By Sarah Berry
Most of us are acutely aware that our teeth are a status symbol and a characteristic on which we are (often unfairly) judged. This has driven the surging demand for veneers and teeth-whitening toothpastes.
What few of us know is that looking after our teeth is vital. Around two thirds of us (65 per cent) are unaware that not caring for our teeth can have serious consequences for the health of our body, according to The Australian Dental Association’s (ADA) latest consumer survey.
How our oral health affects the rest of our body
“The oral microbiome is a significant diagnostic tool for systemic diseases,” says Dr Steven Lin, author of The Dental Diet and principal at Helix Dentistry. “We know the gut microbiome influences a host of chronic issues, we are now seeing that upstream in the mouth.”
The bacteria in our mouths, and even the shapes of our jaws, have evolved over the last 30,000 years.
This same diet has contributed to changes in the one thousand-odd species of bacteria in the mouth – bacteria which can influence our taste for sweet, sour, salty and bitter, as well as affecting our health – making our oral microbiome less diverse and more prone to pathogens.
Today, about one in three Australians adults has gum disease and nearly 90 per cent have experienced dental decay.
The relationship between our oral health and general health can reflect how we look after ourselves broadly, but it can be causal too.
When our mouths are overrun with pathogens, the bad bacteria can spread through the body and contribute to the development of Type 2 diabetes, dementia, stroke and cardiovascular disease. There is also evidence that an imbalance of bacteria in our mouths can activate and progress an array of autoimmune diseases.
“We suspect what’s happening is chronic infections and inflammation in the mouth releases certain agents that make us more susceptible to other conditions,” says ADA Vice President Dr Scott Davis.
We can swallow the overgrowth of bad bacteria, inhale it or, if we have inflamed gums (also known as gingivitis) and they are bleeding, bad bacteria can enter the bloodstream and travel to different parts of the body.
“The bacteria produces toxins, which can then cause inflammation, which we know is really harmful for the body,” says Dr Fleur Creeper, a specialist periodontist and member of the ADA Oral Health Committee. “So, there can be inflammation in the oral tissues, but also at other sites in the body,”
But although most of us brush our teeth twice a day (though about one in five think it’s enough to brush once daily), many of us are still not properly looking after our teeth. In some cases, we’re also using products that may be making our oral health worse.
Brush, don’t flush
Common ingredients in mouthwash and whitening toothpastes, like hydrogen peroxide, can cause an imbalance in our oral microbiome because they kill the good bacteria as well as the bad.
Dr Lin says standard antimicrobial toothpaste and mouthwash ingredients include alcohol, chlorhexidine, triclosan and hydrogen peroxide. “While antimicrobials can be prescribed for certain conditions, the evidence suggests we should not be using them daily.”
This has driven a new trend of peroxide-free whitening toothpastes, like Waken, which sells a product a minute in the UK and launched in Australia in May. Researchers have also developed toothpastes containing a fluoride alternative called hydroxyapatite which, researchers claim in a new paper, may work just as well. Fluoride strengthens teeth and prevents decay, but some people remain concerned that, in high doses, it is a neurotoxin, and can lead to fluorosis, which causes discolouration.
Creeper points out that both dose and frequency of use are important when considering how any ingredient affects the microbiome. As evidence about alternative toothpaste is still emerging, which product we use comes down to personal preference. But, Creeper adds, there is rarely good reason to use mouthwash.
“The premise of a lot of mouthwashes is to kill the bacteria. But, we don’t need to kill them, we just need to stop them sticking to the teeth and gums... It’s like quite cleaning your toilet. You can’t just squirt stuff in and flush you’ve got to get in there and scrub.”
Brush up for better health
While humans have always cleaned our teeth – chewing on sticks with frayed ends, fish bones or porcupine quills, using wine-soaked toothpicks, or salt-rolled rags – daily brushing only caught on after World War II veterans brought their disciplined orals hygiene habits home with them.
Since then, the message has evolved to “brush twice a day for two-to-four minutes each time”. This arose out of research findings that plaque (the microbes that stick to our teeth and gums) re-grow within hours of brushing. Up to four minutes of gentle scrubbing removes up to 60 per cent of the plaque without damaging the teeth and gums.
“The longer bacterial colonies aren’t disturbed, the more potentially anaerobic they become – they’re the bad bugs,” says Davis. “Literally, just disturbing the bacterial colonies, cleaning between your teeth and brushing means more oxygen gets in, and it means the anaerobic bacteria die.”
“If you have gum disease and your dental professional cleans your teeth and shows you cleaning skills, things such as your diabetes will stabilise and arthritis can improve,” says Davis.
Sadly, knocking out our originals for a set of couture or piano key replacements does not make a healthy mouth nor does it remove the need to scrub, as your gums are still in place.
What we can do is improve our diet by reducing sugar and ultraprocessed food intake, drinking more water, seeing the dentist once a year and ditching smoking and vaping (the chemical effects are terrible for our mouths, Creeper says). Make these changes, brush twice a day, and you’re well on your way to a healthier mouth and body.
Add a floss once a day – which three out of four of us (75 per cent) rarely or never do – and you remove the other 40 per cent of plaque. The effects of simply brushing and flossing is profound.
And it’s never too late to improve our oral health, says Davis. “It’s cheap. Six minutes a day. Just do it.”
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