Your smile may reveal some important clues about your overall health. Research suggests that gum disease may be a risk factor for a variety of health issues, including some cancers, heart attack, stroke, and even dementia.
The good news is that taking better care of your gums can help you protect your long-term health.
Are you at risk for gum disease?
Gingivitis is the mildest and most common form of gum disease. It occurs when bacteria-laden plaque takes up residence between your gums and teeth, causing inflammation. If you’re not brushing and flossing properly, this plaque can harden along your gumline and form tartar, which cannot be removed with just a toothbrush. The longer plaque and tartar stay on your teeth, the more irritated your gums will become, making them red, swollen, and prone to bleeding.
"In an ideal world, your gums should be healthy enough not to bleed when you brush your teeth," says Jonathan Miodownik, DMD, an associate program director of the Mercy Dental Clinic, located within St. Joseph Mercy Oakland hospital in Pontiac, Michigan.
Besides bleeding and swelling, gum disease may be marked by receding gums that can make your teeth look too long. It can also lead to bad breath, which is caused by the accumulation of bacteria on your teeth and gums, he explains.
Advancing age is a risk factor for gum disease. In the United States alone, as many as two in three older people have gum disease, according to the Centers for Disease Control and Prevention (CDC). Other risks may include smoking, a history of diabetes, tooth grinding, and poor oral hygiene, Dr. Miodownik adds.
Hormonal changes, certain medications (such as high blood pressure or immune system-suppressing drugs), or a vitamin C deficiency can also lead to gingivitis.
Left untreated, the condition can progress into periodontitis—more advanced gum disease that can erode the tissue and bones supporting your teeth. Healthy gums hug each tooth, but diseased gums begin to form pockets where bacteria can seek shelter and do even more damage. When plaque then gets trapped in these pockets, it can no longer be removed with brushing and flossing alone.
"The plaque accumulates, and this triggers an inflammatory response, first in your mouth and then elsewhere in your body," Miodownik explains.
Research has linked periodontal disease (gum disease) to a range of health issues, including:
Heart attack: People with gum disease may have a higher risk for heart attack. In a February 2016 study of 1,610 people published in Circulation, those with a history of gum disease were 28 percent more likely to have a heart attack. Precisely how gum disease affects the heart isn’t known yet, but several theories exist.
One theory is the main bacteria found in diseased gums—Porphyromonas gingivalis—may enter your bloodstream through your gums. This bacterium has actually been found in the kind of plaque that clogs heart arteries, further adding credence to this theory, Miodownik says. In addition, inflammation of the endothelial cells—the lining of the blood vessels—is also believed to play a role in causing heart disease. “The bacteria may induce the body’s inflammatory response,” he adds.
Dementia: Gum disease may also affect your brain health and increase your risk for mental decline. An analysis of health data compiled on 262,349 people aged 50 and older found that people with chronic periodontitis have a 6 percent higher risk for developing dementia than their peers without gum disease. The findings, published in March 2019 in the Journal of the American Geriatrics Society, held true even after researchers controlled for other behaviors known to increase risk for dementia, such as smoking.
The link between periodontitis and brain disease may be tied to bacterial infection, inflammation or the buildup of plaque in the arteries. Another January 2019 study published in Science Advances found P. gingivalis in the brain tissue of people with Alzheimer's disease, the most common type of dementia.
Diabetes: This relationship is more of a two-way street, says Miodownik. Essentially, people with diabetes are more likely to develop gum disease, especially if their condition isn’t under control. People with diabetes are at higher risk for infections. When the condition is left unchecked, blood sugar levels in saliva help bacteria grow. Meanwhile, severe gum disease can cause blood sugar levels to rise, increasing the risk for complications associated with diabetes.
Cancer: No one can say with 100 percent certainty if poor oral health raises cancer risk. But when researchers culled data from dental exams of 7,466 people who were followed for a median of 14.7 years, they found a 24 percent increase in the risk of developing cancer for those who had severe gum disease, compared to individuals who had mild or no gum disease when the study began. The 2018 study, published in the Journal of the National Cancer Institute, found the highest risk was for lung cancer, followed by colon cancer.
Another June 2019 study published in the United European Gastroenterology Journal suggests that gum disease may increase the risk for liver cancer. The study, which involved more than 469,000 adults between 40 and 69 years old who were followed for an average of six years, found those with poor oral health were 75 percent more likely to develop the disease. Experts at the American Academy of Periodontology also note that gum disease has been linked to an increased risk for kidney cancer, pancreatic cancer, and blood cancers.
It’s unclear how gum disease could affect cancer risk. Some theories suggest that diet may play a role. People with poor oral health and tooth loss are less likely to eat diets rich in crunchy fruits and vegetables—which are known to help protect against cancers. It’s possible that systemic inflammation is also involved, Miodownik points out.
Stroke: If you have gum disease, you may be more likely to have a stroke, and the more severe your gum disease, the higher this risk is, according to a January 2018 study published in Stroke. The study’s authors suggest that seeing your dentist regularly for cleanings and taking ownership of your oral health may help reduce the likelihood that you have a stroke.
Preterm delivery: Hormonal changes during pregnancy can increase the risk for gum disease. Meanwhile, pregnant people who develop gum disease may be more likely to deliver prematurely or have a baby that’s smaller than average.
Researchers are still investigating how poor oral health affects pregnancy, but all infections pose health risks to a fetus. Miodownik points out that pregnant people and those who are trying to conceive should be mindful about proper oral hygiene and visit their dentist regularly for routine checkups and cleanings.
Healthy gums, healthy body
The good news is that gum disease is largely preventable.
When there is plaque on your gum lines, it can be cleaned out during regular dental visits and by practicing better oral hygiene. Once plaque hardens into tartar, however, you’ll need the help of a dentist to remove it.
"Brush your teeth twice a day and floss once a day," Miodownik says. “Seeing your dentist for a cleaning twice a year is a great place to start, but some people— including pregnant women—may need to visit their dentist more often.” Talk to your dentist about how often you need cleanings.
Using mouthwash with antibacterial properties can help fight plaque, but the real aim is to physically break down the plaque—and that is what brushing and flossing do best, Miodownik explains. "Brushing gets plaque off of the front chewing surface and back of your teeth while flossing breaks up the plaque in between your teeth," he adds.
Some people may benefit from using an electric toothbrush or water flosser that sprays water in between teeth to remove plaque, but brushing with a regular toothbrush and flossing is typically enough to keep gums healthy.
“Gingivitis is reversible because the bone hasn't shrunk and your gums haven't yet receded so you can still prevent tooth loss and other consequences," Miodownik says. "Periodontal disease is more of an uphill battle."
Your dentist can do a deep scaling and root planing procedure to get rid of plaque above and underneath your gums and to smooth your roots so your gums re-attach to your teeth. If this doesn't make enough of a difference, a gum specialist or periodontist may be needed. "Periodontists can surgically reduce the pockets around your gums,” Miodownik says, “and they can also add gum tissue back to some areas.”
