Nil by mouth: Opening up to oral hygiene

SAY cheese. But just remember that when you bare those pearly whites to the world, you might actually be revealing more than you would like. That's because the mouth is increasingly seen as a window to our general health. Open wide and you don't just flash your fillings and that missing molar at the back that you never quite got round to replacing. You could be indicating the first signs of anything from pneumonia and meningitis to mouth cancer.

“The impact of poor oral hygiene is often underestimated," says the British Dental Foundation's chief executive, Dr Nigel Carter, “and someone’s poor oral health can be a precursor to a number of serious health issues such as stroke, coronary heart disease, diabetes and low-birth-weight babies."

The evidence as to why all this might be the case is still a little patchy, says Edinburgh dental surgeon David Offord, though it is thought to have something to do with the bucketloads of bacteria swimming around in our mouths on a daily basis. Most of them are completely harmless and can be kept that way through the body's natural defenses and good oral hygiene.

But when gum disease enters the equation, or medication or some other treatment reduces saliva flow, the normal balance is thrown out of kilter, making it easier for bacteria to enter the bloodstream. “Gum disease, or what they call periodontal disease, has been linked with a number of systemic conditions," explains Offord. “If, for instance, diabetes or arthritis is poorly controlled and the patient happens to have, concurrently, poorly controlled gum disease, if they get the gum disease under control their arthritis or diabetes may become more controlled."

Scientists also recently linked oral health to a complaint called endocarditis, inflammation of the inner lining of the heart. A study in Bristol found that if the bacteria in plaque enters the bloodstream, it can cause life-threatening clots around the heart, with elderly people particularly at risk.

Another common condition is angular cheilitis, an inflammation at the corner of the mouth. “This would suggest an iron deficiency, something that would require a blood test," says Offord. “Also, a dry mouth can be related to medication – taking lots of tablets. And oral ulceration reflects stress."

Add to this the fact that early tooth-loss is being considered a risk factor for Alzheimer's and osteoporosis, and it would seem there's an awful lot of activity going on in our gobs. So it might surprise you to know that around 80 per cent of us probably have periodontal disease and don't even know it. “The difficulty is it can be asymptomatic," says Offord. “You might have bad breath or bleeding gums and not realise there's a problem."

Look out, too, for a change in taste or smell, which could also indictate that something's not right. Leave it too long, and the very least that could happen is a wobbly tooth, followed swiftly by a missing tooth.

“The thing is, gum disease starts with poor hygeine, so it's quite preventable. Make sure you have regular visits to the dentist or hygeinist and a proper cleaning regime. Some people may have a predisposition to gum disease and would need to have a much more intensive routine."

In case you needed clarification, ‘regular' visits means twice a year, or once if you have a low-maintenance mouth. A ‘proper' cleaning regime means brushing for two minutes twice a day, with a fluoride toothpase, and – yes – flossing.

Refreshingly, Offord admits that, like many, he too is a reluctant flosser. “It's quite Marmite," he says.

“The good news for people who find flossing difficult is water jets, which shoot water between the teeth at high pressure. They do the same job as flossing and are great for removing debris from between the teeth."

Sugary snacks should be kept to a minimum, he adds, and look out for those pesky hidden sugars in food and drinks. But the biggest bad guys in his sights are alcohol and cigarettes. “Smoking and excessive alcohol affect the lining of the mouth and eventually lead to cancer," says Offord. “In general health terms, smoking can be fingered as an issue in particular around periodontal disease. Even smoking one a day inhibits bloodflow to the peripheries. And reduced bloodflow means reduced ability to heal."

In fact, a recent report in the Journal of Clinical Periodontology found heavy drinkers and smokers were three times more likely to develop oral health problems that could lead to chronic illnesses. Excessive alcohol consumption, in particular, can increase the risk of mouth cancer by up to four times. "The growing body of evidence suggests what we once thought were safe alcohol consumption levels are, in fact, not so," says Carter, “particularly if it’s compounded by smoking.

“Even those who don’t drink or are occasional drinkers are susceptible to health problems. The crucial thing to remember is, with a good oral hygiene routine, dental problems can be prevented and kept at bay. Developing a good routine and sticking to it will also help to stave off a whole range of health problems, so there is no excuse for poor oral hygiene."