Save your smile - and health Dental care can prevent maladies of the mouth and beyond

Mary Beth Faller The Arizona Republic Mar. 21, 2006 12:00 AM

Teeming with bacteria from rotting food, it's a gateway to infection, inflammation and systemic disease.

It's your mouth. Ignore it at your own risk.

That risk may be greater than you realize. Skipping basic oral hygiene and dental checkups not only can lead to a dingy smile but to serious health problems.

When you were a child, your parents and your dentist probably warned about this slippery slope: If you don't brush, floss or get regular cleanings at the dentist, tartar - hard calcium deposits - builds up on the teeth. Plaque, a sticky film of bacteria, is drawn to the tartar.

Next comes tooth decay, in which the bacteria break down and produce acid, destroying tooth enamel.

Congratulations, you have a cavity.

Fortunately, cavities can be filled and the consequences usually end there.

But those same bad habits can also lead to gum disease, which has potentially more lasting damage, and possibly even to heart attacks or problems in pregnancy.

"Your blood cells don't like the bacteria, so they flock to the gums to fight it, engorging the gums," explains Steven M. Morales, a dentist in Phoenix. "Your body is trying to fight the bacteria because you're not getting it with your toothbrush or floss."

Those engorged gums are the beginnings of periodontal disease, which at that early stage is called gingivitis. Gums are puffy and bleed easily.

If only the soft gum tissue is inflamed, gingivitis usually can be reversed - with thorough brushing, flossing and a professional cleaning.

Left unchecked, the infection grows, with pockets forming deep inside the gums. The bacteria start to eat away at ligaments that connect the teeth to the bone and, eventually, the bone itself. Gums recede, teeth loosen and breath stinks.

"If the inflammation process has broken down the ligaments to the teeth, it's irreversible," Morales says. If the disease is severe, you can lose teeth. Even if there is no permanent damage, you may have to have your teeth cleaned every three to four months for life.

"It's all about timing," Morales says.

Avoiding the dentist "I had a serious reason for being afraid," says Kerry Dewey, 54, of Phoenix. "I had a lot of dentists who hurt me and a lot of dentists who told me I needed things done that were out of my range of comprehension for the time and money."

Dewey has always cared for her teeth, but she had to take medication that led to dry mouth, a serious condition that can damage teeth and gums. Her teeth were highly sensitive. Even getting them cleaned was excruciating, requiring nitrous oxide for her to get through it: "My heart would race, and I would be in such a state."

She went a few years without going to the dentist.

"It had gotten to the point where I thought, 'I'll let my teeth rot.' That's what my parents did. Then you get false teeth," Dewey says.

But she worried. She had read about the link between gum disease and heart attacks.

Over the past few years, researchers have been focusing on the connections between periodontal disease and cardiovascular disease, stroke, diabetes and problems in pregnancy.

The nature of the link is unclear. Researchers don't know whether to blame inflammation from the gum infection, bacteria entering the bloodstream or chemicals produced when the bacteria break down.

But lingering infection is dangerous.

"If you have an infection in your arm or your leg, a physician has to treat it," says Maureen Toal, a Phoenix dentist. "If someone has an infection in their oral cavity, the closest neighbor is the brain. How long do we want to have this unattended?"

Annie Jardine, 40, of Scottsdale, had a festering tooth infection for months.

"I'm a go-go-go person, and I had no energy, and that scared me to where I knew something was really wrong," she says. "I had pain to the point where it was in my jaw and into my ear. I felt horrible physically."

Jardine finally underwent a root canal by Toal, had crowns placed on several teeth and took antibiotics for several weeks.

Diabetes and periodontal disease appear to be a two-way street, with each disorder exacerbating the other. Studies have shown that treating gum disease can make diabetes easier to manage.

Pregnancy concerns "There's no conclusive evidence, but there are a lot of interesting theories out there," says Miles Hall, Cigna Dental's national dental director.

Several studies have shown a link between gum disease and preterm birth in pregnant women. Hall said one study of pregnant women with gum disease found that they had higher levels of a chemical similar to a drug given to induce labor.

A study just published in the February issue of the Journal of Periodontology found that chronic gum disease in pregnant women is also linked to preeclampsia, a serious disorder characterized by high blood pressure, as well as to low-birth-weight babies.

Hormonal changes can make a pregnant woman's gums become puffy and inflamed, causing them to trap bacteria. So pregnant women need to be extra vigilant about brushing, flossing and getting their teeth cleaned at the dentist.

If they have gum disease, treatment helps. Pregnant women who received periodontal cleanings had fewer preterm births than those who didn't, according to a 2005 study.

Facing her fears Dewey knew she needed to deal with her dental problems before it was too late. As the owner of Kerry's Referrals, an employee-placement service in Phoenix, she knew the value of a nice smile.

Her doctor recommended that she see Toal, whose dental practice specializes in work done under anesthesia.

Dewey needed a lot of work,, and she had it done under general anesthesia in a hospital.

"When I woke up, I expected to be in bad pain," she said. "How could you not? But I didn't need pain medication, and I could eat normally."

She returned a few weeks later to get permanent crowns, again while under anesthesia.

"Everyone constantly compliments me on how beautiful my teeth are. I can chew normally!" Dewey says.

She has since returned to her dentist - fearlessly.

Reach the reporter at marybeth or (602) 444-8167.

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