1. Does stress cause problems in the mouth?

Stress causes many problems. There have been links between stress and periodontal( Gum) disease. There have been links between Stress and grinding of teeth. There have been links between stress and mouth cancer. Stress not only negatively impacts the mouth but negatively impacts the whole body.

Stress and Your Smile

According to David Cochran, DDS, PhD, President of the American Academy of Periodontology and Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio, "stress can make an individual more susceptible to harmful habits that negatively impact oral health. Stress may lead an individual to abuse tobacco or alcohol, and to possibly even neglect his or her oral hygiene. These lifestyle choices are known risk factors for the development of periodontal disease, which has been connected to several other chronic diseases, including heart disease and diabetes."

A study published in the February 2009 Journal of Periodontology (JOP) confirmed that stress may interfere with oral hygiene. In the study, 56 percent of participants self-reported that stress led them to neglect regular brushing and flossing. In addition, the hormone cortisol may also play a role in the connection between stress and gum disease. Chronic stress is associated with higher and more prolonged levels of cortisol; previous research has found that increased amounts of cortisol in the bloodstream can lead to a more destructive form of periodontal disease.

"During periods of high stress such as what we are currently experiencing in this economic climate, individuals should seek healthy sources of relief such as regular exercise, eating a balanced diet, and getting adequate sleep," says Dr. Cochran. " Doing so can help maintain a healthy mouth, and potentially help ward off other negative health concerns."

Preserve Your Gum Line, Improve Your Bottom Line

Reducing stress in an effort to avoid gum disease may not only help sustain overall health, but it might also help your pocketbook as well. A study published in the November 2007 Journal of Periodontology found that preventing periodontal disease may be one way to help lower your total health care expenses. In the study, patients with severe periodontal disease had 21 percent higher health care costs as compared to those with no periodontal disease. Severe periodontal disease (periodontitis) involves bone loss and diminished tissue attachment around the teeth. And since past research has shown that periodontal disease may lead to other serious health conditions, striving to maintain oral health may help diminish the need to incur additional health care expenses, and ultimately help reduce overall health care spending.

"In these stressful times I encourage my patients to pay even more attention to their teeth and gums,” says Dr. Cochran. "And in turn, since preventing gum disease may help reduce overall health care expenses, maintaining a healthy mouth may actually be a stress reliever in itself.”


2. What causes bad breath?

Bad breath(halitosis) can be caused by gum disease

Factors that contribute to gum disease include poor oral hygiene, irregular professional dental cleanings, smoking or chewing tobacco, certain medications, defective fillings, crooked teeth and systemic diseases.Warning signs of gum disease are:

• Gums that bleed during tooth brushing

• Gums that have pulled away from the teeth

• Persistent bad breath or bad taste

• Permanent teeth that are loose or separating

• Any change in the way your teeth fit together when you bite

A healthy lifestyle, regular brushing and flossing, and regular visits to the dentist for cleanings are the best way to keep your gums healthy and to avoid gum disease.


3. Can I pass my periodontal gum disease to others?

Gum disease can have a genetic predisposition. To date researchers have not found a total cure for gum disease. There are many causes of gum disease and with a disease with many causes finding a cure becomes extremely difficult. Dentists treat gum disease by maintaining you in a state of health.


4. Does oral health affect overall health?

There have been links between periodontal disease pre-term birth weight, heart disease, high blood pressure and diabetes. Patients who have compromised immune systems also seem to suffer from Periodontal disease.

A consensus paper on the relationship between heart disease and gum disease was recently published concurrently in the online versions of two leading publications, the American Journal of Cardiology (AJC), a publication circulated to 30,000 cardiologists, and the Journal of Periodontology (JOP), the official publication of the American Academy or Periodontology (AAP). Developed in concert by cardiologists, the physicians specialized in treating diseases of the heart, and periodontists, the dentists with advanced training in the treatment and prevention of periodontal disease, the paper contains clinical recommendations for both medical and dental professionals to use in managing patients living with, or who are at risk for, either disease. As a result of the paper, cardiologists may now examine a patient’s mouth, and periodontists may begin asking questions about heart health and family history of heart disease.

The clinical recommendations were developed at a meeting held earlier this year of top opinion-leaders in both cardiology and periodontology. In addition to the clinical recommendations, the consensus paper summarizes the scientific evidence that links periodontal disease and cardiovascular disease and explains the underlying biologic and inflammatory mechanisms that may be the basis for the connection.

According to Kenneth Kornman, DDS, PhD, Editor of the Journal of Periodontology and a co-author of the consensus report, the cooperation between the cardiology and periodontal communities is an important first step in helping patients reduce their risk of these associated diseases. Inflammation is a major risk factor for heart disease, and periodontal disease may increase the inflammation level throughout the body. Since several studies have shown that patients with periodontal disease have an increased risk for cardiovascular disease, we felt it was important to develop clinical recommendations for our respective specialties. Therefore, you will now see cardiologists and periodontists joining forces to help our patients.

For patients, this may mean receiving some unconventional advice from their periodontist or cardiologist. The clinical recommendations outlined in the consensus paper advise that periodontists not only inform their patients of the increased risk of cardiovascular disease associated with periodontal disease, but also assess their risk for future cardiovascular disease and guide them to be evaluated for the major risk factors. The paper also recommends that physicians managing patients with cardiovascular disease evaluate the mouth for the basic signs of periodontal disease such as significant tooth loss, visual signs of oral inflammation, and receding gums.

While additional research will help identify the precise relationship between periodontal disease and cardiovascular disease, recent emphasis has been placed on the role of inflammation - the body’s reaction to fight off infection, guard against injury or shield against irritation. While inflammation initially intends to have a protective effect, untreated chronic inflammation can lead to dysfunction of the affected tissues, and therefore to more severe health complications.

"Both periodontal disease and cardiovascular disease are inflammatory diseases, and inflammation is the common mechanism that connects them,” says Dr. David Cochran, DDS, PhD, President of the AAP and Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio. "The clinical recommendations included in the consensus paper will help periodontists and cardiologists control the inflammatory burden in the body as a result of gum disease or heart disease, thereby helping to reduce further disease progression, and ultimately to improve our patients’ overall health. That is our common goal.”

NOTE: A copy of The American Journal of Cardiology and Journal of Periodontology Editors’ Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease can be viewed online.


5. What is the relationship between periodontal gum disease and respiratory disease?

Bacterial respiratory infections are thought to be acquired through aspiration (inhaling) of fine droplets from the mouth and throat into the lungs. These droplets contain germs that can breed and multiply within the lungs to cause damage. Recent research suggests that bacteria found in the throat, as well as bacteria found in the mouth, can be drawn into the lower respiratory tract. This can cause infections or worsen existing lung conditions. People with respiratory diseases, such as chronic obstructive pulmonary disease, typically suffer from reduced protective systems, making it difficult to eliminate bacteria from the lungs.

Scientists have found that bacteria that grow in the oral cavity can be aspirated into the lung to cause respiratory diseases such as pneumonia, especially in people with periodontal disease. This discovery leads researchers to believe that these respiratory bacteria can travel from the oral cavity into the lungs to cause infection.

Chronic obstructive pulmonary diseases (COPD) cause persistent obstruction of the airways. The main cause of this disease is thought to be long-term smoking. Chemicals from smoke or air pollution irritate the airways to cause obstruction. Further damage to the tissue and working function of the lungs can be prevented, but already damaged tissue cannot be restored - untreated or undetected COPD can result in irreversible damage. Scientists believe that through the aspiration process, bacteria can cause requent bouts of infection in patients with COPD. Studies are now in progress to learn to what extent oral hygiene and periodontal disease may be associated with more frequents bouts of respiratory disease in COPD patients.