How Obesity Damages Your Oral Health

This month, the New England Journal of Medicine  published a research study about the high prevalence of obesity in America (and worldwide).  The article discusses health related and mortality issues, but does not discuss the impact of obesity on your dental health—and it can have a profound effect.   

Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries.  Many medical professionals consider obesity a chronic disease. Obesity is on the rise in the United States and younger and younger members of our community are becoming obese due to poor nutrition and eating habits. Research demonstrates that obesity increases the risk for hypertension; type 2 diabetes; arthritis; cardiovascular disease; respiratory problems; and endometrial, breast, prostate, and colon cancers.  How obesity affects your dental health is in three main ways:

Obesity Increases Inflammatory Hormones and Proteins

A 2006 research study in Grand Rounds in Oral and Systemic Medicine demonstrated that obesity increases the risk of periodontal disease, and it may be insulin resistance that regulates the relationship between obesity and periodontal disease. Individuals with elevated body mass indices (BMI) produce a higher level of inflammatory hormones and proteins.  Very often it is these same hormones and proteins that are also responsible for many of the diseases outlined in the previous paragraph.  And a diet that is comprised of highly processed foods is likely to provide enough essential nutrients, potentially making it more difficult to fight off an infection in your mouth.  In fact obese people have about double the risk of gum disease.

A Typical Obese Person’s Diet Contributes to Plaque and Cavities

It’s obviously understood that obesity occurs when a person consumes more calories than they are able to use during a day (much fewer than 1% of the cases are due to any other cause).  In order to consume the requisite calories to result in obesity, the diet will consist of calorie-dense foods, most often high-sugar, high-fat, high-carbohydrate foods.  Anytime we eat food, some of it gets trapped in our mouths.  Foods that are high in carbohydrates and sugars (1) start turning almost instantly into plaque, and (2) provide the ideal food for bacterias, which give off acid waste, resulting in cavities.  As my professor in dental school said, “One Frosted Flake gets stuck to a tooth, and the bacteria are in ‘fat city.’” 

Obese People Tend to be Mouth-Breathers

Being called a “mouth-breather” is a derogatory slang term referring to low intelligence.  Physiologically the type of air, the quantity of air, and what the body does with it is very complex. For a great explanation, you can tune in to Lectures in Respiratory Physiology by UCSD Professor John B. West, MD, PhD, on YouTube. When breathing takes place through the mouth, a great deal of physiology cannot take place, moisturized air comes from the sinuses, and that's the big issue missing in mouth breathers. Mouth breathing affects the pH of the entire body, meaning the blood ... meaning the saliva.  A low pH oral environment is not only corrosive to the teeth directly, but the acidic pH activates the acidophilic and acidogenic bacteria to set up housekeeping. Building a healthy biofilm in the presence of acidic saliva is nearly impossible. Acid begets acid. 

Obese people tend to breath through their mouths because obesity causes the tonsils, tongue and adenoids to be a greater size than normal, thus obstructing sinus-breathing. But this is not only a condition of the obese.   Interestingly, mouth-breathing can also be a problem for the very fit, as breathing by mouth might be necessary during long durations of high exertion.

Action plan for a Healthier Weight and Smile

There are things you can do to increase your oral health, which will also affect your weight and overall health, such as:

• Reduce portion size and consume fewer calories 
• Drink enough water (and stay away from soft drinks and juices)
• Limit your intake of candies, cookies, processed snacks and pastries
• Avoid junk food, deep-fried food, and fast food
• Do not use food as a reward
• Increase your physical activity
• Brush twice a day and floss each night after brushing
• Visit your dentist regularly

Keep smiling,

Dr.Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121

Death from a Tooth Infection--How That Can Happen

Recently, two different new patients came to see me with long-standing tooth infections.  One of them will probably lose the tooth because it is too diseased to save, and the other will need a root-canal—but I am convinced they would not have needed one if the tooth was treated earlier.  But these patients are lucky.  

Untreated tooth infections can lead to systemic disease, and every year untreated tooth infections cause many people to actually die.  Earlier this year, there was a story that had made national news about a 26 year-old truck driver and father of two after he suddenly died as the result of complications from a toothache.

Vadim Anatoliyevich first complained of a toothache in January of this year, when he was on a routine work trip to New York. He stopped in Oklahoma and was seen by a dentist, who looked at the infection, cleaned it, and gave him antibiotics. He continued driving and felt better, but when he arrived in New York, he was in pain again and his mouth became swollen.

Anatoliyevich’s brother Miroslav met up with him to help him drive home faster, and noticed at one point that Vadim was having trouble breathing and couldn’t stand up. Then in Utah, Miroslav drove his brother to the nearest hospital, where doctors said they “made it just in time.” However, the infection from Anatoliyevich’s tooth had progressed and spread to the rest of his body. His lungs had fluid in them, and he couldn’t breathe on his own.  The infection could not be stopped and in early February, he died.

The story is tragic and scary, but calls attention to the fact that dental infections can lead to serious health complications more often than you might think. Every year there are cases where the patient did not receive appropriate and timely treatment of an infected tooth. In most cases, the infected tooth starts as a localized site with pain and infection.

Obviously you’re not going to die of the physical pain, but these problems can start from some form of periodontal issue or, as is most often the case, cavities. The decay leads to abscesses, which are usually infections between the tooth and the gums.  Not treated, the problem progresses and the patient becomes septic, which can lead to multiple organ failure and death.

Unlike your mouth, your lungs are a sterile cavity. When bacteria from your mouth get into your lungs, they can replicate quickly and cause a serious infection like pneumonia — and this can happen as a result of a tooth infection or gum disease. People can actually breathe in pathogenic biofilms from their mouth into their lungs, where they can create an infection. I have seen people get lung issues because of an untreated infection in their mouth.  Periodontal disease is a big deal.

It’s not just lungs that are a concern.  Bacteria from dental infections can get into your bloodstream and affect various organs, including your heart.  Dental infections can even affect your brain and cause abscesses there. It’s important for people to recognize that it’s not just a tooth — there are a lot of risks of the infection spreading elsewhere.

This is not a new phenomenon, of course. Dental infections and other tooth-related problems were listed as the fifth-leading cause of death in London back in the early 1600s. But it certainly happens today, too.  And although the number of people who die from an untreated tooth problem is not at epidemic levels, the details can be disturbing.

One famous case is the 2007 death of Deamonte Driver, a 12-year-old Maryland boy who died when bacteria from an abscess infected his brain. He had two brain operations totaling $250,000 before he died, but he could have been saved with a timely tooth extraction that would have cost $80.  Kyle Willis, a 24-year-old unemployed father from Cincinnati, died in 2009 after putting off a tooth extraction and prescription antibiotics for an infection.  John Schneider of Mt. Orab, Ohio, was 31 when he died in 2014 after what he thought was a sinus infection but was actually an untreated abscess that eventually led to multiple organ failure.

The scope of the danger was highlighted a few years ago by the Pew Charitable Trusts, which found preventable dental conditions made up more than 830,000 emergency room visits in 2009. That was up 16 percent from 2006.  While the number of deaths aren’t regularly examined, a 2013 study published in the Journal of Endodontics offered a quick cross-section of the issue based on one kind of condition. Researchers found that between 2000 and 2008, there were more than 61,000 hospitalizations nationally for periapical abscesses, an infection at the tip of a tooth’s root that is a common symptom of untreated tooth decay.  More than 1 in 1,000 of those patients actually died.

I strongly recommend that people see a dentist ASAP if they notice they have any swelling in their mouth.  Anything that hurts when you press your finger on the outside of your gums, see the dentist right away.

It’s also crucial to regularly brush your teeth, floss, and follow good dental hygiene.  Most gum disease and periodontal infections, including cavities, don’t hurt, which is why it’s so important to routinely see your doctor.  Your dentist is able to find these problems before they get out of hand and treat them as needed.

Of course, most people can develop a tooth or gum infection and won’t die from it.  But if your immune system is compromised, it could develop into a more serious problem.  These complications can happen, and when they do, it’s both creepy and tragic—and almost always preventable.

Keep smiling,

Dr.Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121

The Problem with Chain "Dental Service Organizations"

Everyone knows that insurers are decreasing benefits, increasing rates, and limiting practice options.  I recently terminated my participating provider status with a dental insurance company that wanted to change my relationships and treatment options with my patients (they'll still reimburse for your work, but I am outside their printed network of dentists, who have agreed to their new orders).

But there is also an increasing trend toward expansion and consolidation in many industries, from cell phone carriers and cable companies to banks and mortgage companies. The dental industry is no different and corporate-owned dental practices are slowly spreading.  Many outlets have reported that Dental Service Organizations (sometimes called Dental Support Organizations, or DSOs), dentistry chain organizations run by corporations, are growing at a faster rate than private practices, and may become the future of dental care in America.  I'm sure you've heard ads for them on the radio or seen them on TV, usually with professional actors and jingles.

Dollars vs. Dentistry

In its 2012 story, “Corporate dental chains see big profits in adults who can’t afford care,” the Center for Public Integrity catalogues the variety of ways companies motivated by profit over patients are operating. These corporate chains often consolidate the supportive services needed to run a dental practice – from clerical services to equipment leases.  No one disputes that doctors and dentists are subject to competitive pressures when it comes to the business side of their practices. But shareholder-owned corporate entities can tip the equation – at times, with disastrous effect – toward return on investment and away from quality patient care. 

You see, first and foremost, a DSO is a business corporation.  According to widely circulated reports from insiders, they set daily goals—for instance, if the goal is to make $15,000 in a day, the office simply had to sell $15,000 of dental treatments that day, or they’d be replaced that staff who would.  Trying new materials and technology only happened when the powers that be decided it was good for the bottom line, not when they are good for the patient.

The Lack of Accountability

As you can tell, at the core of the issue is a simple truth: the oath dentists take as health care providers binds them to the best interests of patient health and well-being. This promise is a far cry from the drive to make a buck that motivates some investors in corporate dentistry. Of equal concern is that in situations when outside influence leads to poor quality care, there is no remedy.

Connecticut’s health care disciplinary process relies on the license of the practitioner. If there is no license to sanction, patients have little recourse for substandard care they may have received when it was influenced by non-licensed individuals.

My Vision as Your Dentist

In my opinion, dentistry is unique in that we are physicians, contractors and artists at the same time. We engineer and build things, alter appearances and make changes to the human body. It’s built into our genes that we will create and do it our way. This kind of fierce independence won’t stop any time soon and it could be the reason that there is reportedly a fairly high turnover of dentists in DSOs. Many of us still want autonomy and the ability to just do it the way we think benefits the patient the most, not the way the big corporations tells us we have to do it. 

I see my dental offices, in West Hartford and New Britain, as a respite for people from the new order we see in medicine which is turning more and more depersonalized.   Patients tell me all the time they would never ever go to a DSO office and will always be a part of an independent practice where they are treated well and don’t feel like a number. DSOs are here to stay and will continue to grow over the coming years but the warning that they will take over dentistry as we know it just doesn’t fit in with I see.

That’s why my practice will always be in a small practice where patient care comes first.

Keep Smiling,
 
Dr. Elzbieta W. Basil, DMD is a private practice dentist with offices in West Hartford Center and Downtown New Britain, Connecticut.  She is a Clinical Instructor at the UConn School of Dental Medicine, and has won several awards naming her regional “Best Dentist” and “Top Dentist.” She is an active member of the Connecticut State Dental Association and the American Dental Association. Tel: 860-561-2121