Smile therapy

Brush and floss to prevent tooth decay – and gum disease linked to heart disease and pancreatic cancer

Eternal vigilance is not only the price of liberty; it’s the price of a healthy mouth. Unchecked dental caries and periodontal disease – the dastardly duo more commonly known as tooth decay and gum disease – can lead to excruciating pain, tooth loss, social embarrassment and poor general health, including heart disease, stroke and pneumonia.

Periodontal disease is even thought to be the origin of infections causing joint replacement failure. A recent Harvard School of Public Health study suggests it is also a risk factor for pancreatic cancer. That’s why it’s so important to recognize that tooth decay and gum disease are preventable. You can keep them at bay with twice daily brushing and flossing, along with regular visits to a dentist.

“Every study shows you’re better off with your natural teeth,” says Dr. Chris Wyatt, assistant professor at the University of British Columbia’s faculty of dentistry. He’s also director of the geriatric dentistry program at UBC, which provides dental care for 2,000 residents of long-term care facilities. Ironically, he’s a prosthodontist dealing with the consequences of tooth decay and gum disease using crowns, bridges, veneers, dentures or dental implants to replace missing teeth. But he acknowledges, “Whatever we do as dentists is second best.”


Overzealous cleaning can make gums bleed, but if careful brushing around the cuff of a tooth with a soft brush turns the bristles red, the problem may be gingivitis. This inflammation of the gums can be treated. Ignored, it can progress to periodontal disease, an infection of the structures that hold teeth in place. This is not a reversible condition and will usually need to be treated by a gum specialist called a periodontist.

A healthy mouth has a normal flora – an array of bacteria living in balance. They synthesize some vitamins, have an immune function and tend to keep other potentially harmful bacteria at bay.

Plaque, a whitish, jelly-like coating contains bacteria and their by-products. If not brushed or flossed off within 24 hours, it hardens to calculus (tartar), a breeding ground for damaging germs. This has to be scraped off by a dental professional. Streptococcus mutans and Lactobacillus are two villains implicated in dental caries. Thriving on a sugary diet, they produce acids that attack tooth enamel.

The hazards of a dry mouth

Saliva protects teeth by washing away food debris and bacteria and neutralizing damaging acids. Aging, smoking and drugs such as antihistamines, antidepressants and high blood pressure medications can reduce the normal volume of saliva (about three pints daily). Diseases such as diabetes and Parkinson’s as well as chemotherapy and radiation treatment for cancer can have similar outcomes. Without enough saliva, bacteria accumulate and the result is a sharp rise in tooth decay and gum disease. Dry mouth, called xerostomia, also makes wearing dentures painful.

The onset of cognitive or physical disorders often means personal dental care declines. “That’s when we start to see this rampant increase in disease,” Wyatt says. “In an older adult, most of it is root decay.”