Oral Health

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Oral health goes far beyond having sound white teeth and no cavities. According to the first ever U.S. Surgeon General's Report on Oral Health, published in 2000, the mouth (including the gums, teeth and jawbone) is a "mirror for general health and well-being."

Major oral health issues of concern to women include gum disease, dry mouth, canker sores, tooth loss and tooth decay. Researchers also have found that people with periodontal disease (gum disease) are almost twice as likely to suffer from coronary artery disease and have an increased risk of stroke, diabetes and respiratory problems. Recent studies indicate that periodontal disease and cardiovascular diseases may be associated because many older people have both, but no evidence has been found that gum disease causes heart disease. More research is needed to explain any connections between periodontal disease and other health problems, but the link suggests the importance of taking care of your teeth and gums.

A significant association between obesity and prevalence of periodontal disease, especially among individuals aged 18 to 34 years, has also been established. Low dietary intake of calcium and vitamin C are cited as probable causes.

In recent years, there has been an increase in female smokers. A significant association exists between smoking and periodontal disease and oral infections. Smoking decreases the blood supply to the oral tissues, making the teeth more susceptible to gum disease, and more importantly, oral cancer.

Women's oral health care needs change at specific times during the lifespan, such as during puberty, menstruation, pregnancy and menopause. Nearly one out of four women between the ages of 30 and 54 has periodontitis (an advanced state of gum disease in which the bone and gum tissue that support the teeth are breaking down). In addition, nearly half of women ages 55 to 90, who still have their teeth, have periodontitis.

Because gum disease is usually painless, many women may not realize they have it until it reaches an advanced state (one of the warning signs is persistent bad breath or a bad taste in the mouth). At that time, teeth may become loose and need to be extracted.

The basic principles of good oral health are quite simple and take just a few minutes each day. Brush, floss and use a tongue scraper daily; see your dentist and dental hygienist regularly; and limit snacks between meals. When your mouth and teeth are disease-free, your risks for developing other diseases throughout your life may be reduced. Don't make caring for your teeth and gums the last thing on your health to-do list.

Gum disease, a bacterial infection of tissues that support our teeth, affects three out of four adults over the age of 35. It is a major cause of tooth loss in adults, especially older Americans. According to the U.S. Centers for Disease Control and Prevention, one-fourth of adults over age 65 have lost all of their teeth because of cavities and gum disease. The main cause of gum disease is bacteria, which is found in plaque. Plaque is a sticky colorless film that constantly forms on your teeth and tongue. Daily brushing, flossing, tongue scraping and other forms of interdental cleaning remove plaque.

The bacteria in plaque produce toxins, which trigger an immune response, and the body releases chemicals to wall off and kill the bacteria. The chemicals produced by the body (inflammatory cytokines) cause the symptoms of gum disease. In the earliest stage of gum disease, the bacterial toxins and inflammatory cytokines cause gingivitis—a condition in which gums swell, turn red and bleed easily. Left untreated, periodontitis can develop. Periodontitis is advanced gum disease. As plaque and calculus (tartar) continue to build up, pockets form between the teeth and gums. The gums may begin to recede (pull down on lower jaw or up on the upper jaw) on the teeth. With advanced periodontitis, the periodontal pockets get deeper and the gums may recede farther. The disease destroys more gum tissue and progresses to the bone. At this late stage of gum disease, teeth (even healthy teeth) can become loose, fall out or have to be extracted by a dentist.

Evidence is significant that people with periodontal disease may be more at risk for heart disease and may have nearly twice the risk of having a fatal heart attack as people without periodontal disease. Although the reason for the increased risk is uncertain, the latest research indicates the association is related to the fact that both periodontal disease and heart disease are chronic diseases that take many years to develop, so they both occur in older people. Their severity may also be linked to poor nutrition, smoking and poor health. Additionally, it may be that people who take care of their teeth also take care of other health issues.

Periodontal disease may contribute to heart disease because bacteria traveling from the mouth into the bloodstream may lodge in the blood vessel walls, triggering inflammation and causing the walls to thicken. A thickened blood vessel wall can increase a person's risk of heart disease, especially heart attack. As a result, patients who have untreated gum disease have a greater risk of heart disease than patients who don't have gum disease.

Another possibility is that periodontal bacteria enters the bloodstream and causes blood clots that contribute to clogged arteries. The bacteria may also cause the blood to become thicker.

In addition to heart disease, women have special oral health needs during certain phases of their lives, such as puberty, menstruation, pregnancy and menopause. At these times, women need to be proactive with their dentist and dental hygienist and bring up general health issues for discussion. For example, if you are pregnant or are contemplating pregnancy, it's important to treat any areas of oral infection so they won't interfere with your baby's fetal development.

The fluctuations of female sex hormones at various stages in a woman's life cause an exaggerated response by the gums to plaque. Bacteria in plaque are the cause of gum disease. During these times, women need to be extra vigilant about brushing and flossing every day to prevent gum disease. Below is some specific information on what happens at each stage:

• Menstruation: Just prior to or during menstruation, some women find their gums swell and bleed. Others develop cold sores and canker sores. In addition, some women find it takes longer to stop bleeding after oral surgery. The symptoms usually go away once your period starts.

• Pregnancy: Up to 75 percent of all pregnant women have gingivitis. During pregnancy, hormonal changes make your mouth more susceptible to gingivitis. Pregnancy-related gingivitis usually increases in the second trimester. During this time, some women may notice swelling, bleeding, redness or tenderness in the gum tissue. They may also have halitosis (bad breath) from the increase in hormones from the pregnancy.

• Oral contraceptives: One of the most common problems in women who take oral contraceptives is hormonal gingivitis. The inflamed gums become swollen, red and bleed easily. The hormone progesterone in oral contraceptives can make your gum tissue more sensitive to irritants in the mouth, such as food or plaque. If you are having symptoms of gingivitis and take the pill, tell your dentist, not only because it may be causing your gum inflammation, but also because an antibiotic prescribed by your dentist may interfere with the effectiveness of the contraceptive, although this is theoretical and no case reports have been found. Other methods of birth control are advised while taking the antibiotic.

• Menopause: This normal transition, usually around the age of 50, marks the time in a woman's life when she stops menstruating. It can also signal the beginning of changes in her mouth, such as oral pain or discomfort, red or inflamed gums, burning sensations, altered taste sensations (salty, metallic, peppery, sour), dry mouth (xerostomia) and oral bone loss. The changes associated with menopause may be due to hormonal changes, calcium and vitamin deficiencies, various medical conditions and medications.

• Osteoporosis: This condition is characterized by decreasing bone mass and density. Osteoporosis causes about 1.5 million bone fractures each year, with most of those affected being women. A number of studies have suggested a link between osteoporosis and bone loss in the jaw. Researchers suspect it may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation. Osteoporosis, when combined with the bacterial infection of gum disease, speeds up the process of bone loss around the tooth, which increases your risk of tooth loss. Recently, there have been concerns about the increase of dead bone forming in the mouth in people taking Fosamax, an anti-osteoporosis medication. New research shows that this is only important in patients who are receiving intravenous Fosamax as part of the chemotherapy regimen for cancer. There are no problems with patients who are taking oral Fosamax and receiving dental care or surgery.