What Most People Don’t Know
Ken Michener’s tooth had been hurting off and on for months, and the pain was intense one Monday night in August. So Michener, 31, or Naperville, Illinois, who worked night shifts at a company that manufactures vitamins and dietary supplements, left at 3 am, halfway through his shift. At home, he tossed and turned. By the next afternoon, he’d found an oral surgeon to pull his sore molar, and started taking antibiotics to beat the bacterial infection and reduce swelling. They did neither. By Friday, Michener was still hurting, and his left cheek bulged. At a local hospital, his oral surgeon removed another tooth, drained some pus, gave him painkillers and more antibiotics, and checked him into intensive care.
By the following Monday, when Michener was rushed by ambulance to Loyola University Medical Center, in suburban Chicago, his cheek was so swollen that he couldn’t open his left eye. The infection had invaded the muscles that open the jaw, causing his jaw to clamp shut. It had also spread to Michener’s neck and was squeezing his airway. He couldn’t open his mouth, couldn’t speak and, despite a breathing tube designed to help, struggled to draw each breath.
Few mouth infections grow as menacing as Michener’s. But runaway dental infections can be treacherous. They have eaten through the skin in people’s necks, choked off airways, migrated to the heart, burrowed into brains and, yes, even killed people.
Have we scared you enough yet? Here’s the point: Everyone is vulnerable, because bacteria that routinely lurk in the mouth cause tooth decay and gum disease. The problem: Most people don’t know they have these infections. They often cause no pain and few symptoms, but can lead to far worse. Gum disease may also heighten the risk for heart disease, diabetes, pneumonia and premature birth, according to recent clinical trials. But the good news is that with good old regular brushing and flossing, you may prevent all that. And by seeing your dentist often, you can nip most problems in the bud.
Regular dental checkups can pay off in other ways too. For example, dentists can spot signs of diabetes, heart disease and cancer, along with a variety of rare skin and autoimmune diseases. Since people typically visit their dentists more often than they visit other doctors, that can lead to early diagnosis and early treatment. All of which means that your dentist can do much more than save your teeth and gums. Your dentist can save your life.
An Oral Epidemic
Americans have brighter smiles than ever before. But behind those gleaming smiles, all is not well. Oral health has improved some in recent decades: more kids are being treated with dental sealants; the incidence of mild gum disease (gingivitis) has decreased about 40% since the 1960s; and untreated tooth decay in permanent teeth has decreased slightly since the late 1980s, according to an August report from the Centers for Disease Control and Prevention. But here’s the bad news: one in three Americans over age 30 still have more advanced gum disease known as periodontitis; more than nine in ten Americans have at least some tooth decay; and nearly three in ten adults over 65 have no teeth at all.
Not getting enough fluoride may be part of the problem. One in three Americans live in communities with insufficient fluoride in their drinking water, and bottled and filtered water often contain little fluoride. Also, 108 million Americans don’t have dental insurance. In fact, on in five low-income children and adolescents have untreated tooth decay, a level twice that of their more affluent peers. Oral disease is still widespread in this country because the will and the money to reduce it have not been there. The result, according to a 2000 Surgeon General’s report, is a “silent epidemic” or oral disease that threatens the health of Americans.
Runaway Infections
In the operating room at Loyola University Medical Center, oral surgeon Mark Steinberg and two residents made two small incisions inside Michener’s cheek and three on his neck; then they installed flat rubber tubes in each to drain pus. They made a slice the width of a nickel through Michener’s neck into his windpipe, and inserted a six-inch-long curved plastic tracheostomy tube that allowed him to breathe.
Michener remained in intensive care for two more days and in the hospital for the rest of the week. His massive infection began receding. “It was lonely,” Michener remembers. “You couldn’t talk. You couldn’t move. You couldn’t sleep.” Nurses suctioned mucus from his windpipe for four days so he could breathe. “You didn’t want to fall asleep and gag to death, so you had little catnaps and that was it.”
Infections like Michener’s are rare, but not exceedingly so. Between 1996 and 2001, physicians at San Francisco General Hospital, a large public hospital, treated 157 patients with runaway tooth infections that had eaten into their jaws, faces, and necks. All the patients recovered. Still, “patients who get a big dental abscess – well, they can die from it,” cautions M. Anthony Pogrel, DDS, MD, co-author or the study and chairman of the oral and maxillofacial surgery department at the University of California, San Francisco.
A Silent Threat
Gum infections, too, harm more than just mouths. While mild gum infections called gingivitis may lead to red and swollen gums, they’re not especially dangerous by themselves. But they can worsen into periodontitis, painless but chronic gum infections that, if left untreated, degrade bony sockets and ligaments that hold teeth in place. The immune system fights gum infections to keep oral bacteria from spreading to other parts of the body. It usually succeeds, but no always. Gum-disease bacteria can enter the bloodstream and move to the heart, causing life-threatening infections in previously damaged heart valves. What’s more, scientists believe the resulting inflammation releases infection-fighting compounds that can inadvertently damage other tissues.
The arteries may be the most common target. People with periodontitis were twice as likely to die from a heart attack and three times as likely to die from a stroke, according to a study that examined 18 years of medical histories for 1,147 people. Steven Offenbacher, director of the Center for Oral and Systemic Diseases at the University of North Carolina School of Dentistry, who co-authored the study, is helping conduct another to see if treating periodontitis in heart patients will cut the risk of heart attacks.
Pregnant women with serious periodontal disease have about four times the risk of delivering preterm babies, and they face an increased risk of preeclampsia, in which blood pressure climbs sky-high after the 20th week, threatening the lives of both mother and fetus. In an early clinical trial, researchers found that treating seriously infected gums reduces pre-term births fivefold, but the work needs to be confirmed in larger trials.
Diagnostic Dentists
Ann McKay, 38, from Pittsboro, North Carolina, was far from happy after visiting her dentist for a checkup in October 2003. Over the previous year, a lump the size of a pencil eraser had grown slowly inside her upper lip. At her regular dental checkup McKay, a stay-at-home mom with a two year old daughter, said “I have this thing in my mouth; it bothers me, and I’d like to have it taken out.” Her dentist referred her to a nearby periodontist, who thought the growth, like most such growths, was harmless. But he removed the tissue and sent it for testing to laboratories at the University of North Carolina School of Dentistry. There, an oral pathologist peered at the tissue under a microscope. She noted a “huge organized collection” of crinkly white blood cells, way too many and way too large to be normal. Her diagnosis: cancer.
“I didn’t know what non-Hodgkin’s lymphoma was. Then you get on a computer and you’re scared half to death,” recalls McKay. At the University of North Carolina Hospital in Chapel Hill, McKay had chest x-rays and blood work, a full-body PET scan and a CAT scan. The tests showed no other signs of cancer. Nevertheless, for 20 days in December 2003 and January 2004, she underwent radiation therapy on her lip to make sure the cancer was vanquished. Seven months later, McKay became pregnant with her second child. Gabriel was born in April, and mother and son are healthy. “I’m a very lucky person,” she says.
Besides spotting lymphoma, dentists can recognize signs of leukemia and oral cancer, an extremely dangerous and disfiguring cancer that’s diagnosed in 29,000 Americans each year and kills 7,000. “When people go to the dentist, they should expect to get an oral cancer exam,” during which the dentist thoroughly checks the tongue, palate, inside of the cheeks, and lips for any bumps or unusual sores, says Bruce Pihlstrom, DDS, acting director of the center for clinical research at the National Institute of Dental and Craniofacial Research. If the dentist doesn’t do it, the patient should ask, he says.
Diagnosing cancer is just the beginning. Dentists can also spot signs of gastrointestinal problems like Crohn’s disease, skin diseases, autoimmune diseases and more. “I cannot tell you how many times I have seen patients with multiple gum infections and diagnosed them with diabetes,” says Robert Ghalili, DMD, a periodontist in private practice in New York City. “The body is never really resting when you have a mouth infection.” Another one of his patients had been suffering from what doctors thought was chronic fatigue syndrome. But her energy level rebounded when her serious gum disease was treated.
If more people realized the consequences of not taking care of their teeth and gums, they’d probably call a dentist tomorrow. Still, 35% of Americans over the age of two haven’t been to one in the past year. “People lose sight of the fact that their head is attached to the rest of their body,” says Kenneth Krebs, DMD, president of the American Academy of Periodontology. Healthy teeth and gums let us talk, smile, laugh and kiss without embarrassment. That’s reason enough to take care of our oral health. But as medical science reaffirms that head and body are indeed connected, there’s more reason than ever to brush twice a day, floss daily, get dental checkups every six months, or see a dentist promptly if you have a problem.
Ken Michener learned that lesson the hard way. As he recovered from his illness, Michener remained at home for a month, wearing a round-the-clock intravenous line that kep antibiotics coursing through his bloodstream. Nurses came to his home twice a week to change his bandages and check on him. “If you have a problem, you’ve got to take care of it. Don’t wait. Don’t be mach,” Michener says. “I was stubborn,” he concludes. “Not anymore.”
January 15th, 2008 by 
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