Flossing may protect heart

August 11, 2002

BY JIM RITTER, Staff Reporter at the Chicago Sun-Times Newspaper (Chicago, Illinois)

You know you're supposed to floss every day.

You know that regular flossing, along with brushing, keeps your gums healthy and can prevent your teeth from falling out. But you still don't do it.

So consider this: Flossing, according to a growing body of research, might be good for your entire body, not just your mouth. Although not yet definitive, studies are finding evidence that keeping gums healthy might help prevent heart attacks, strokes, premature births, diabetes complications and infections after joint-replacement surgeries.

Gum disease is an infection of the body "that throws things out of whack," said Dr. Ken Bueltmann, a Glenview periodontist and president of the American Academy of Periodontology. A periodontist is a dentist who specializes in periodontitis, a disease of the gum and underlying bone.

If you don't brush and floss, you're almost certain to get periodontal disease. It begins when bacteria in plaque, the colorless sticky film that forms on teeth, infects the gums. Untreated, plaque spreads below the gum line. Infected pockets form between the teeth and gums, destroying gum tissue and bone. Eventually, teeth loosen and must be pulled. Some people are genetically prone to periodontitis. Tobacco, stress and pregnancy also increase the risk.

The mouth is home to more than 200 kinds bacteria, and about a dozen types are involved in periodontal disease. Gum pockets store bacteria, and these germs, or their toxic byproducts, can be released to the bloodstream and wreak havoc throughout the body.

Premature births: According to various studies, pregnant women with periodontal disease are four to seven times more likely to give birth to low-weight, premature babies. The theory is that periodontal disease increases levels of fluids that induce labor.

Diabetes

Studies are remarkably consistent in showing that diabetics have a higher risk for periodontal disease than non-diabetics. Diabetic LeRoy Altosino of Niles, for example, has lost several teeth to the disease. He now flosses and brushes daily and gets treated by his periodontist every three months.

It's possible periodontal disease increases blood sugar, putting diabetics at increased risk for diabetic complications. However, the evidence is not conclusive.

Surgical infections

 Melanie Thillens of Buffalo Grove needed a hip replacement, but first her surgeon wanted to make sure that bacteria from her gums wouldn't infect the new joint. So before the operation, he sent her to the dentist for treatment of her periodontal disease.

It was good advice. The American Academy of Orthopaedic Surgeons says patients getting total replacements of hips and other joints "should be in good dental health prior to surgery and should be encouraged to seek professional dental care if necessary."

Heart attacks and strokes

One theory is that bacteria from the mouth flow through the bloodstream to the heart, where they attach to fatty deposits in arteries, contributing to clot formation.

Another possibility is that periodontal disease induces inflammation in the arteries, leading to clots.

Several earlier studies found that people with periodontal disease have a higher risk for heart disease.

But two recent studies found no significant link.

There's not enough evidence yet to list gum disease as a risk factor for heart attacks and strokes, said Dr. Robert Bonow, president of the American Heart Association and chief of cardiology at Northwestern Memorial Hospital.

Still, it doesn't hurt to floss.

"It's cheap, it's good for gums, and maybe it's good for the rest of your health, too," Bonow said.

The best way to prevent periodontal disease is to brush and floss daily and see a dentist twice a year, making sure the dentist checks your gums.

Flossing helps remove plaque from between teeth where toothbrushes can't reach. Those spaces account for about one-third of the surface of the teeth. Floss comes waxed and unwaxed, regular and flavored, thick or thin. Bueltmann's advice: use a brand that feels comfortable and doesn't shred.

But many people just won't do it.

"It's human nature," Bueltmann said. "Like diet and exercise. We know we should do it, but we don't."

It will take more definitive studies, including some under way, to confirm the effects of periodontal disease on the rest of the body.

In the meantime, "the prudent thing to do is to make sure your gums are healthy," Bueltmann said. "At a minimum, it will save your teeth."