Oral Health

Health

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August 20, 2022

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“There is no health without oral health.” You may have heard this statement but what does it mean? The health of our mouth, or oral health, is more important than many of us may realize. It is a key indicator of overall health, which is essential to our well-being and quality of life.

Although preventable to a great extent, untreated tooth decay (or cavities) is the most common health condition worldwide. When we think about the potential consequences of untreated oral diseases including pain, reduced quality of life, lost school days, disruption to family life, and decreased work productivity, making sure our mouths stay healthy is incredibly important. [1]

What is a Healthy Mouth?

The mouth, also called the oral cavity, starts at the lips and ends at the throat. A healthy mouth and well-functioning teeth are important at all stages of life since they support human functions like breathing, speaking, and eating. In a healthy mouth, tissues are moist, odor-free, and pain-free. When we talk about a healthy mouth, we are not just talking about the teeth but also the gingival tissue (or gums) and the supporting bone, known together as the periodontium. The gingiva may vary in color from coral pink to heavily pigmented and vary in pattern and color between different people. Healthy gingiva is firm, not red or swollen, and does not bleed when brushed or flossed. A healthy mouth has no untreated tooth decay and no evidence of lumps, ulcers, or unusual color on or under the tongue, cheeks, or gums. Teeth should not be wiggly but firmly attached to the gingiva and bone. It should not hurt to chew or brush your teeth.

Throughout life, teeth and oral tissues are exposed to many environmental factors that may lead to disease and/or tooth loss. The most common oral diseases are tooth decay and periodontal disease. Good oral hygiene and regular visits to the dentist, combined with a healthy lifestyle and avoiding risks like excess sugar and smoking, help to avoid these two diseases.

Oral Health and Nutrition: What You Eat and Drink Affects Your Teeth

Just like a healthy body, a healthy smile depends on good nutrition. A balanced diet with adequate nutrients is essential for a healthy mouth and in turn, a healthy mouth supports nutritional well-being. Food choices and eating habits are important in preventing tooth decay and gingival disease.

Minerals like calcium and phosphorus contribute to dental health by protecting and rebuilding tooth enamel. [2] Enamel is the hard outer protective layer of the tooth (fun fact: enamel is the hardest substance in the human body). Eating foods high in calcium and other nutrients such as cheese, milk, plain yogurt, calcium-fortified tofu, leafy greens, and almonds may help tooth health. [2] While protein-rich foods like meat, poultry, fish, milk and eggs are great sources of phosphorus.

When it comes to a healthy smile, fruits and vegetables are also good choices since they are high in water and fiber, which balance the sugars they hold and help to clean the teeth. [2] These foods also help stimulate saliva, which helps to wash away acids and food from teeth, both neutralizing acid and protecting teeth from decay. Many fruits and vegetables also have vitamins like vitamin C, which is important for healthy gingiva and healing, and vitamin A, another key nutrient in building tooth enamel.[2]

Water is the clear winner as the best drink for your teeth—particularly fluoridated water. It helps keep your mouth clean and helps fight dry mouth. Fluoride is needed regularly throughout life to protect teeth against tooth decay. [3] Drinking water with fluoride is one of the easiest and most beneficial things you can do to help prevent cavities.

According to available research, carbonated or “sparkling” water, although slightly more acidic than regular water, is generally fine for your teeth. [2] While it is great to replace soda with carbonated water, it should not be used as a replacement for water with fluoride. However, not all carbonated waters are created equal. Citrus-flavored waters may have higher acid levels, increasing the risk of damage to tooth enamel. A good way to help protect your teeth is to drink these in one sitting or with meals. If you prefer drinking it without food, another option is to use a straw to help the water bypass your teeth. Remember, sparkling waters that have added sugar are sugar-sweetened beverages, which increase your risk of developing tooth decay and other chronic diseases.

hand reaching into chips in a bowl, with cans of cola on the side

What you eat and how often you eat can affect your teeth. Plaque is a sticky film of bacteria that forms on teeth and, unless removed daily, this plaque builds up. Plaque bacteria use sugar from things you eat and drink to make acid that attacks tooth enamel. This “acid attack” can last up to 20 minutes even after you’ve finished eating or drinking. This is why snacking all day or sipping a sugary drink for a long period of time can lead to tooth decay. Excess intake of added sugars leads not only to tooth decay but is also associated with other health problems, including obesity, diabetes, and cardiovascular diseases. [4] Although you may not be adding that much sugar to your food, you can still be eating more sugar than you realize. This is because added sugars are often hidden. Learning about where sugar may be hiding and how to identify these added sugars can help you win this game of hide and seek.

Malnutrition and oral health

Nutrition and oral health are closely related. The World Health Organization defines malnutrition as deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients. This means that malnutrition can be over-nutrition or undernutrition. Dental pain or missing teeth can lead to difficulty chewing or swallowing food which negatively affects nutrition. This may mean eating fewer meals or meals with lower nutritional value due to impaired oral health and increased risk of malnutrition. On the other hand, lack of proper nutrients can also negatively affect the development of the oral cavity, the progression of oral diseases and result in poor healing. [5] In this way, nutrition affects oral health, and oral health affects nutrition.

Nutrition is a major factor in infection and inflammation. [5] Inflammation is part of the body’s process of fighting against things that harm it, like infections and injuries. Although inflammation is a natural part of the body’s immune response to protect and heal the body, it can be harmful if it becomes unbalanced. In this way inflammation is a dominant factor in many chronic diseases. Periodontal diseases and obesity are risk factors involved in the onset and progression of chronic inflammation and its consequences. [6]

Oral Health and General Health

While it may appear that oral diseases only affect the mouth, their consequences can affect the rest of the body as well. There is a proven relationship between oral and general health. Many health conditions may increase the risk of oral diseases, and poor oral health can negatively affect many general health conditions and the management of those conditions. Most oral diseases share common risk factors with chronic diseases like cardiovascular disease, cancers, diabetes, and respiratory diseases. These risk factors include unhealthy diets, particularly those high in added sugar, as well as tobacco and alcohol use. [7]

Endocarditis and heart disease

Infective endocarditis (IE), an infection of the inner lining of the heart muscle, can be caused by bacteria that live on teeth. [8] Gingivitis and periodontitis are inflammatory diseases of the gingiva and supporting structures of the teeth caused by specific bacteria. There is evidence that the surface of inflamed tissue around teeth is the point of entry for the specific bacteria that cause as much as 50% of the IE cases in the U.S. annually. This means that improving oral hygiene may help in reducing the risk of developing IE. In addition, periodontal disease may be associated with heart disease and shares risk factors including tobacco use, poorly controlled diabetes, and stress. [9,10]

Pregnancy and birth complications

Oral health is an important part of prenatal care. Poor oral health during pregnancy can result in poor health outcomes for both mother and baby. For example, studies suggest that pregnant women who have periodontal disease may be more likely to have a baby that is born too early and too small. [7] Hormonal changes during pregnancy, particularly elevated levels of progesterone, increase susceptibility to periodontal disease, which includes gingivitis and periodontitis. For this reason, your dentist may recommend more frequent professional cleanings during your pregnancy.

If you are struggling with morning sickness, the stomach acid from vomiting can erode or wear away tooth enamel. To help prevent the effects of erosion, rinse your mouth with 1 teaspoon of baking soda mixed in a cup of water, then wait 30 minutes before brushing your teeth. [11]

Conditions that impact oral health

Certain conditions may also affect your oral health, including:

Anxiety and stress. Stress is a normal human reaction that everyone experiences at one point or another. However, stress that is left unchecked can contribute to many health problems including oral health issues. While behavioral changes play a leading role in these poor oral health findings, there are certain physiological effects on the body as well. Stress creates a hormone in the body called cortisol. Spikes in this hormone can weaken the immune system and increase susceptibility to developing periodontal disease. Evidence has shown that stress reduces the flow of saliva which in turn can contribute to dental plaque formation. [12] Certain medications like antidepressants and anti-anxiety medications can also cause dry mouth, increasing risk of tooth decay. Additionally, stress may contribute to teeth grinding (or bruxism), clenching, cold sores, and canker sores.
Osteoporosis and Paget’s Disease. Medical conditions such as osteoporosis are a fitting example of why it is so important to let your dentist know about all the medications you are taking. Certain medications like antiresorptive agents, a group of drugs that slows bone loss, can influence dental treatment decisions. That is because these medications have been associated with a rare but serious condition called osteonecrosis of the jaw (ONJ), which can damage the jawbone. Bisphosphonates (Fosamax, Actonel, and Boniva) and Denosumab (or Prolia) are examples of antiresorptive agents. Although it can occur spontaneously, ONJ more commonly occurs following surgical dental procedures like extracting a tooth or implant placement. Be sure to tell your dentist if you are taking antiresorptive agents so they can take that into account when developing your treatment plan.

Positive oral health can enhance mental and overall health, while neglect of oral health can negatively impact an individual’s self-image and self-esteem. Poor oral health may also affect speech, which can cause or contribute to social anxiety. In this way, regular dental exams and professional cleaning not only help support positive oral health but are also vital to overall well-being and good mental health as well.

Eating Concerns: What to Eat If You Have…

Braces and orthodontic treatments

Depending on the type of orthodontic treatment, your braces may have brackets, bands, and wires. In this case, it is important to avoid eating hard or sticky food. This includes things like nuts, popcorn, hard candy or gum, which could break or displace parts of your orthodontics and potentially delay your treatment. Enjoying pasta, soft veggies, fruits, and dairy products are good choices. Having good oral hygiene is key in making sure tooth decay do not form around the braces. This means making sure the teeth and braces are thoroughly cleaned of food debris so that plaque does not accumulate. Allowing plaque to build-up can cause white spots on the surfaces of the teeth. You can ask your dentist for tips on how to maintain good oral hygiene.

If you have clear trays or aligners that are removable, you should always remove your trays before eating or drinking any liquid other than water. Regardless of whether food is hard or soft, removing your tray before eating helps to ensure effectiveness of your treatment.

Dentures

If you wear dentures, adjusting to what and how you eat can be a major challenge. When you first get dentures, your mouth and tissue need time to adjust to chewing and biting. Starting with soft foods like soups, smoothies, and applesauce for your first few meals can help make the transition more comfortable. Be mindful of hot dishes and drinks as it can sometimes be difficult to gauge the temperature of your food. After a couple of days, you can move onto more solid foods as your mouth begins to adjust to the dentures. Take care to avoid hard or sticky food and tough meats which could break or damage your dentures. Denture-friendly foods include slow-cooked or ground meats, cooked fish, ripe fruits, and cooked vegetables. A good tip is that if you can cut the food with a fork, chances are the food will not damage your dentures.

Dry mouth

Dry mouth or xerostomia can make it difficult to talk, chew, and swallow food. Symptoms of dry mouth may include increased thirst, sore mouth and tongue, difficulty swallowing and talking, and changes in taste. [14] If you are experiencing a dry mouth, it is important to talk to your oral health care provider (as well as primary care provider) to better understand the potential causes and management. Regardless of the cause, you have lots of options for making it easier to eat. First, ensure that you drink plenty of fluids and sip cold water between meals. Chew your food well if you’re having trouble swallowing and only take small bites. Combining solid foods with liquid foods such as yogurt, gravy, sauces, or milk can also help. You want to avoid foods that are acidic, hot, or spicy as these may irritate your mouth further. Good oral care also plays a key role in alleviating dry mouth and preventing tooth decay, which is a common oral complication of dry mouth.

Oral Health Tips

Here are some actions you can take to support good oral health: [15]

Drink fluoridated water and brush with fluoride toothpaste.
Practice good oral hygiene. Brush teeth thoroughly twice a day and floss daily between the teeth to remove dental plaque.
Visit your dentist at least once a year (the average person should go twice a year), even if you have no natural teeth or have dentures.
Do not use any tobacco products. If you smoke, seek resources to help you quit.
Limit alcoholic drinks. Some alcoholic beverages can be very acidic, resulting in erosion of tooth enamel, and those with a high alcohol content can lead to dry mouth. Also be mindful of drink mixers, many of which are high in sugar and can increase the risk of tooth decay.
If you have diabetes, work to support control of the disease. This will decrease the risk for other complications, including gum disease. Treating gum disease may help lower your blood sugar level.
If your medication causes dry mouth, discuss other medication options with your doctor that may not cause this condition. If dry mouth cannot be avoided, drink plenty of water, chew sugarless gum, and avoid tobacco products and alcohol. Your oral health care provider may be able to recommend over-the-counter or prescription medications to improve your dry mouth as well.
See your doctor or a dentist if you experience sudden changes in taste and smell.
When acting as a caregiver, help those who are not able to brush and floss their teeth independently.
Chew sugar-free xylitol gum between meals and/or when you are unable to brush after a meal.

Bottom Line – There Is No Health Without Oral Health

As growing research and studies reveal the link between oral health and overall health, it becomes more evident that taking care of your teeth isn’t just about having a nice smile and pleasant breath. Studies show that poor oral health is linked to heart disease, diabetes, pregnancy complications, and more, while positive oral health can enhance both mental and overall health. Good oral hygiene and regular visits to the dentist, combined with a healthy lifestyle and avoiding risks like excess sugar and smoking, help to keep your smile and body healthy.

Glossary of terms

Oral Cavity (mouth) starts at the lips and ends at the throat including the lips, inside the cheeks and lips, the tongue, gums, under the tongue, and roof of the mouth.
Enamel is the hard calcified tissue covering the surface of the tooth.
Gingiva (gums) is the soft tissue covering the necks of the teeth and the jaw bones.
Periodontium is a group of specialized tissues that surround and support the teeth, including the gingiva and bone.
Periodontal disease (gum disease) includes gingivitis and periodontitis. Gingivitis is the mildest form, in which the gums become red, swollen, and bleed easily. Gingivitis is reversible with professional treatment and good at-home oral care. If untreated, gingivitis can advance to periodontitis where chronic inflammation causes the tissues and bone that support the teeth to be damaged. Overtime, teeth can become loose and may fall out or need to be removed. [16]

References

Peres MA, Macpherson LM, Weyant RJ, Daly B, Venturelli R, Mathur MR, Listl S, Celeste RK, Guarnizo-Herreño CC, Kearns C, Benzian H. Oral diseases: a global public health challenge. The Lancet. 2019 Jul 20;394(10194):249-60.
American Dental Association. n.d. Nutrition: What you eat affects your teeth. Mouth Healthy.
Kohn WG, Maas WR, Malvitz DM, Presson SM, Shaddix KK. Recommendations for using fluoride to prevent and control dental caries in the United States. (2001).
Chi DL, Scott JM. Added sugar and dental caries in children: a scientific update and future steps. Dental Clinics. 2019 Jan 1;63(1):17-33.
Ehizele AO, Ojehanon PI, Akhionbare O. Nutrition and oral health. Benin Journal of Postgraduate Medicine. 2009;11(1).
Suvan JE, Finer N, D’Aiuto F. Periodontal complications with obesity. Periodontology 2000. 2018 Oct;78(1):98-128.
Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. International journal of health sciences. 2017 Apr;11(2):72.
Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK, Sasser HC. Poor oral hygiene as a risk factor for infective endocarditis–related bacteremia. The Journal of the American Dental Association. 2009 Oct 1;140(10):1238-44.
Borrell LN, Papapanou PN. Analytical epidemiology of periodontitis. Journal of clinical periodontology. 2005 Oct;32:132-58.
Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, Taubert KA, Newburger JW, Gornik HL, Gewitz MH, Wilson WR. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association? A scientific statement from the American Heart Association. Circulation. 2012 May 22;125(20):2520-44.
American Dental Association. (n.d.). Pregnant? 9 Questions You May Have About Your Dental Health
Reners M, Brecx M. Stress and periodontal disease. International journal of dental hygiene. 2007 Nov;5(4):199-204.
American Dental Association. (n.d.). Osteoporosis and Oral Health.
Cancer Treatment Centers of America. (n.d.). Dry mouth.
Centers for Disease Control and Prevention. 2021. Oral Health Tips.
The American Academy of Periodontology. (n.d.). Gum Disease Information.

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