Dental Health: The Heart-Disease Puzzle’s Missing Piece?

“At least she has her teeth,” my grandmother would say when gossiping about a friend. My grandmother had none of her’s and took her dentures out every night and put them in a glass of water by her bed.

Growing up it was clear to me that dental health did not afford the same import as physical health. That is, until my father died of dental related disease.

He had not known he had had rheumatic fever as a youngster, and so he was not given the precautionary shot of penicillin when having a tooth capped. He contracted an infection in his heart and died shortly afterwards of subacute bacterial endocarditis. 

According to a report updated in October, the Academy of General Dentistry (AGD) posed the question believed by many: Are heart disease and oral health are linked? Two different connections exist between heart disease and your oral health:

• Studies have shown that people with moderate or advanced gum (periodontal) disease are more likely to have heart disease than those with healthy gums.

• Oral health holds clues to overall health. Studies have shown that oral health can provide warning signs for other diseases or conditions, including heart disease.

At risk?
Could dental disease then be the missing piece of the puzzle for understanding heart disease? Many of the risk factors for gum disease are the same as those for heart disease, such as tobacco use, poor nutrition and diabetes. Overall, people who have chronic gum disease are at higher risk for a heart attack, according to the AGD.

The AGD goes on at length to describe gum disease and its dangers. Called gingivitis in its early stages and periodontal disease in the late stages, gum disease is caused by plaque buildup along and below the gum line. Some researchers have suggested that gum disease may contribute to heart disease because bacteria from infected gums can dislodge, enter the bloodstream, attach to blood vessels and increase clot formation. It has also been suggested that inflammation caused by gum disease may also trigger clot formation. Clots decrease blood flow to the heart, thereby causing an elevation in blood pressure and increasing the risk of a heart attack.

Gum disease affects 80% of American adults and often the condition goes undiagnosed. Warning signs that you may have gum disease include:

• red, tender or swollen gums;

• bleeding gums while brushing or flossing;

• gums that seem to be pulling away from your teeth;

• chronic bad breath or a bad taste in your mouth;

• teeth that are loose or separating from each other.

Poverty and dental disease
Mary Otto, a Washington, D.C.-based freelancer, is the American Healthcare Journalist’s topic leader on oral health, curating related material at healthjournalism.org. In a series of stories, “The Burden of Poverty: A Backpack of Heartache,” she writes about the reporters at the School News Network, based in Grand Rapids, MI, who are exploring the deep challenges poverty creates for local students and their families as well as strategies schools are employing to helping disadvantaged students succeed.

Articles in the series so far have examined the correlation between low test scores and low income and have provided a candid look at the struggles of a nearly homeless honor student. The series has highlighted the ways schools are trying to address the health disparities that can make it harder for poor children to succeed in school.

One recent story looked at the role school nurses play in helping poor children cope with chronic diseases. A Nov. 14 piece explains how a school-based dental program attends to the oral health needs of children who might otherwise be distracted from their studies by the debilitating pain of untreated dental disease.

Otto also reports that a new federal report raises questions about the billing practices of nearly 100 Indiana Medicaid dentists, as well as the quality of care provided by several dental chains that serve poor children in the state.

While the report, produced by the U.S. Department of Health and Human Services’ Office of Inspector General, does not explicitly name specific dentists or clinics, the authors note that two-thirds of the dentists whose billing practices raised concerns worked for four dental chains. Three of the chains have been the focus of state and less likely to have access to professional dental services than people without disabilities.

“The challenges that the 4.9 million Americans living with developmental disabilities may face in maintaining home dental hygiene routines have received little attention. In many cases, people living with conditions such as attention-deficit-hyperactivity disorder, autism, cerebral palsy and intellectual disabilities need help with tasks such as tooth brushing and flossing. The majority of these people live at home and providing this assistance can be challenging for caregivers, particularly family members, according to a unique large-scale study featured on the cover of the October issue of the Journal of the American Dental Association,” wrote Otto. The piece was picked up by  Janice Neumann for Reuters Health  that ran Oct 2 in the Orlando Sentinel under the headline “Caregiver Training May Help Mentally Disabled Adults with Dental Care.”

Aside for these specific issues, there is the bottom line cost of dental care. While your health insurance can come through with coverage for serious illness, faced suddenly with a root canal, an implant, periodontal surgery, or a new crown, can break the bank,

How are patients dealing with rising costs of dental coverage?

Coming out of Georgia, Rockdale County where employees are facing an increase in their premiums, Alice Queen of The Rockdale Citizen writes that premiums are also rising  in Anoka County, MN, Peter Bodley reports for The Anoka County Union Herald reeports that in spite of the expense, these jurisdictions acknowledge the importance of providing dental benefits.

Research shows that without dental coverage, people get less care and suffer more.

Yet the expense of benefits and the complexity of obtaining them continue to present barriers to many people, and the Affordable Care Act did not completely address these problems.

Otto stresses that U.S. children are lacking in dental care, and other preventive treatments. A newly published federal study  finds that millions of American young people have been missing out on key preventive health care services, including simple treatments that can protect against tooth decay.

Otto points to the data: “Fifty-six percent of the nation’s children did not see a dentist in 2009. That same year, a full 86 percent did not receive a dental sealant or topical fluoride treatment, two measures shown to greatly reduce cavities, according to the study, published Sept. 12 in the Centers for Disease Control (CDC)’s Morbidity and Mortality Weekly Report.

Meanwhile, oral disease remains prevalent among young people. Approximately 23 percent of children aged 2 to 11 years have at least one primary tooth with untreated decay and 20 percent of adolescents aged 12 to 19 years have at least one permanent tooth with untreated decay, the report notes

Otto offers these suggestions: “when choosing a dental insurance plan, it is desirable to pay as little in total as possible for premiums and dental service out-of-pocket costs, assuming that the plan’s provider network and customer service are satisfactory. Consumers who predict that they will only need routine dental exams twice a year should look for a dental plan with low premiums, low deductibles, and low copayments or coinsurance for routine dental services. Otherwise they might spend money unnecessarily by purchasing a dental plan that costs more than their dental services would cost without insurance.”

And if you are anticipating extreme costs due to more extensive procedures, such as crowns or removal of impacted wisdom teeth, choose a dental plan that minimizes the out-of-pocket costs for the particular services that they require, in addition to premiums and deductibles. Moreover enrollees should take into account whether their dental insurance plan has a cap on annual benefits, which is the maximum amount of costs that the insurer will pay, after which the enrollee must pay 100% of incurred costs.

Some dental plans require enrollees to wait for a period of time, such as one or two years, before they will cover certain services. If a dental service requires urgent attention, then a consumer should make sure not to choose a plan with a long waiting period for that particular dental service. In addition, if a consumer wishes to see a particular dental care provider, then they should verify that the provider is in their plan’s network prior to enrolling in a dental plan.

But mostly a shift in perception is needed.  Your teeth are you, not a separate appendage that you dutifully bruch at night, and maybe florss and are happy to be able to chew your steak with, but you don’t give a second thought until an excruciting ache wakes you in the middle of the night. And ache that could very well proceed a heart condition.