London - When we glance at our teeth in the mirror, most of us are thinking only of our appearance. But more important is to look at the state of our gums.
Gum disease - or peridontal disease as it’s known properly - affects around 80 percent of Britons at some point.
As well as bad breath and problems with your teeth, emerging research is now linking it to conditions ranging from heart disease to miscarriage and erectile dysfunction. Earlier this month it was revealed gum disease can even make it harder for women to conceive.
“Gum disease occurs when plaque - a jelly like film of bacteria - clings to the teeth and irritates the gums, resulting in inflammation,” explains Dr Nigel Carter, chief executive of the British Dental Health Foundation.
“The first sign is normally bleeding of the gums around one or more of the teeth, and often there are no more symptoms until years later when the teeth become wobbly and ultimately fall out as the inflammation eats at the ligaments attaching the teeth to the bones, and even the bone itself.”
The early stage of gum disease - when the gums are inflamed and bleeding - is known as gingivitis.
“Dentists will be able to spot the problem, as the gum colour changes from a healthy pink to a duller colour, but most people would not see this,” says Mr Carter.
Gum disease can affect anyone of any age, but is especially prevalent among the elderly, as they produce less saliva. This means bacteria find it easier to stick to the teeth. Smokers, diabetics and pregnant women are also at higher risk, and genetics can play a part.
The condition can be prevented by cleaning twice a day for two minutes each time. But a survey last month by the British Dental Health Foundation found that 47 percent of the UK population do not clean their teeth regularly.
Cleaning and flossing should be backed up by visits to the dentist every six to 12 months.
Once gum disease has set in, bacteria are able to enter the blood stream via blood vessels around the teeth and then travel around the body. This sets off a cascade of reactions, leading to inflammation and damage.
Here, we reveal the surprising effects this can have on your health...
DELAYED CONCEPTION
Researchers in Australia have discovered that if a woman has gum disease it will take on average two months longer for her to conceive, compared with a woman with healthy teeth and gums.
The theory is that the bacteria that cause gum disease might trigger inflammation in the lining of the womb, making it harder for a fertilised egg to implant here. Gum disease has an impact after conception, too. Studies have linked it to an increased risk of both premature birth and miscarriage.
Last year, a study carried out by the University of Pennsylvania followed 872 pregnant women, of whom 160 had gum disease. Among the pregnant women without gum disease, 7 percent gave birth before 35 weeks of pregnancy - compared with 23 percent among the women with gum disease.
And one study carried out at Guy”s and St Thomas’ Hospital in London in 2004 followed almost 4,000 pregnant women and found the worse the state of the teeth and gums, the higher the risk of them having a late miscarriage.
“It may be that the inflammation in the gums triggers the production of chemicals (such as prostaglandin) that stimulate birth,” says Mr Carter.
ARTHRITIS
Those with rheumatoid arthritis - an incurable condition which causes the joints to become hot and inflamed - are eight times more likely to have gum disease than otherwise- healthy people.
Researchers in Germany found the link after examining 57 patients with the condition.
The good news is that treating gum disease might improve the symptoms. A small study published in 2009 found that removing tartar and plaque helped reduce the symptoms, and that six weeks later patients had lower levels of a compound in their blood that acts as a marker for the severity of rheumatoid arthritis.
“Gum disease and the link to rheumatoid arthritis is a subject that is really gaining international attention,” says Dr Paola De Pablo, a rheumatologist at the University of Birmingham.
“We believe what happens is that the bacteria from the gums secrete proteins and these proteins prompt a response from the immune system which kick-starts the arthritis.”
BRONCHITIS
Earlier this year, a study in the Journal of Periodontology found a link between respiratory infections and gum disease.
The scientists studied 100 people who had been in hospital with a respiratory disease such as bronchitis and 100 people who had no history of respiratory disease, and examined their dental health. The group with the history of respiratory diseases had worse gum health than the control group.
It is thought the bacteria that gather in the pockets around the base of the teeth can be spread to the lungs in inhaled droplets, causing infections or making existing lung conditions worse.
ERECTILE DYSFUNCTION
Erectile dysfunction has also been linked to poor gum health. Earlier this year, Indian researchers reported that the worse the gum disease, the worse the erectile problem.
Their study, published in the Journal of Periodontology, involved 70 men.
Other research has suggested that gum disease may hinder production of a chemical called nitric oxide, which relaxes blood vessels and increases blood flow to the penis. The researchers think inflammation produced by gum disease may reduce nitric oxide levels.
DEMENTIA
Studies have hinted that gum disease may contribute to the risk of dementia.
Two years ago, researchers from the University of Columbia tested a group of men and women over 60 and found that those with diseased, receding gums and loose teeth were more likely to struggle with memory exercises.
“There have been a few studies linking poor dental health to an increased risk of dementia,” says Clive Ballard, a professor of age-related diseases at King’s College, London. “Colleagues of mine are investigating this further and the theory is that untreated gum disease may kick-start the inflammatory process in the brain that leads to the production of amyloid plaque [a form of protein that attacks the brain cells].”
HEART DISEASE
Having gum disease doubles your chance of developing coronary disease. Indeed, last year a Scottish study of 11,000 people found that simply brushing your teeth less than twice a day increases your risk of having heart disease.
Until recently it was suspected that when the gums became inflamed, bacteria leaked into the blood stream and caused inflammation and damage in the blood vessels leading to cardiovascular disease. “This has been the theory but it is not yet proven,” says John Cleland, a professor of cardiology at Hull University.
It is thought that bacteria directly cause infection in the valves of the heart.
“If we are sending a patient for surgery to their valves, we will have any gum disease treated first to reduce the risk of subsequent infection,” adds Professor Cleland.
DIABETES
Gum disease can increase the symptoms of type 2 diabetes.
Last year, researchers from Edinburgh University reviewed seven previous studies and concluded that treating gum disease and reducing the inflammation around the teeth helped reduce the complications of the condition, such as eye problems.
It is thought the inflammation in the mouth leads to chemical changes that make insulin (which mops up excess sugar from the blood) less effective than normal.
Treating the gum disease therefore helps bring blood sugar levels back to normal and stops the risk of long-term complications. - Daily Mail