`Floss Or Die': Gum Disease Can Lead To More Than Tooth Loss

It was the "Floss or Die" poster that got to 54-year-old Jack Kelsch.

Kelsch works as a grants administrator at the Harvard School of Dental Medicine in Boston, where the perils of periodontal disease are water-cooler fare and "deep pockets" means gum disease, not money. But as he found, that poster was no joke.

Most people know gum disease can lead to tooth loss. But can it also lead to heart disease? Stroke? Death from all causes?

Yes, according to new evidence showing that infections in the mouth - notably periodontal disease in the "pockets" where the teeth meet the gums - can indeed have a major impact on health.

Luckily, this is offset by more upbeat news: A number of new treatments for periodontal disease have been approved by the U.S. Food and Drug Administration in recent months.

A bacterial beachhead

Periodontal disease is a serious problem for 29.6 million Americans, according to the American Academy of Periodontology. It all starts when bacteria take up residence in the gums around teeth. White blood cells then flock to the area to fight the infection, triggering inflammation.

At first, this results in gingivitis - swelling and redness of the gums. But when chronic inflammation destroys gums and bone around teeth, it's periodontitis.

Several years ago, North Carolina researchers showed that periodontal disease in pregnant women was associated with an increased risk of low-birth-weight babies.

In 1993, a study of 7,610 Americans published in the British Medical Journal showed that people with periodontal disease had a 25 percent higher risk of coronary heart disease and a 46 percent higher risk of death from all causes than those without gum disease.

Last summer, a study of more than 1,000 Boston men showed that those with the worst periodontal disease were twice as likely as those with the least to die of heart disease and three times as likely to suffer stroke, even when other factors such as smoking and cholesterol were accounted for.

In fact, the deeper the pockets of infection, the greater the risk of death from all causes, says the author of that study, Dr. Raul Garcia, director of the Veterans Affairs Dental Longitudinal Study at the Boston VA Outpatient Clinic.

Plaque on the walls

When bacteria from the periodontal pockets enter the bloodstream, they contribute to the formation of plaque on artery walls, which leads to clots that can cause heart attacks and strokes. Recent studies have documented oral bacteria in brain regions damaged by strokes and diseased coronary arteries.

Bacteria from the mouth can also cause infections elsewhere.

If your dentist or hygienist discovers that your pockets are deeper than 4 or 5 millimeters and you're losing bone around the teeth, you're a candidate for scaling and root planing. This is a deeper cleaning process than the one we're all supposed to have every six months. It involves scraping bacteria off tooth roots, under local anesthesia, and can take up to an hour for just one quadrant of the mouth.

If that doesn't do the trick, surgery is often required - opening the gums, cleaning bacteria from tooth roots and the jawbone, then stitching the gums together to reduce pockets.

Oral antibiotics might seem a logical answer, but they're not. They cause side effects and can create resistant strains of bacteria. But new ways of delivering antibiotics and other germ-killing drugs just to the gums, not the whole body, and a new understanding of the way some antibiotics work, do hold promise.

In recent years, periodontists have been using Actisite, a plastic fiber impregnated with antibiotics that is placed in the gums.

A newer approach is PerioChip, approved in May by the FDA. Inserted into pockets, it releases a bacteria-killing chemical, chlorhexidine, over a week. Yet another new local treatment is Atridox. Approved in September, this gel is injected into the pocket, where it releases an antibiotic, doxycycline, also over about a week. The latest remedy, Periostat, approved in November, is also based on doxycycline. It attacks a tissue-destroying substance pumped out by white blood cells, including those that flock to the gums.

Used alone, none of these treatments is likely to reverse periodontal disease, but used with existing treatments they should help. Prevention, of course, is also key: brushing, flossing and professional cleaning.

Remember the poster: "Floss or die." ------------------------------- Warning signs of periodontal disease

The American Dental Association and the American Academy of Periodontology recommend that you see your dentist if you have any of the following signs of periodontal disease. It is also possible to have periodontal disease without these signs:

-- Gums that bleed easily.

-- Red, swollen or tender gums.

-- Gums that have pulled away from the teeth.

-- Pus between the teeth and gums when the gums are pressed.

-- Persistent bad breath or bad taste.

-- Permanent teeth that are loose or separating.

-- Any change in the way your teeth fit together when you bite.

-- Any changes in the fit of partial dentures.

To keep teeth and gums healthy, you should:

-- Brush teeth twice a day.

-- Floss once a day.

-- Schedule regular dental checkups. - Judy Foreman, The Boston Globe

(Copyright 1999, United Feature Syndicate Inc.)