http://www.azcentral.com/arizonarepublic/arizonaliving/articles/1229gums.html Gums provide picture of overall health, studies say Julie Sevrens Lyons San Jose Mercury News Dec. 29, 2003 12:00 AM SAN JOSE - Got floss? If you don't, or if you rarely use the dental aid between your teeth, you might want to rethink your commitment to oral health. Having immaculate spaces between your molars and bicuspids isn't as sexy as bleaching them a pearly white, but it has far greater implications for your overall health, doctors believe. While it long has been known that gum disease can lead to tooth loss if left untreated, researchers point to a growing body of evidence that inflammation below the gum line may be associated with more insidious and far-reaching health effects. Studies increasingly suggest that gum problems may contribute to heart disease and stroke, exacerbate diabetes and spur pre-term labor in pregnant women. Unhealthy gums also may be a sign of broader systemic illnesses, such as diabetes. Scientists suspect they've only just begun to discover what health problems might be linked to gum disease. "What's going on in the mouth can be a mirror for what's going on systemically," said Sally Cram, a consumer adviser for the American Dental Association. Common ailment Turns out, tooth loss might be the least of worries for a gum-disease sufferer. "And it would be better if people were more tuned into it," said Michael Rethman, president of the American Academy of Periodontology. To be sure, swollen, bleeding gums long have been perceived as harmless enough to most members of the public. More often, trips to the dentist have been initiated out of desires to get teeth lightly buffed or a nagging toothache addressed than gums poked and prodded. Cram used to tell gum-disease patients they were suffering from "a really chronic, low-grade infection, but it really doesn't kill people." Now, she says, she tells them the opposite. With scientific research in the past few years indicating that gum-disease patients are likely at higher risk for heart attacks and strokes, the best thing she can say about the ailment is that "it is totally preventable," she said. Disease symptoms An estimated 80 percent of American adults have some form of gum disease, according to the National Institutes of Health. Also known as periodontal disease, it is characterized by red or swollen gums, bad breath, bloody gums, loose teeth and pain while chewing. It often starts with the slight build-up of bacteria on teeth. Perhaps good dental hygiene went on a holiday. Any of this filmy paste that is not removed with thorough and regular brushing and flossing can harden, becoming a substance known as tartar that only a professional cleaning can eliminate. In its earliest stage, this inflammation of the gums is called gingivitis, a mild form of gum disease that often can be reversed through good dental cleanings. Left untreated, it can become much more severe, a condition known as periodontitis that everyone would be better off avoiding. Gums pull away from the teeth and bacteria spread below the gum line. Then the bacteria create toxins that can eat away at the teeth, producing bone loss, Cram said. Studies have suggested that these bacteria can travel throughout the body, where they may cause inflammation. "We are pretty sure people who have moderate to severe disease" in their gums "do seem to have other things at the same time at a higher rate. These include heart disease and stroke," said Dr. Mark Ryder, chairman of periodontology at the University of California-San Francisco. "If you are a diabetic with periodontal disease, your odds of having worsened diabetes are also higher." Risk of stroke In one of the more telling studies, researchers reported in August that the more teeth a person has lost, the more likely he or she is to have advanced gum disease and potentially dangerous plaque in the carotid artery, the main vessel that leads to the brain. Published online in the journal Stroke, the report supports the notion that bacteria from the gums can enter the circulatory system and cause or contribute to disease in other regions of the body. Other studies have found an association between gum disease in pregnant women and the birth of pre-term, low-birth-weight babies, and the development of pneumonia and chronic obstructive pulmonary disease in seniors. If gum disease can give way to other health problems, research suggests the converse might be true. Having diabetes may set people up for having gum problems, because it can make them more susceptible to infection and probably contribute to the breakdown of tissues around the teeth, Ryder said. In this regard, gum disease is the chicken and the egg, likely coming first and last, scientists believe. At times it may help contribute to diseases, and at others it may result from them. Either way, the mouth "may be a window to a whole bunch of things that are awfully important," Rethman said. Measuring the gums Dentists can help patients get a sense of whether their gum disease is advanced by taking X-rays of the teeth and measuring the gums. Healthy gums resemble a good-fitting turtleneck: The collars of flesh are snug, yet flexible, Cram said. They might separate from the teeth a little bit, creating pockets of about two to three millimeters. Those that are infected are more reminiscent of a cowl neck. "The collar starts loosening up and pulling away from the tooth," Cram said. With periodontitis, pockets may be five or six millimeters in depth; patients with severe forms of the disease can have pockets 10, 11 or 12 millimeters in size. Treatment can be as simple as a deep-cleaning method known as scaling and root planing or the administration of any of a number of antibacterial medications. Surgery may be warranted. Dental professionals say that prevention remains the best medicine.