The Silent Signs of Gum Disease

Diabetes is a pervasive problem in America, a cultural epidemic with wide-ranging and potentially severe consequences. According to the 2011 National Diabetes Factsheet, 25.8 million people or 8.3 percent of the U.S. population has diabetes at an estimated annual total cost of about $245 billion. 1

November is National Diabetes Month and Delta Dental wants to remind people of the well-documented connection between diabetes and oral health. 2 People with diabetes tend to develop periodontal (gum) disease earlier in life, and more severely. Though it is often painless, Delta Dental cautions people suffering from diabetes to be mindful of its warning signs. These can include bad breath, bleeding gums after brushing or flossing, red, swollen or tender gums, or changes in the way your teeth fit when you bite. Unfortunately, many people ignore those periodontal red flags until it’s too late.3

Individuals often ignore the warning signs of periodontal disease because there is usually no pain involved. So they will brush a little better to get rid of the bleeding or use mouthwash to hide their bad breath. The best idea is to schedule regular visits to your dentist to make sure that you are not developing periodontal disease.

Maintaining regular dental visits is particularly critical for patients suffering from diabetes.Oral diseases such as tooth decay and gum disease are often reversible if they are diagnosed and treated early. Dentists can also check for other common mouth conditions that afflict people with diabetes such as dry mouth, ulcers and infections. Periodontal disease and other mouth conditions may also be a sign that other medical conditions exist elsewhere in the body. Depending on their findings, the dentist might advise patients to seek a medical consultation.

Even before visiting the dentist, patients can use an online risk assessment tool (such as Delta Dental’s myDentalScore) to answer a series of questions that can gauge their risk levels for gum disease, oral cancer and other serious oral health problems. Additional lifestyle best practices for people with diabetes include controlling blood sugar, brushing and flossing daily, and quitting smoking.

1 Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.

2 National Institute of Dental and Craniofacial Research. Diabetes and Oral Health. http://www.nidcr.nih.gov/OralHealth/Topics/Diabetes/default.htm

3American Diabetes Association. 2013  Diabetes Facts.   http://www.diabetes.org/diabetes-basics/diabetes-statistics/

Don’t Beware the Dentist’s Chair

The U.S. Centers for Disease Control and Prevention (CDC) estimates that 26 million Americans suffer from diabetes. Even more troubling, another 57 million – about a fourth of U.S. adults – have pre-diabetes, which means their blood sugar levels are higher than normal, but not yet high enough to be classified as diabetes. Delta Dental is reminding Americans during “National Diabetes Month” that regular dental visits are crucial for people with diabetes.

According to the American Diabetes Association, controlling blood sugar levels is a key to preventing many serious complications of diabetes such as heart disease, kidney disease and stroke. Research also suggests a two-way relationship between serious periodontal (gum) disease and diabetes. Not only are people with diabetes more susceptible to severe gum disease, but it may have the potential to affect blood glucose control and contribute to the progression of diabetes.1 People with diabetes tend to develop periodontal disease earlier in life, and more severely. Instead of losing their teeth from gum disease in their 60s, they might begin losing teeth in their mid-40s. Smokers with diabetes are especially at-risk for gum disease and tooth loss.

Unfortunately, studies have found that people with diabetes see their dentist less often than those without the disease.2 Dentist visits are crucial because oral diseases such as tooth decay and gum disease are often reversible if they are diagnosed early and preventive treatments are delivered. Dentists will also check for other common mouth conditions that afflict people with diabetes such as dry mouth, ulcers and infections. Mouth conditions may also be a sign that other medical conditions exist elsewhere in the body. Depending on their findings, the dentist might advise patients to seek medical attention.

Daily brushing and flossing, regular dental check-ups and good blood glucose control are the best defenses against periodontal disease. In addition, quitting smoking may be the most important thing that people can do to protect their oral and overall health. The good news is that with proper dental hygiene at home and regular visits to the dentist (at least twice annually), there’s no reason people with diabetes should have worse oral health than people without.

1 American Diabetes Association. News and Research. http://www.diabetes.org/living-with-diabetes/treatment-and-care/oral-health-and-hygiene/oral-health-faqs.html Accessed October 2012.

2 Macek MD, Tomar SL. Dental care visits among dentate adults with diabetes and periodontitis. J Public Health Dent. 2009 Fall;69(4):284-9.

Help Your Teeth Age Gracefully with You

Advances in medical technology, public health, personal health knowledge and greater access to health insurance are some of the key factors helping people in the U.S. today live longer and in better health than previous generations. The most recent data indicate that life expectancy from birth is at an all-time high of nearly 78 years, with women at 80.5 and men at 75.5 years.1

Improvements in oral health are also significant, and adults 65 and older are keeping more of their natural teeth for their entire lives than previous generations. During National Healthy Aging Month, Delta Dental is advising older adults that practicing good oral health habits is more important than ever.

The popular idiom “long in the tooth” references how gums wear away in the aging process, leaving the root of the tooth exposed. The tooth root is much softer and more prone to dental decay than the enamel that covers the tooth crown. Dental disease is cumulative over a lifetime, so almost all adults ages 65 and older have had dental caries in their permanent teeth.2 Older adults who take any one of several hundred medications that can cause a decrease in saliva should be especially careful because a lack of saliva brings a much higher risk for tooth decay.

Smart dental hygiene is important even for those seniors who have lost their regular teeth. Besides helping ensure dentures and other prosthetic replacements fit properly, dentists can catch life-threatening diseases like oral cancer early when they are at a more treatable stage.

Studies show that individuals with dental insurance are far less likely to have unmet dental needs than those with insurance, and are also more likely to get regular dental exams.3 However, once individuals retire they often neglect to purchase ongoing dental coverage. Medicare does not provide dental coverage but individual plans are available for purchase. Seniors can also check to see if membership in any national organizations or associations qualifies them to purchase dental benefits.

1 The 2012 Statistical Abstract.. The National Data Book. Data Source: U.S. National Center for Health Statistics, National Vital Statistics Reports (NVSR), Deaths: Preliminary Data for 2008, Vol. 59, No. 2, December 2010. Accessed August 27, 2012 at:http://www.census.gov/compendia/statab/2012/tables/12s0104.pdf

2 “Dental Caries (Tooth Decay) in Seniors (Age 65 and Over).” National Institute of Dental and Craniofacial Research. http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/DentalCariesSeniors65older. Accessed August, 2012.

3 Bloom B, Simile CM, Adams PF, Cohen RA. Oral health status and access to oral health care for U.S. adults aged 18–64: National Health Interview Survey, 2008. National Center for Health Statistics. Vital Health Stat 10(253). 2012.

Delta Dental Encourages Major League Baseball to Quit the Spit (Tobacco)

While smokeless tobacco has not been completely banished from baseball, Delta Dental applauds Major League Baseball (MLB) and the Major League Baseball Players Association (MLBPA) during Oral, Head and Neck Cancer Awareness Week for making a positive step toward completely eliminating tobacco’s visibility from impressionable young fans. Under a recent agreement, MLB players, managers and coaches will no longer be able to carry a smokeless tobacco tin or package in their uniforms during games or when fans are in stadiums. Additionally, they will be prohibited from “chewing” during televised interviews, at autograph signings and other fan events.

Smokeless tobacco has been banned from Minor League Baseball since 1993 and from collegiate athletics since 1994. The surge of support for an outright ban on smokeless tobacco has a website, and players like Boston Red Sox outfielder Adrian Gonzalez and Chicago White Sox pitcher John Danks have recorded public service announcements speaking out against smokeless tobacco. Joe Garagiola, an 84-year-old former tobacco chewing-MLB catcher and current broadcaster, is the chairman of NSTEP, the National Spit Tobacco Education Program. NSTEP is a 17-year-old program operated by Oral Health America that educates baseball players of all ages about the dangers of chewing or “spit” tobacco.

The American Cancer Society estimated that more than 39,000 people were diagnosed with oral cancer and nearly 8,000 people died of the disease in 2011, and that men are twice as likely as women to be diagnosed.Tobacco use is considered a major risk factor for the development of oral cancers. Whether they like it or not, athletes serve as role models for impressionable children and teens. The Centers for Disease Control and Prevention (CDC)’s 2009 Behavioral Risk Factor Surveillance Study found that more than 11 percent of male high school students and four percent of male middle school students were current smokeless tobacco users.2 Though smokeless tobacco has been banned in all venues by the NCAA and MILB, a significant number of young players get hooked on the habit earlier in life.

Delta Dental puts its support and resources behind this message. Delta Dental of Tennessee, for instance, leveraged their sponsorship with the Memphis Redbirds (Triple-A affiliate of the St. Louis Cardinals) to present Oral Cancer Awareness Night at AutoZone Park. The event included oral cancer screenings performed by teachers from the University of Tennessee Health Science Center’s College of Dentistry.

Delta Dental wants the professional baseball community to be aware of the inherent risks and dangers of smokeless tobacco use, and the influence that the actions of professional baseball players have on their youthful fans. We ask that – for their own health and that of their young fans – players pause next time before throwing in a dip. We applaud the progress that MLB has made in limiting tobacco use in the sport but would support a complete ban on smokeless tobacco during games when so many young fans are watching attentively.

Below is a video in which Dr. Kohn explores the relationship between smokeless tobacco use and oral cancer.

1 American Cancer Society. Oral Cancer Fact Sheet. Accessed February 2012. http://www.cancer.org/acs/groups/content/@nho/documents/document/oralcancerpdf.pdf

2 Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2000–2009. Morbidity and Mortality Weekly Report 2010;59(33):1063–8

You Booze, You Lose: Excessive Drinking Harms Oral Health

People most often associate the health risks of excessive alcohol drinking with damage to the liver or stomach lining. But during Alcohol Awareness Month, Delta Dental warns that alcohol abuse can also prove harmful to oral health.

It is estimated that each year in the United States there will be more than 30,000 new cases of oral cancer diagnosed and about one person every hour will die from this disease.1  Heavy alcohol consumption is a risk factor for oral cancer.* According to the American Cancer Society, about 70 percent of oral cancer patients consume alcohol frequently.Tobacco smoking (i.e., cigarette, pipe or cigar smoking), particularly when combined with heavy alcohol consumption, has been identified as the primary risk factor for approximately 75 percent of oral cancers in the U.S. Using tobacco with alcohol poses a much greater risk than ingesting either substance alone. According to the National Institute on Alcohol Abuse and Alcoholism, there are approximately 17.6 million adults who are alcoholics or have alcohol problems.3 

People with alcohol problems also tend to neglect other healthy habits like eating properly or taking care of daily hygiene. A small 2003 study conducted at an alcohol rehabilitation center found that residents had a higher incidence of periodontal (gum) disease and cavities.4

Drinking, like most other things, is best done in moderation for both your oral and overall health and well-being. Some epidemiological studies suggest a heart protective association for low-to-moderate average alcohol consumption.5  Indeed, sipping alcoholic beverages like red wine (which contain heart-healthy antioxidants like resveratrol) may be beneficial for lowering LDL cholesterol and helping prevent clogging of arteries.6

*According to the Centers for Disease Control and Prevention (CDC), heavy drinking for men is typically defined as consuming an average of more than two drinks per day. For women, heavy drinking is typically defined as consuming an average of more than one drink per day.

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1 National Institutes of Health. NIH Fact Sheets. Oral Cancer – updated February 14, 2011. Accessed March 30, 2012. 

Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48:3282-7.

3 Medline Plus – Alcoholism http://www.nlm.nih.gov/medlineplus/alcoholism.html. Accessed March 30, 2012.

4 Araujo MW, Dermen K, Connors G, Ciancio S. Oral and dental health among inpatients in treatment for alcohol use disorders: a pilot study. J Int Acad Periodontol. 2004 Oct;6(4):125-30.

5 Di Minno MN, Franchini M, Russolillo A, Lupoli R, Iervolino S, Di Minno G. Alcohol dosing and the heart: updating clinical evidence. Semin Thromb Hemost. 2011 Nov;37(8):875-84. Epub 2011 Dec 23.

6 Wu JM, Hsieh TC. Resveratrol: a cardioprotective substance. Ann N Y Acad Sci. 2011 Jan;1215:16-21.

Resolve to Kick Butts in 2012

Of the nearly 8,000 deaths in the United States attributed to oral and pharyngeal cancer annually,1 about 75 percent are due to tobacco and heavy alcohol use.2   Resolving to quit smoking may be one of the most difficult challenges to undertake in 2012, but it also comes with some of the best life- and mouth-saving benefits.

A lifestyle factor that the Surgeon General calls “the single greatest avoidable cause of death,”3 smoking also drastically affects periodontal (gum) health.4-5 According to the Centers for Disease Control and Prevention (CDC), half of the cases of severe gum disease in U.S adults can be attributed to cigarette smoking and the prevalence of gum disease is three times higher among smokers than nonsmokers.6

Smoking is the leading cause of oral and pharyngeal cancer and using tobacco in any form – including dipping snuff 7 or chewing – increases the risk of developing an oral cancer.8 Even if you’ve smoked for decades, you can reap nearly immediate benefits by quitting.9-11 Within 20 minutes, your heart rate drops, and within 12 hours, the carbon monoxide level in your blood returns to normal. Within one year, your added risk for coronary heart disease will fall to half that of a smoker’s, and within 15 years, your risk is that of a nonsmoker’s.10 Quitting reduces many of the cosmetic effects of smoking and can even improve sensitivity to smell and taste.

There are many reasons why smoking is a health risk, but here are the top five ways that kicking butts can immediately improve your oral health:

  1. It significantly reduces your risk of developing oral and pharyngeal cancer
  2. It reduces your risk of developing periodontal disease
  3. It improves the color of your teeth
  4. It can help eliminate halitosis (bad breath)
  5. It can help reduce dental decay12

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1 National Cancer Institute, National Institutes of Health – Oral Cancer http://www.cancer.gov/cancertopics/types/oral

2 Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Research 1988; 48(11):3282–3287

3 U.S. Dept. of Health and Human Services. The health conse­quences of smoking: A report of the Surgeon General. U.S. Dept. of Health and Human Services, CDC, National Center of Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. Available at: “http://www.surgeongeneral.gov/library/smokingconsequences/”. Accessed June 29, 2010.

4 Tomar SL, Asma S. Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey. . J Periodontol. 2000 May;71(5):743-51

5 “Longitudinal Study of the Association Between Smoking as a Periodontitis Risk and Salivary Biomarkers Related to Periodontitis.” M. Kibayashi. Journal of Periodontology. 2007, vol. 78, no. 5, pages 859–867.

6 Preventing Cavities, Gum Disease, Tooth Loss, and Oral Cancer – 2011 At A Glance. http://www.cdc.gov/chronicdisease/resources/publications/AAG/doh.htm. Accessed 2012.

7 Oral Cancer.” National Institutes of Health. July 2007. http://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=106&key=O#O

8 “Oral Health Topics A-Z: Smoking (Tobacco) Cessation.” American Dental Association. http://www.ada.org/public/topics/smoking_tobacco_faq.asp. Accessed 2009.

9 “Quitting Smoking: Why to Quit and How to Get Help.” National Cancer Institute, August 17, 2007. www.cancer.gov/cancertopics/factsheet/Tobacco/cessation Accessed 2010.

10 “Guide to Quitting Smoking.” American Cancer Society, August 7, 2008. www.cancer.org/docroot/PED/content/PED_10_13X_Guide_for_Quitting_Smoking.asp Accessed 2008.

11 “Women and Smoking: Questions and Answers. ” National Cancer Institute, February 27, 2008. www.cancer.gov/cancertopics/factsheet/Tobacco/women Accessed 2010.

12  Rooban T, Vidya K, Joshua E, et.al. Tooth decay in alcohol and tobacco abusers. J Oral Maxillofac Pathol. 2011 Jan;15(1):14-21.