Many of us reflect on our health and habits as we approach the New Year, often making resolutions to improve both. But what if one of the most beneficial habits for our overall health was the simple, daily act of caring for our teeth?

Ben Massell Dental Clinic (BMDC) volunteer dentist Dr. David Kurtzman has long been educating patients in his private practice and the BMDC about the importance of oral care. While insurance and even the field of dentistry can tend to separate our teeth as distinct from our overall health, Dr. Kurtzman reminds us that our mouth is an organ which is inexplicably connected to our entire body.

We had the pleasure of interviewing Dr. Kurtzman about how the mouth is the “front door” to better gut health, the fascinating journey of germs throughout our body, and whether or not he recommends using mouthwash.

INTERVIEW WITH DR. DAVID KURTZMAN:

How can we know “how we are doing” in terms of oral health?

If you mean “we” as individuals, just take a quick survey of your mouth. Does anything hurt? Do I feel holes in my teeth, or are parts of my teeth missing? Am I missing teeth? Do my gums bleed a lot when I eat or brush? Things like that. If you mean “we” as a society, the answer is similar only we focus on the number of people who can answer “yes” to these questions. In my experience, “as a society” we are not doing too well. We have great dentists and great dental technology, but under half of the population sees a dentist regularly and around 35% never see a dentist unless they are in pain! The amount of untreated decay is huge. The CDC estimates over 45% of children from 2-19 years have untreated decay and over 90% of adults aged 19-64 have the same!

Medical and dental literature in the past ten years or so has been reporting distinct and frightening connections and correlations between oral (dental) and systemic (full body) diseases like diabetes and heart disease.

In some East Asian Countries, the mouth is looked upon as a “window to overall health.”

Tell us more about how the mouth can be “a window to overall health.”

An unhealthy mouth is a pretty good indicator of problems in the rest of the body. While we generally view our mouths as kind of separate from the rest of our bodies (“dentists” and “doctors” go to different schools, take different insurances and use a lot of different words) the mouth is actually the top part of the digestive tract, and an opening to the lungs! Saliva and chewing are the first steps in breaking down and digesting food. Healthy saliva helps pre-digest food, and it protects our teeth from cavities and our mouths from infection. We hear a lot about “gut bacteria” and “healthy bacteria in our system,” and the same is true of the mouth. As long as the “healthy” bacteria are predominant, our mouths tend to be healthy. Anything that can cause the “bad bacteria” to grow is bad for our mouth and bad for our health. Poor oral care (not cleaning teeth daily) is a big cause of this. Lack of good, healthy saliva is another. Because of certain drugs and medications as well as the natural effects of aging, many people don’t have enough saliva and end up with tooth decay, infections and pain!

An unhealthy mouth will spread its disease to the rest of the body as well. Infection can spread to the lungs via your saliva and to the rest of your body in your blood.

How exactly do the bad bacteria in our mouths cause problems throughout our bodies?

Our blood system circulates blood throughout our bodies. This blood not only carries oxygen and nutrients, but it can also carry bacteria (“germs”) and toxins (poisons). Any “bad” bacteria in our mouths can be picked up by the blood as it passes through our faces and heads and spread to the heart and to the rest of the body.

How would the bad bacteria get into our blood?

Well, if you have bleeding gums, you have little sores or openings into the tiny blood vessels in your gums. Blood can seep out and germs can get in. Believe it or not, every time you eat and chew, the bacteria count in your blood goes up a little bit – it doesn’t take much. Other sores like a cut from crunchy food, biting your tongue, irritation form dentures or partial dentures all allow bacteria into the blood.

What happens once the bad bacteria get into the blood?

That blood that’s carrying the bacteria from your mouth goes down your neck, into the veins under your clavicles, then into your heart. Suddenly, there’s a bacterial load in your heart. If you’ve got any problems in your heart, like an artificial valve, or scars from previous diseases, that bacteria find a home and grows causing major problems.

The heart also pumps this infected blood to the rest of the body. If you have things like atherosclerotic plaques, artificial joints, implants or any area that the bacteria can attach to, they also find a home there. Anywhere the blood flows, it can carry bacteria and cause an active infection.

Another problem is any bacteria from your mouth that gets into your bloodstream travels to your heart, lungs, and system before it goes into the liver – which is the organ that is designed to detect, capture, and clear bacteria.

As I mentioned, the bad bacteria can also get into your lungs via your saliva. If you have any problems in your lungs- for example, some people with poor lung function end up with mucus just sitting in the bottom of the lungs and it doesn’t get cleared- the bacteria can get into that and multiply, causing lung infections and breathing problems.

So, when people ask, “why is the bacteria in your mouth possibly harmful, it’s just your mouth?” Well, it’s not just your mouth, because your blood system will drag it to the rest of your body. It is a “system” like any organ systems in medicine- ENT, Gastroenterology, breast, hematology, cardiac, etc. Presenting the mouth as teeth, gums, tongue, saliva, pre-digestion, breathing- suddenly it becomes more than just a smile, and a cosmetic thing.

This is fascinating, and a great reminder of how essential it is to maintain our oral health. How can we prevent the bad bacteria from taking over?

Prevention is simple: brush, floss and stay away from the stuff that feeds the bad bacteria, i.e. sugar and acid. When you do have sugar (and sugary foods) and acidic things (soft drinks, tart candies), rinse your mouth out with water afterward if you can. Know that repeated small inoculations of sugar are worse than a single exposure- if you slam a coke, that’s not great but it’s better than taking small sips of it all day.

Chew your food slowly. Saliva contains chemicals that break down carbohydrates, and chewing the food breaks it down and gets it ready to be processed by the saliva and the stomach.

Get a cleaning twice a year; even once a year is fine if you’re brushing and flossing regularly. If you’re afraid of the dentist, there are dentists who understand. If it’s a financial concern, find a place to have an affordable cleaning.

So if someone has time to do one thing, only one thing?

Brush your teeth. That’s the most important. Then floss, or really just get between your teeth- it can be a toothpick even, just moisten it first so it isn’t sharp. Those two things are key.

What about mouthwash?

Actually, I don’t recommend mouthwash for a healthy mouth. Remember, your mouth has good bacteria and bad bacteria; mouthwash kills both of them. It’s like an antibiotic- I recommend it for an infected mouth, but not generally for a healthy one.

Any other tips?

Yes, a big one: at night, when you brush your teeth before bed, don’t put anything in your mouth besides water. When you sleep, generally, your lips are closed. If your lips are closed, oxygen isn’t getting in. There are two types of bugs: the ones that thrive on oxygen, and the ones that thrive without it. The ones that thrive without oxygen are anaerobes, and in general they’re the bad guys. So when you’ve brushed your teeth for the last time and decide to eat a cookie before bed, suddenly there’s food in there plus closed lips. So, the anaerobes now have a warm, moist, oxygen-free, food-rich environment in which to grow. In fact, those anaerobes are part of why we have bad breath in the morning- there’s bacteria growing. That’s why we brush twice a day.

So how does Ben Massell Dental Clinic fit in?

Most of the work we do at BMDC is primary care level dentistry, simply taking care of oral health. Pain, infection, disfunction- these are the problems we treat that are caused by oral disease, which can be prevented with good oral care. These are the problems that potentially impact the health of the whole body.

Thank you so much to Dr. Kurtzman! Click here to support the Ben Massell Dental Clinic, and sign up for The Ben Massell Brush Up quarterly newsletter here.