when you're smiling


Follow these six simple steps to keep gum disease at bay

Want to improve your smile in just seven minutes a day? How about if those seven minutes included a toothbrush, toothpaste and some dental floss? If you're like a lot of people, you'd probably hesitate. That's because many of us have issues with regular brushing and flossing. But if you don't want to end up with periodontal disease (a.k.a. gum disease), a chronic condition affecting more than 30 million Americans, it's time to put those hang-ups aside. Full-blown periodontal disease doesn't happen overnight. It's a progressive condition that gets worse over time. And most adults have some form of it right now.

Normal, healthy gums are pale pink and firm. But a collection of bacteria on the teeth from a buildup of plaque causes the gums to bleed easily and become tender, red and swollen--a precursor to a stage of periodontal disease called gingivitis. (Plaque is a soft, sticky white film that forms naturally on the teeth.) Untreated, gingivitis progresses to periodontitis--an inflammation of the tissue that joins the teeth and gums. Eventually, this can lead to tooth loss.

Gum disease can also affect your heart and lungs and may make pregnant women more likely to give birth to premature, low-birth-weight babies, according to a recent report from the surgeon general. Research shows that after bacteria lodges itself in the gums, it can travel to the heart through the blood, causing small artery-dogging clots--and triggering heart disease, heart attacks and strokes. According to the Chicago-based American Academy of Periodontology, people with gum disease have nearly twice the risk of suffering a fatal heart attack than those who don't have it. These bacteria can also get into the lungs through breathing (causing diseases like emphysema) and into the uterus, sometimes leading to early labor.

There are several steps you can take, however, to ensure that you never get gum disease or, if you do, that you prevent tooth loss. The key is keeping the bacteria under control.

1 Plaque Attack
Your first line of defense against gum disease is brushing at least twice a day and flossing once; this will prevent a buildup of plaque and tartar on the teeth. (Plaque that's not removed by regular brushing and flossing hardens into tartar, a crusty deposit only dentists can remove.) Your best weapons are the most basic ones: toothbrush, toothpaste, dental floss and mouthwash.

TOOTHBRUSH: The size and shape should fit your mouth, allowing you to reach all areas easily. Always use soft-bristled toothbrushes, as they're best for cleaning plaque from the crevices between the teeth and won't irritate the gums. In addition to traditional toothbrushes, says Manhattan-based dentist Lana Rozenberg, DDS, "electric ones, particularly those with revolving tufts of bristles and those that move back and forth very rapidly, have been shown to remove more plaque than ordinary brushes." Some newer brushes even use sound waves to remove plaque. Others have a little rubber point attached to the bottom that helps keep plaque along the gum line under control. Simply run the tip under the gum line to gently scrape away the plaque. (These rubber-tip stimulators are also sold separately.) No matter which brush you choose, replace it every three months (and after you've been sick) because of bacteria buildup.

TOOTHPASTE: The topic is controversial, but many dentists recommend using a toothpaste with fluoride to harden the tooth's surface and make it more resistant to the buildup of bacteria and decay. Other ingredients to look for include natural antibacterials like tea tree oil, goldenseal and myrrh, and anti-inflammatories like echinacea. Natural cleansing ingredients such as sodium bicarbonate (baking soda), bloodroot and neem (an Ayurvedic extract) also help combat plaque.

FLOSS: Medium-width floss is best, as anything thinner can cut the gum if not guided along the tooth properly. If your teeth are extremely close together, get the waxed kind, as it will help the floss glide easily between the teeth. Dental devices called oral irrigators clean the areas between the teeth and can be used along with flossing, particularly by people who already have gum disease and need to keep it in check. These devices shoot an intermittent, pulsating stream of water between the teeth and under the gum line.

MOUTHWASH: This helps wash bacteria from the mouth, especially when you can't brush after a meal. Look for natural antibacterials like those mentioned above. Use after brushing and flossing, especially at bedtime.

TONGUE SCRAPER: These long, plastic (or metal or wooden) devices are usually ridged on one side to help clean the tongue--the oft-forgotten spot in the mouth that collects bacteria contributing to gum disease. After brushing and flossing (but before using a mouthwash), run the device along your tongue (from back to front) one to three times, making sure to rinse the tongue scraper between passes.

2 The Food Factor
Dental-health experts like Lois Duerst, DDS., a spokesperson for the American Academy of General Dentistry who practices in Hastings, Minn., say you must boost the body's ability to fight off periodontal disease. One of the best ways to do this, says Duerst, is by eating a balanced diet rich in a variety of nutrients--particularly calcium, vitamins C and D and the B vitamins.

In a study of 227 post-menopausal women, those with strong bones were less likely to suffer from periodontitis and tooth loss than those with low bone density. Because calcium strengthens the jawbone, which anchors the teeth in place, you need at least 1,000 milligrams (mg.) of it per day, which you can get from broccoli, kale, spinach, yogurt, beans and calcium-fortified orange juice. Vitamin D, which aids in calcium absorption, keeps teeth from becoming too soft and thus susceptible to decay and disease. Brewer's yeast and green leafy vegetables are good sources of vitamin D (as is 15 minutes of sunshine a day); the recommended daily dosage is 400 international units.

Vitamin C is essential for boosting immune function and producing healthy connective tissue, and can be found in citrus fruits, tomatoes, strawberries, red peppers, broccoli and kiwi. The B vitamins, particularly folate, are important for keeping the gums and surface tissues in the mouth healthy. Good sources are green leafy vegetables, brewer's yeast and sea vegetables. The daily recommendation is 400 micrograms. Recent studies also suggest that the antioxidant co-enzyme Q10 helps prevent gum disease by helping the body fight off infection. Experts suggest 50 to 150 mg. a day.

Since the foods you eat contribute to the growth of bacteria in the mouth, it's a good idea to limit sugary and starch-based snacks. You should also drink at least eight glasses of water a day to produce more saliva, which dilutes the toxins produced by plaque.

3 Up in Smoke
Besides the obvious drawbacks--bad breath, increased risk for most chronic diseases and wrinkles--smoking increases your risk of periodontitis by 400 percent, according to a recent study by the Centers for Disease Control and Prevention. Researchers believe that smoking not only leaves the gums more vulnerable to bacterial infection, but that it also suppresses the body's immune system. In addition, smoking reduces blood flow to the gums, depriving them of the oxygen and nutrients that keep them healthy.

4 Gender Differences
Studies suggest that women may be more prone to gum disease than men. They're most susceptible to developing it immediately before getting their period each month, during pregnancy and menopause, and when they're on birth control pills--all times when hormonal changes make gums more sensitive to bacteria. For this reason, women need to be extra thorough about brushing and flossing to prevent bacteria from collecting on the gums and periodontal disease from setting in or getting worse.

5 A Family Affair
If either of your parents has or had gum disease, you're at a high risk of developing it, explains Rozenberg. A study in the Journal of Medical Genetics (February 2000) found that gum disease is more common in people whose gene for the enzyme cathepsin is defective. (Cathepsin C, found in the skin and bone cells, triggers several of the chemicals that control the body's immune response.) Researchers also found that when a spouse has a gum infection, the partner is often infected with the same strain of bacteria, believed to be transmitted through kissing and an exchange of saliva.

6 Stay on Top of It
Once you get periodontal disease, you can never get rid of it. But you may be able to reverse the damage a bit, keep the bacteria under control and prevent the condition from reaching more advanced stages. The best way to do this is to be vigilant about caring for your teeth and gums. Just one night's lapse is enough to start the buildup of plaque. If you already have some degree of gum disease, your dentist can take full-mouth X-rays to track bone loss and can measure the areas, or pockets, where the gums are receding with a periodontal probe, a device that looks like a tiny ruler. Normal, healthy pocket depth is 1 to 3 mm. The first stage of gum disease begins at measurements greater than 3 mm. and up to 6 mm. Moderate gum disease is diagnosed when pocket depth measures 6 to 8 mm., and advanced gum disease is diagnosed when the pocket depth measures 8 mm. or more. If advanced stages of the disease are detected, professional cleaning (called scaling) of the teeth and gum pockets is done while you're under anesthesia (local or general) depending on how serious your condition is. In very advanced cases, you may need surgery to reduce the pockets--and perhaps even antibiotics to stop bacterial growth.

Regardless of when you're diagnosed or at which stage, the goal is to stop the disease's progression. "Once diagnosed, people become complacent about gum disease," says Duerst. "But it's not something you can become complacent about. It's like diabetes: you must be vigilant about treating it."

It's easy to spot New York City-based health and beauty writer VALERIE LATONA: She's the one flashing her toothy smile.

brushing and flossing 101
To brush, hold your toothbrush beside your teeth horizontally, with the bristles at a 45-degree angle to your gum line. In small circular motions (never back and forth), gently brush both the fronts and backs of the teeth--for about two minutes total. Then delicately massage the gums with the brush--above, below and behind your teeth. Finish by brushing your tongue, which also collects bacteria.
To floss, take an 18-inch piece and wrap ends around both index fingers. Guiding the floss with your thumbs and index fingers, slide it between your teeth. Curve the floss into a C-shape against one tooth and gently slide it into the space between the gum and the tooth. Hold the floss against the tooth and gently scrape the side (so as not to cut the skin), moving the floss away from the gum on both sides. Repeat for each tooth, including back molars.
editors' picks
WELEDA PINK TOOTHPASTE with myrrh: (800) 289-1969; www.weleda.com
THE NATURAL DENTIST HERBAL TOOTHPASTE AND GUM THERAPY with echinacea and goldenseal: (800) 615-6895; www.thenaturaldentist.com
TOM'S OF MAINE TOOTHPASTE with spearmint oil and birch tree extract: (800) 775-2388; www.toms-of-maine.com
THURSDAY PLANTATION TEA TREE TOOTHPASTE with tea tree oil: (631) 293-0030; www.thursdayplantation.com
NATURE'S GATE HERBAL NATURAL TOOTHPASTE GEL with goldenseal, vitamin C, and essential oil of wintergreen: (800) 327-2012; www.levlad.com/natures%5fgate
PEELU TOOTHPASTE with essential oils of spearmint and tea tree: (800) 457-3358

IPSAB HERBAL GUM TREATMENT with prickly ash bark and peppermint essential oils: (800) 862-2923; www.caycecures.com
AUBREY ORGANICS NATURAL MINT MOUTHWASH with witch hazel oil, peppermint oil, and vitamins C and E: (800) AUBREY-H; www.aubrey-organics.com
NATURE'S PLUS HERBAL ACTIVES OPTIFRESH MOUTHWASH with echinacea and neem: (800) 645-9500; www.naturesplus.com

By Valerie Latona

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