An estimated 70 percent of older adults have gum disease (periodontitis) and 20 percent have untreated tooth decay, putting them at risk for hypertension, cardiovascular disease, and double the chance of dying from heart attack or stroke. The link between the mouth and the rest of the body is called the oral-systemic connection. According to the National Institute of Dental and Craniofacial Health, scientists have found the bacteria that cause periodontal disease in other parts of the body, suggesting that those bacteria cause multiple illnesses.
• High blood pressure. In a meta-analysis of 81 studies (with more than 200,000 participants), researchers found that people with severe periodontitis had 49 percent higher odds of having high blood pressure. Moderate periodontitis was associated with a 22 percent higher risk
• Atherosclerosis. Researchers have discovered a link between periodontal disease and thickening of the arteries as well as plaque formation. They believe that harmful oral bacteria enter the bloodstream through tiny injuries in the mouth. The immune system responds by increasing inflammation. Over time, immune cells may build a foundation for plaques to form, and those plaques trap even more bacteria.
• Endocarditis. Germs from the mouth can spread to the heart, causing an infection of the inner lining of the heart chambers or valves, called endocardium.
• Dementia. Periodontal disease-related bacteria may even colonize in the brain. A study from Columbia University found that people who had lost many or all of their teeth, had poor periodontal health, or had high antibody levels against certain periodontal bacteria were more likely to experience cognitive decline. Postmortem examinations of the brains of people who had Alzheimer’s disease have identified periodontal bacteria in amyloid plaques.
• Other ailments. Oral bacteria and inflammation can worsen asthma and chronic obstructive pulmonary disease; increase blood sugar in people with diabetes; and cause earlier onset, faster progression, and increased bone and cartilage destruction in people with rheumatoid arthritis.
Conditions that worsen oral health
The oral-systemic connection works in both directions. Several health conditions can affect the mouth.
• Diabetes. Gum disease is more common and can be more severe in people who have diabetes. In turn, people with gum disease have a harder time controlling their blood sugar levels. A study from the State University of New York Buffalo found that people with diabetes were 15 times more likely to have lost all their teeth than those who didn’t have diabetes. Studies suggest that periodontal disease treatment can improve blood sugar levels in people with diabetes.
• Cancer. In a study published in the Journal of the National Cancer Institute, researchers found that people with severe periodontitis had a 24 percent increase in the relative risk of developing cancer—particularly lung and colorectal cancer. Periodontal disease-related bacteria have been found in colon and rectal cancer and breast cancer tumors. The presence of these bacteria in colon and rectal tumors is tied to an increased likelihood of the cancer spreading, recurring, and worsening patient outcomes.
• Busting barriers. Despite the critical importance of keeping gum disease and tooth loss at bay as we age, the barriers to accessing it often increase once people retire. Medicare specifically excludes dental care, and only some Medicare Advantage plans offer it, leaving 70 percent of older Americans with no dental insurance, according to the Center for Medicare Advocacy.
The cost of care without insurance can be shocking, and even the insured can face exorbitant copays when care gets complex.
Prevention can help avoid many big problems, and the following tips can help make it more affordable:
• Look into dental savings plans, which can slash up to 60 percent off costs at participating dentists.
• If you have a standard Medicare plan, look into Medicare Advantage plans that offer routine dental coverage.
• Visit a dental school. Supervised students can clean your teeth and perform a variety of procedures for 20 to 70 percent less than you’d pay otherwise.
• In 42 states, you can save big by skipping the dentist and seeing a dental hygienist directly. (Visit https://www.adha.org/direct-access to see what is available where you live.)
• Visit a low-cost dental clinic. You can find listings at Tooth Wisdom (toothwisdom.org) or Free Clinics (https://www.freeclinics.com).
• If you need an expensive procedure, ask your dentist if the cost is negotiable. Many dentists will offer a prepayment discount.
