that bacteria left in the mouth don’t stay in the mouth. “We know that if you have gum disease, you have higher levels of bacteria in your mouth, which means bleeding,” Dolman says. “And because of the bleeding, you’re sending bacteria into your circulatory system, and from there, other systems.”
Studies show that bacteria from the mouth found in the lungs can cause pneumonia and bronchitis. Other oral bacteria have been detected in significantly damaged atherosclerotic arteries, a precursor to strokes and heart attacks. And in a study of more than 100 women with periodontal disease who were either pregnant or had recently given birth, they were seven times more likely to deliver a premature, low-birth weight baby than those with healthy gums.
By way of comparison, combined alcohol use and smoking during pregnancy increases the probability of premature births 2.5 times.
Considering the complications from poor oral hygiene, dentists and oral hygienists agree prevention is essential.
“When people have good routines,” Ward says, “it really makes a difference. Less bleeding, less pain, less inflammation, less redness, less disease.”
That’s the message he tries to instill in his patients. “I’ve been told if you do something for 30 days it becomes a habit,” he adds. “The odds are good that if I can get them to stick with it for that long, they’ll stick with it forever.”