Old-time neighbourhood doctors were on the right track when they asked us to open up and say ‘aah’, as research is showing. The health of our mouths offer an early warning about many different health problems, from diabetes to heart problems. Both diseases are major causes of early mortality in the UAE. And doctors in the country say those living here could do more to improve their physical condition simply by taking better care of their oral health.
“It has now been absolutely proven that poor oral hygiene and health can have very direct effects on the body as a whole. We call these Oral-Systemic Links and poor oral health, in particular inflammation in your gums, can negatively influence many general health conditions,” says Dr Neil Mitchell, Medical Director, Dentist Direct Dubai. Hypertension, risk of stroke, Alzheimer’s, endocrinal issues, pneumonia and cancers of the mouth, throat and pancreas are among the other problems linked to people whose teeth and gums are in a poor condition.
There are various bacteria associated with periodontitis or gum disease. A MENA study by Dr Khaled Al Bloushi indicates a high frequency of three bacterial pathogens: A. actinomycetemcomitans, P. gingivalis and B. forsythus. They affect the susceptibility of an individual in three ways, says Dr Tareq Y Shabani, Consultant/ General Dentist at King’s College Hospital London Jumeirah Medical Centre.
“Risk factors include smoking, stress and ageing. Biofilm reservoirs for gram-negative bacteria cause major vascular response, with inflammatory response in blood vessels, leading to degeneration, and intravascular coagulation. And the periodontal pocket acts as a store for inflammatory mediators that have been associated with platelet aggregation, coagulation and deposition of cholesterol, leading to atherosclerosis and myocardial infarction," Dr Tareq says.
Hormones and pregnancy
The same mediators released during periodontal disease also account for pre-term labour and low-birth-weight, if the mother is maintaining improper oral hygiene during pregnancy, Dr Tareq adds.
In fact, a woman with gum disease has seven times the risk of delivering a preterm baby, and twice as likely to give birth to a low-birthweight child. American studies have found oral bacteria present in the placentas of low birth weight babies too.
Dr Rajul Matkar, Specialist Gynaecologist Globehealth Clinics and a Consultant with Darlie Global & Dr Neem, says as much as 30 per cent of patients in her practice have poor oral health issues. "Oral health is very important for every individual. Poor oral hygiene can lead to a range of health problems," she says.
"Hormonal changes during pregnancy, puberty, menopause and menstruation put you at an increased risk for tender gums that bleed easily, a disease called gingivitis or inflammation of the gums," Dr Matkar says. "If not treated, this will lead to periodontal disease due to bacterial infection. The immune system attacks the infection and causes inflammation. Infection and inflammation also can contribute to low birth weight and premature babies by interfering with fetal development in the uterus Inflammation can also cause problems for the rest of the body."
For the UAE the most relevant effect of poor oral hygiene is diabetes, since periodontal disease is associated with diabetes mellitus. Uncontrolled diabetes, often leads to periodontal disease. Conversely, some studies have shown that the increase in the inflammatory mediators associated with periodontitis can be a risk factor or worsen the status of a diabetic patient, doctors say.
One in five people in the country are diabetic, according to official data, which raises alarm signals for associated issues such as oral care.
“Many dentists in the UAE are pressing to ensure that diabetics are made more aware of how improving their oral health is actually a key part of their long term care,” says Dr Mitchell. “Your dentist can help with advice on a number of matters, such as smoking cessation, and therefore should be a key part of anyone's overall health care plan.”
In many cases, the problem starts young. A Dubai Health Authority study in 2015 showed that almost two thirds of 15 to 17-year-olds had tooth cavities, while 80 per cent of 12 to-15-year-olds suffered from gum problems. Those between five and seven years old reported decayed, missing or filled teeth – known as the DMF factor - 3.8 times on average, as compared to 1.9 across North Africa and the Middle East, and 0.6 in the UK and Denmark. “This is the challenge in the UAE right now. The target the DHA has set is to reduce the DMF to 0.6 by 2020,” Dr Mitchell adds.
Dr Harishma Menon, GP-Dentist at Burjeel Medical Centre, Al Ain says oral health status during childhood is often a predictor of future dental problems, and poor guidance by parents on oral health could set children up to experience poor oral health for life.
“The ability of parents to provide appropriate oral care, such as brushing one's teeth can have an impact on the oral health of their children. Lack of parental confidence providing and modelling such behaviours is often linked to a lack of knowledge of the risk factors for early childhood caries (tooth decay),” she says.
Oral health promotion and education can help mitigate some of this risk, but there are a variety of other reasons for poor oral health. Whether in adults or children, the reasons are complex, often based on structural issues of affordability, geographic location and the organisation, delivery and financing of dental services.
“People don’t realise that the frequency of intake of sugary foods is more important than the amount of sugary foods you take in. This means that you are more likely to develop tooth decay if you snack on chocolates, for example, intermittently through the day than if you consumed all the chocolates at once,” explains Dr Emeka Okechukwu, Specialist Restorative Dentist, Mediclinic Ibn Battuta.
While smoking and high alcohol consumption increase the risk of periodontal disease, tooth loss and oral cancer, the stresses and strains of daily life also take their toll.
“Busy and demanding schedules mean that people in the UAE only spend a few seconds cleaning their teeth rather than the two minutes required for effective oral hygiene,” says Dr Okechukwu, who cites the example of a business executive who neglected his oral health and was so stressed with the demands of his job and personal life that he came down with an oral health condition which gets its name from its discovery in the mouths of soldiers fighting in the trenches in the first world war.
Finally, the frequency of dental visits remains a major factor – perhaps because they fear pain or because of cost considerations. “The urban myth of painful trips to the dentist causes people to delay visits to the dentist until treatment is more invasive than it would have been if they had come earlier. Most dental treatments today can be carried out with minimal discomfort to the patient,” Dr Okechukwu says.
Dr Menon points out that cost is a factor. Since patients have to shell out for consultations from their own pocket, they are often reluctant to visit a dentist until pain management is acute. “Favourable visiting patterns, which include a yearly preventive check–up, can help reduce the risk of poor oral health,” she insists.
There is, after all no need to fear opening up and saying aah.
Indicators of poor oral health
There are many symptoms of poor oral health that may not show up right away but eventually with time the symptoms can get worse, says Dr Harishma Menon, GP-Dentist at Burjeel Medical Centre, Al Ain
1. Bleeding and/or painful gums from plaque and tartar build-up
2. Bad breath
3. Decay in one or multiple teeth that can cause sensitivity or pain
4. Infection that can cause pain
5. Loose teeth
6. Persistent sensitivity to hot or cold foods and beverages