Next time you're evaluated for the risk of heart disease, don't be surprised if the doctor pulls out a tongue depressor and says, "Say 'ah.' "
Mounting evidence shows a link between periodontal disease—chronic infection of the gums—and a host of serious and sometimes life-threatening medical problems, from heart disease and stroke to diabetes and respiratory disease.
"If you want to assess a person's general health," says James R. Orcutt, a dentist in Ithaca, N.Y., and a former president of the New York State Dental Society, "look first in their mouth."
Some researchers believe that the bacteria shed by chronic oral infections can spread through the bloodstream and contribute to disease in the heart and other parts of the body.
Other researchers believe that chronic gum infections may trigger a chain of chemical events that causes inflammation —swelling— throughout the body. When plaque lining the arteries becomes inflamed, blood clots can form, leading to heart attack or stroke.
Studies have found that people who have periodontal disease are nearly twice as likely to suffer from coronary artery disease as those who don't. Chronic gum disease can also worsen existing heart conditions. Just last year a study led by a doctor at the University of Minnesota School of Public Health found that tooth loss caused by gum disease may be an early warning sign of cardiovascular disease.
The downside of poor oral health doesn't end there. Researchers have also found that periodontal disease may make it more difficult for people with diabetes to control their blood sugar.
Despite the consequences of poor oral health, says Linda Niessen, a professor of geriatric dentistry at Baylor College of Dentistry in Dallas, dental care remains "the poor relation in the nation's health care system."
More than a third of all Americans—about 108 million people—do not have dental insurance, according to a groundbreaking report on oral health issued in 2000 by the U.S. surgeon general. That's two and a half times the number who do not have medical insurance.
Only 60 percent of the nation's baby boomers have dental coverage through their employers, the report found, and most of them will lose it when they retire.
Moreover, says Robert Klaus, president of Oral Health America, a Chicago-based advocacy group, many people who have employment-based dental benefits are shocked to learn on retirement that Medicare doesn't cover routine dental care.
Klaus, testifying last fall before the Senate Special Committee on Aging, warned that the oral health of older Americans is in "a state of decay."
That's largely because Medicare doesn't cover routine dental services, and in most states Medicaid doesn't either. When Congress established the two health programs in 1965, life expectancy was shorter than it is today. And many Americans who'd lived long enough to be eligible for the programs had already lost all their teeth.
No longer. Compared with earlier generations, older adults today have stronger teeth and gums—especially baby boomers, many of whom grew up brushing and flossing, drinking fluoridated water and getting regular checkups.
Greg Folse, a geriatric dentist in Lafayette, La., notes that 12 years ago, 60 percent of his patients had lost all their teeth. Now, he says, 62 percent still have some teeth. Of his patients who have teeth, however, 85 percent have moderate to severe gum disease and 60 percent have tooth decay.
The frail elderly are particularly at risk for tooth decay and gum disease, Folse says. "Dry mouth"—one side effect of many medications—inhibits saliva's ability to restore tooth enamel, contributing to decay. And arthritis, stroke and other conditions can make brushing uncomfortable, difficult or even impossible.
In Louisiana, where Folse takes his practice to patients in his van, Medicaid dental services are limited to dentures—which is not much help to people who still have their natural teeth.
It's time for the federal government "to step up to the plate," Folse argues, to increase matching funds to the states to help pay for oral health services and to ensure access to care for vulnerable populations such as low-income older adults and people with disabilities.
Klaus, of Oral Health America, brands as "penny-wise and pound-foolish" public health policies that ignore the connection between gum disease and other conditions.
"We've wrung about all the savings we're going to get out of Medicare and Medicaid through managed care," he says. "The only other way to save money is by prevention."
Anne Moffat is a freelance writer in Chicago. AARP Bulletin senior editor Trish Nicholson contributed to this article.