The Mouth as Early Warning System
Problems in the mouth can signal trouble in other parts of the body. AIDS and osteoporosis are examples.

• Mouth lesions and other oral conditions may be the first sign of HIV infection, and are used to determine the stage of infection and to follow its progression to AIDS.
 
• Studies in post-menopausal women suggest that bone loss in the lower jaw may be related to the skeletal bone loss seen in osteoporosis.

Saliva As a Diagnostic Tool
Saliva, like blood and urine, can be used to detect and measure many compounds in the body. Saliva collection has the advantage of being noninvasive.

• Many medications as well as alcohol, nicotine, cocaine, opiates, and other drugs can be detected and measured in saliva. Hormones and environmental toxins can also be measured in saliva.
 
• Saliva can be used to detect antibodies against viruses such as HIV and hepatitis A and B, as well as antibodies against bacteria like Helicobacter pylori, which causes peptic ulcers.
 
• Saliva could potentially replace blood testing for diagnosis and monitoring of diseases such as diabetes, Parkinson’s disease, alcoholic cirrhosis, and many infectious diseases.

The Mouth As Source of Infection
The human mouth is home to millions of microorganisms, most of them harmless. Under certain conditions, however, some can cause oral infections such as tooth decay or gum disease. Oral bacteria may also enter the bloodstream if normal protective barriers in the mouth are breached. This can happen as a result of dental treatment or even tooth brushing and flossing.

In people with healthy immune systems, the influx of oral bacteria into the bloodstream is harmless. If the immune system is weakened by disease or medical treatments, however, oral bacteria can cause infection in other parts of the body. Infective endocarditis and oral complications of cancer treatments are examples.

• Infective endocarditis results when oral bacteria enter the bloodstream and stick to the lining of diseased heart valves.
 
• Harsh cancer treatments that damage mouth tissues can open the door to debilitating oral infections as well as systemic infections resulting from the spread of oral microorganisms. Besides cancer patients, others at increased risk for general infections caused by oral bacteria include hospitalized patients unable to practice oral hygiene, patients taking medications that reduce saliva flow, and those taking antibiotics that alter the balance of microorganisms in the mouth.

Oral Infections As Risk Factors
Recent studies point to associations between oral infections – primarily gum infections – and diabetes; heart disease; stroke; and preterm, low-weight births. To date, there is not enough evidence to conclude that oral infections cause these serious health problems. Research is under way to determine if the associations are causal or coincidental.

• Gum infections have been called "the sixth complication of diabetes," because people with diabetes are more likely to have periodontal disease. Researchers are exploring a possible two-way connection between the conditions to see if treating gum disease improves diabetic control.
 
• Recent studies point to an increased risk of heart disease and stroke in people with gum infections; the risk increases with the severity of the oral infection. However, there is not yet enough evidence to establish oral infection as an independent risk factor for heart disease or stroke.
 
• Some studies have found that mothers of preterm, low birth weight infants tend to have more severe gum disease than mothers of normal birth weight babies. More research is needed to determine if gum infections do indeed contribute to babies being born too soon and too small.

Periodontal diseases are infections of the gums and bone that surround and support the teeth. In its early stage, called gingivitis, the gums can become swollen and red, and they may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or even fall out. Periodontal disease is mostly seen in adults. Periodontal disease and tooth decay are the two biggest threats to dental health.

Causes
Bacteria in the mouth infect tissue surrounding the tooth, causing inflammation around the tooth leading to periodontal disease. When bacteria stay on the teeth long enough, they form a film called plaque, which eventually hardens to tartar, also called calculus. Tartar build-up can spread below the gum line, which makes the teeth harder to clean. Then, only a dental health professional can remove the tartar and stop the periodontal disease process.

Warning signs
The following are warning signs of periodontal disease:
• Bad breath or bad taste that won't go away
• Red or swollen gums
• Tender or bleeding gums
• Painful chewing
• Loose teeth
• Sensitive teeth
• Gums that have pulled away from your teeth
• Any change in the way your teeth fit together when you bite
• Any change in the fit of partial dentures

Risk factors
Certain factors increase the risk for periodontal disease:
• Smoking
• Diabetes
• Poor oral hygiene
• Stress
• Heredity
• Crooked teeth
• Underlying immuno-deficiencies—e.g., AIDS
• Fillings that have become defective
• Taking medications that cause dry mouth
• Bridges that no longer fit properly
• Female hormonal changes, such as with pregnancy or the use of oral contraceptives

Prevention and treatment
Gingivitis can be controlled and treated with good oral hygiene and regular professional cleaning. More severe forms of periodontal disease can also be treated successfully but may require more extensive treatment. Such treatment might include deep cleaning of the tooth root surfaces below the gums, medications prescribed to take by mouth or placed directly under the gums, and sometimes corrective surgery.
To help prevent or control periodontal diseases, it is important to:
1. Brush and floss every day to remove the bacteria that cause gum disease.
2. See a dentist at least once a year for checkups, or more frequently if you have any of the warning signs or risk factors mentioned above.

 

Oral Cancer
Each year, more than 30,000 new cases of cancer of the oral cavity and pharynx are diagnosed and over 8,000 deaths due to oral cancer occur. The 5-year survival rate for these cancers is only about 50 percent. Mortality from oral cancer is nearly twice as high in some minorities (especially black males) as it is in whites. Methods used to treat oral cancers (surgery, radiation, and chemotherapy) are disfiguring and costly. Preventing high risk behaviors, that include cigarette, cigar or pipe smoking, use of smokeless tobacco, and excessive use of alcohol are critical in preventing oral cancers. Early detection is key to increasing the survival rate for these cancers.

Risk Factors Oral Cancer: Deadly to Ignore

Those who chew tobacco are at high risk for gum and cheek lesions that can lead to cancer. Alcohol consumption is another risk factor. Combinations of tobacco and alcohol are believed to represent substantially greater risk factors than either substance consumed alone. Other factors that can place a person at risk for these cancers are viral infections, immunodeficiencies, poor nutrition, exposure to ultraviolet light (a major cause of cancer to the lips), and certain occupational exposures.

Oral cancer accounts for two to four percent of all cancers diagnosed annually in the United States, but relative survival rates are among the lowest of major cancers. Only one-half the number of persons diagnosed with oral cancer are alive five years after the diagnosis. In contrast to other cancers (e.g. breast, colorectal, and prostate cancers) the overall U.S. survival rate from oral and pharyngeal cancer has not improved during the past 16 years. Survival rates for oral cancer in minorities have decreased.

 

Incidence of oral cancer varies greatly throughout the world. In western countries, such as the United States, England or Wales, oral cancer accounts for two to five percent of all cancers. These numbers are low compared with a 40 percent prevalence in Sri Lanka and 50 percent in India. Southeast Asian persons also have a high frequency of oral cancer.

Oral cancer today occurs twice as often in males as in females. This is considerably different from the 5:1 male to female ratio of forty years ago. Increased tobacco use among women is the main reason for the change in cancer rates compared with rates in the 1950s. Age is also a factor--95 percent of oral cancers occur among persons over the age of 40 and 60 being the average age at diagnosis.

Signs and Symptoms of Oral Cancer
• a mouth sore that fails to heal or that bleeds easily
• a white or red patch in the mouth that will not go away
• a lump, thickening or soreness in the mouth, throat, or tongue
• difficulty chewing or swallowing food.

Most early signs of oral cancer are painless and are difficult to detect without a thorough head and neck examination by a dental or medical professional.
Oral cavity and pharyngeal cancers occur on anatomic sites that lend themselves to early diagnosis and treatment. Detection of oral cancer through periodic medical and dental examinations can significantly reduce the risk of these life-threatening cancers.

Tooth decay (dental caries) affects children in the United States more than any other chronic infectious disease. Untreated tooth decay causes pain and infections that may lead to problems; such as eating, speaking, playing, and learning.
The good news is that tooth decay and other oral diseases that can affect children are preventable. The combination of dental sealants and fluoride has the potential to nearly eliminate tooth decay in school-age children.

Here are some things you can do to ensure good oral health for your child:
• Encourage your children to eat regular nutritious meals and avoid frequent between-meal snacking.
• Protect your child’s teeth with fluoride: 
 -Use a fluoride toothpaste. If your child is less than 7 years old, put only a pea-sized amount on their toothbrush.
 -If your drinking water is not fluoridated, talk to a dentist or physician about the best way to protect your child’s teeth.
• Talk to your child’s dentist about dental sealants. They protect teeth from decay.
• If you are pregnant, get prenatal care and eat a healthy diet. The diet should include folic acid to prevent birth defects of the brain and spinal cord and possibly cleft lip/palate.

 

There are threats to oral health across the lifespan. Nearly one-third of all adults in the United States have untreated tooth decay. One in seven adults aged 35 to 44 years has gum disease; this increases to one in every four adults aged 65 years and older. In addition, nearly a quarter of all adults have experienced some facial pain in the past six months. Oral cancers are most common in older adults, particularly those over 55 years who smoke and are heavy drinkers.

Oral Health for Older Americans

December 2006—Older Americans make up a growing percentage of the U.S. population; according to the 2000 U.S. Census, nearly 35 million are 65 years or older. By 2050, that number is expected to increase to 48 million. Oral diseases and conditions are common among these Americans who grew up without the benefit of community water fluoridation and other fluoride products.
Older Americans with the poorest oral health are those who are economically disadvantaged, lack insurance, and are members of racial and ethnic minorities. Being disabled, homebound, or institutionalized also increases the risk of poor oral health.

Many older Americans do not have dental insurance. Often these benefits are lost when they retire. The situation may be worse for older women, who generally have lower incomes and may never have had dental insurance.
Medicaid, the jointly-funded Federal-State health insurance program for certain low-income and needy people, funds dental care for low income and disabled elderly in some states, but reimbursements for this care are low. Medicare, which provides health insurance for people over age 65 and people with certain illnesses and disabilities, was not designed to provide routine dental care.

About 25 percent of adults 60 years old and older no longer have any natural teeth. Interestingly, toothlessness varies greatly by state. Roughly 42 percent of Americans over age 65 living in West Virginia are toothless, compared to only 13 percent of those living in California. Having missing teeth can affect nutrition, since people without teeth often prefer soft, easily chewed foods. Because dentures are not as efficient for chewing food as natural teeth, denture wearers also may choose soft foods and avoid fresh fruits and vegetables.

Periodontal (gum) disease or tooth decay (cavities) are the most frequent causes of tooth loss. Older Americans continue to experience dental decay on the crowns of teeth (coronal caries) and on tooth roots (because of gum recession). In fact, older adults may have new tooth decay at higher rates than children.
Severity of periodontal (gum) disease increases with age. About 23 percent of 65- to 74-year-olds have severe disease, which is measured by 6mm loss of attachment of the tooth to the adjacent gum tissue. At all ages men are more likely than women to have more severe disease. At all ages, people at the lowest socioeconomic level have the most severe periodontal disease.

Oral and pharyngeal cancers, which are diagnosed in some 31,000 Americans each year, result in about 7,400 deaths each year. These cancers are primarily diagnosed in the elderly. Prognosis is poor. The five-year survival rate for white patients is 56 percent and for African American patients is only 34 percent.

Most older Americans take both prescription and over-the-counter drugs. Over 400 commonly used medications can be the cause of a dry mouth. Reduction of the flow of saliva increases the risk for oral disease, since saliva contains antimicrobial components as well as minerals that help rebuild tooth enamel attacked by decay-causing bacteria. Individuals in long-term care facilities—about 5 percent of the elderly—take an average of eight drugs each day.

Painful conditions that affect the facial nerves are more common among the elderly and can be severely debilitating. These conditions can affect mood, sleep, and oral-motor functions such as chewing and swallowing. Neurological diseases associated with age, such as Parkinson's disease, Alzheimer's disease, Huntington's disease, and stroke also affect oral sensory and motor functions, in addition to limiting the ability to care for oneself.

Tooth brushing with a fluoride toothpaste is a simple, widely recommended and widely practiced method of caring for one’s teeth. When done routinely and properly, tooth brushing can reduce the amount of plaque which contains the bacteria associated with gum disease and tooth decay, as well as provide the cavity-preventing benefits of fluoride.

To date, the Centers for Disease Control and Prevention is unaware of any adverse health effects directly related to toothbrush use, although people with bleeding disorders and those severely immuno-depressed may suffer trauma from tooth brushing and may need to seek alternate means of oral hygiene. The mouth is home to millions of microorganisms (germs). In removing plaque and other soft debris from the teeth, toothbrushes become contaminated with bacteria, blood, saliva, oral debris, and toothpaste. Because of this contamination, a common recommendation is to rinse one’s toothbrush thoroughly with tap water following brushing. Limited research has suggested that even after being rinsed visibly clean, toothbrushes can remain contaminated with potentially pathogenic organisms. In response to this, various means of cleaning, disinfecting or sterilizing toothbrushes between uses have been developed. To date, however, no published research data documents that brushing with a contaminated toothbrush has led to recontamination of a user’s mouth, oral infections, or other adverse health effects.

Recommended Toothbrush Care

• Do not share toothbrushes. The exchange of body fluids that such sharing would foster places toothbrush sharers at an increased risk for infections, a particularly important consideration for persons with compromised immune systems or infectious diseases.
 
• After brushing, rinse your toothbrush thoroughly with tap water to ensure the removal of toothpaste and debris, allow it to air-dry, and store it in an upright position. If multiple brushes are stored in the same holder, do not allow them to contact each other.
 
• It is not necessary to soak toothbrushes in disinfecting solutions or mouthwash. This practice actually may lead to cross-contamination of toothbrushes if the same disinfectant solution is used over a period of time or by multiple users.
 
• It is also unnecessary to use dishwashers, microwaves, or ultraviolet devices to disinfect toothbrushes. These measures may damage the toothbrush.
 
• Do not routinely cover toothbrushes or store them in closed containers. Such conditions (a humid environment) are more conducive to bacterial growth than the open air.
 
• Replace your toothbrush every 3-4 months, or sooner if the bristles appear worn or splayed. This recommendation of the American Dental Association is based on the expected wear of the toothbrush and its subsequent loss of mechanical effectiveness, not on its bacterial contamination.

A decision to purchase or use products for toothbrush disinfection requires careful consideration, as the scientific literature does not support this practice at the present time.