Plenty of people who wouldn’t dream of delaying a doctor’s appointment or missing a dose of medicine are more than willing to put off seeing their dentist. And the government seems to agree that dental care is less important than medical care—Medicare covers virtually no dentists’ bills. But recent research is making it clear that dental care is medical care, and that the consequence of inadequate attention to the mouth and teeth isn’t just an unpleasant date with a dentist’s drill…it increases your risk for a wide range of serious medical problems.

Medical Dangers of Dental Problems

What’s the real price we pay for dental problems? The list of potentially ­serious consequences is growing longer as researchers focus on this topic…

Alzheimer’s disease. People who have had periodontitis, a form of gum disease, for more than a decade are 70% more likely to develop Alzheimer’s than people who don’t have periodontitis, even after accounting for other factors, according to a 2017 paper by researchers at ­Taiwan’s Chung Shan Medical University.

Cancer. Poor dental health increases risk for a number of cancers. A study by Harvard researchers found that men who had periodontal disease face 63% greater risk for pancreatic cancer than those who didn’t. A study by researchers at University of Washington found that periodontitis sufferers face 73% higher risk for a fatal lung cancer than people who have healthy gums. Both studies accounted for other potential factors such as smoking. Other research has suggested connections between gum disease and increased risk for kidney, blood, and head and neck cancers.

Heart disease. A meta-analysis of five earlier studies by researchers at Canada’s Dalhousie University concluded that people who have periodontal disease have 14% greater risk for coronary heart disease. A separate study by researchers at The Catholic University of Korea and Myongji Hospital found that systolic blood pressure levels decreased as frequency of toothbrushing increased. And a team of researchers at Poland’s Medical University of Warsaw and Medical University of ­Silesia published a paper in 2021 showing a clear relationship between the severity of periodontal disease and the odds that a patient has hypertension. This team also found that treating periodontal disease can significantly reduce high blood pressure.

And more. Additional research suggests that dental issues can increase the risk for asthma, diabetes, endocarditis, erectile dysfunction, high cholesterol, inflammatory bowel disease, kidney disease, liver disease, osteoporosis, respiratory diseases including COVID, rheumatoid arthritis, stroke and more.

How is it that tooth and gum problems have these major health consequences elsewhere in the body? It is related to the multitude of microbes that live in our mouths.

Much has been written in recent decades about the importance of maintaining a healthy gut ­microbiome—the range of bacteria and other microorganisms that live deep in our digestive systems and influence our health.

The oral microbiome has received less attention outside of dental circles, but it is tremendously important to our health as well. One likely reason: Microorganisms that live in the mouth cause periodontal disease, which includes inflammation of the gums, and it’s increasingly apparent that the inflammation can become systemic. Fortunately, our oral microbiome is somewhat under our control.

Strategies for a Healthier Oral Microbiome

The best way to develop a healthier gut microbiome is by making changes to our diet. The same goes for our oral microbiome, but that’s only one of the ways we can alter the mix of ­microorganisms in our mouth for the better.


Avoid most mouthwashes. If you read the label of a typical mouthwash, you might see a claim that it “kills 99.9% of the germs that cause bad breath.” Problem: Mouthwashes that kill the microbes we don’t want in our mouths often kill the beneficial microbes that we do want there. Using most mouthwashes is like dumping harsh chemicals on a garden every day to kill weeds—you’ll kill the weeds, but you’ll probably also kill
the plants you’re trying to cultivate.

Best: Choose a mouthwash that isn’t acidic—and that means avoid most mainstream brands. Many detrimental oral microorganisms thrive in acidic saliva…while alkaline saliva favors the beneficial ones. Examples of alkaline mouthwashes: CariFree Maintenance Rinse, RiseWell All-Natural Alkaline pH Balancing Mouthwash, TheraBreath Oral Rinse and SuperMouth Mouthwash.(Note: Dr. Hoss has a financial interest in SuperMouth products.)


Choose toothpaste that features prebiotics. Prebiotics are powerful compounds that feed and promote the healthy growth of beneficial microorganisms while starving harmful ones in your mouth and gut. Note: Prebiotics are different from probiotics, live microorganisms in food or supplements, that benefit the gut microbiome.

Prebiotics shown to be helpful include inulin, a naturally occurring dietary fiber found in plants such as chicory root, asparagus, leeks and onions…and xylitol, a naturally occurring sweetener found in many fruits and vegetables—its sweetness often is used to make some oral-care products taste better without any sugar. Toothpastes containing one or both of these prebiotics include Boka Natural Toothpaste, Great Oral Health Pro-Mineralizer Natural Toothpaste, Pearlie White Active Remineralization Toothpaste and SuperMouth Hydroxamin with Fluoride Toothpaste.


Make sure that your toothpaste contains fluoride compounds and/or hydroxyapatitethe only two ingredients that have been proven to prevent cavities. Note: Toothpastes in the US that contain hydroxyapatite cannot yet claim they are “anti-cavity” because the FDA has not yet specifically approved that claim. But there’s plenty of reason to trust it—it has been used in Japan for decades and has received approval in Canada. Several US manufacturers use hydroxyapatite, including SuperMouth and Boka. The evidence that fluoride protects against cavities is even stronger, but fluoride can be toxic in large quantities, which causes some people concern.

Warning: Wait at least 30 minutes after eating to brush your teeth. Your saliva is more acidic than usual after you eat, and brushing before this acidity level drops can damage tooth enamel.


Get a pet, and get a little dirty. Americans are keeping their homes and hands cleaner than ever—and there’s a growing suspicion that it might be making us less healthy by depleting our oral and gut microbiome. This doesn’t mean we shouldn’t clean our homes and hands…just that it’s probably wise to balance cleaning with some exposure to microbes. Ways to do that: Adopt a cat or dog…and engage in a hobby that gets your hands dirty, such as gardening. These things expose us to beneficial and detrimental microorganisms, but as long as we follow the other tips listed here, the beneficial ones are likely to thrive. Reminder: Monitor your pet’s dental health. If you notice swollen or bloody gums or the animal has chronically bad breath, discuss it with a vet. The healthier your pet’s oral ­microbiome, the greater the odds that the microorganisms you gain from living with the dog or cat will benefit you.


Eat less sugar. Sugary foods can negatively impact the oral microbiome in ways that do much more than cause cavities. Excess sugar consumption tends to make saliva more acidic—and as noted, acidity benefits the problematic microorganisms in the mouth at the expense of the beneficial ones. Keep in mind that snacks and desserts aren’t the only foods that contain lots of sugar—a wide range of processed foods are packed full of sugar these days. Rule of thumb: Sugary items should be no more than 10% of your diet. Simple carbs, such as candy, cereal and fruit juices tend to increase the acidity of saliva, too.


Correct mouth breathing. It’s normal to breathe through your mouth during a bout of congestion or while exercising. But breathing through your mouth regularly can lead to dry mouth, and that’s detrimental to the oral ­microbiome, according to a 2021 paper by a researcher at King’s College London.

Ask your doctor about treatments that can prevent mouth breathing. Options could include oral exercises, devices worn during sleep, allergy treatments or even surgery, such as to correct a deviated ­septum. Some medications also can cause dry mouth.

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