Gums, Hearts & Minds:The Hidden Link Between Oral Health and Longevity - Insights from the Innersight Podcast #28

The Overlooked Link Between Oral Health and Systemic Well-Being

In recent years, growing evidence in both scientific literature and the media has highlighted the profound connection between oral health and systemic diseases such as dementia, cardiovascular disease, diabetes and even pregnancy complications. For those working in the field of longevity and preventive medicine, these associations are especially relevant.

To explore this relationship further, Dr. Johann Lochner, an oral medicine and periodontics specialist based in Somerset West, shared his insights into how gum health impacts overall wellness. Dr. Lochner’s expertise spans oral medicine, which addresses dermatological and mucosal conditions within the mouth, and periodontics, the study and treatment of gum disease. In addition, he performs restorative procedures such as dental implants, bone grafts and gum tissue augmentation.

Gum disease, particularly periodontitis, is an inflammatory condition triggered by bacterial infection. The chronic inflammation that develops in the gums can spill into the bloodstream, contributing to systemic inflammation, a key factor in diseases of aging, sometimes referred to as “inflammaging.” This systemic inflammatory response not only accelerates aging but also contributes to the development of atherosclerosis and other cardiovascular disorders.

Scientific studies have even detected oral bacteria within arterial plaques, suggesting that gum pathogens may directly contribute to the buildup of arterial blockages. These bacteria, along with the inflammatory cascade they provoke, can make blood “sticky,” promoting clot formation and heightening cardiovascular risk.

Given these connections, the discussion around oral health has shifted from cosmetic or localized concerns to one of systemic significance. Researchers are now exploring the possibility of vaccines targeting harmful oral bacteria to prevent their migration into the bloodstream.

Understanding Gum Disease: From Gingivitis to Periodontitis

Gum disease remains the leading cause of tooth loss globally. While tooth decay (caries) affects the structure of the tooth itself, gum disease impacts the surrounding tissues. Over 90% of the population experiences some form of gum inflammation, commonly referred to as gingivitis. Gingivitis manifests as mild gum irritation and bleeding, especially during brushing or flossing. However, if left untreated, it may progress to periodontitis, a more severe condition that damages both the gums and the supporting bone structure, leading to tooth mobility and eventual loss.

Although gingivitis and periodontitis are related, not every case of gingivitis develops into advanced gum disease. Genetic susceptibility plays a major role; some individuals with poor oral hygiene may experience only mild gum inflammation, while others develop severe tissue destruction due to an exaggerated immune response to bacterial buildup.

The initial cause of gum disease is dental plaque, a soft bacterial film that forms on teeth. When not adequately removed through brushing, plaque hardens into calculus (tartar), similar to chalky deposits inside a kettle. Once calcified, it can no longer be brushed away easily, creating an environment where bacteria thrive and inflammation escalates.

Recognizing and Managing Early Signs

Early detection is essential. Persistent bleeding during brushing or flossing is a primary indicator of gum inflammation. Other signs include swollen, reddened gums and persistent bad breath (halitosis). Individuals should be particularly attentive if their gums appear puffy or bleed regularly, as these may signal the onset of periodontal disease.

Professional dental care remains the cornerstone of prevention. While minor gum irritation can sometimes be improved through diligent oral hygiene, persistent symptoms should always be evaluated by a dentist or dental hygienist. Online remedies or self-treatment methods are strongly discouraged, as improper cleaning can worsen the condition or mask underlying disease.

The traditional guideline of biannual dental checkups remains a sound standard, though individual risk factors may necessitate more frequent visits. For patients experiencing gum bleeding or discomfort, prompt evaluation by a dental professional and if needed, a periodontist is the safest and most effective course of action.

Diagnosing Gum Disease: From Subtle Signs to Definitive Assessment

While gingivitis is extremely common, only about 10-15% of the population develops its more severe form, periodontitis. Though this may sound like a small percentage, it represents a significant number of individuals affected by a condition that can lead to irreversible tissue and bone loss if left untreated.

A key challenge in managing periodontal disease lies in its early detection. Many patients are surprised when diagnosed with advanced periodontitis after years of routine dental check-ups. They often wonder why it was not identified sooner. The reality is that diagnosing periodontal disease requires a deliberate, hands-on examination, it cannot be detected through casual observation alone.

The Role of Periodontal Probing

The cornerstone of diagnosis is a simple yet essential clinical procedure known as periodontal probing. Using a slender, calibrated instrument marked in millimeters, the dentist measures the depth of the gum pockets surrounding each tooth. In healthy gums, this space typically measures between 1 and 3 millimeters.

• Healthy gums: 1-3 mm with little to no bleeding.

• Gingivitis: 1-3 mm pockets accompanied by bleeding.

• Periodontitis: Pockets exceeding 3 mm, indicating tissue and bone breakdown.

As gum disease progresses, the natural groove between the tooth and gum deepens, forming pockets that harbor bacterial colonies and hardened calculus. These bacteria continue to thrive below the gum line, exacerbating inflammation and further destroying the supporting structures of the teeth.

Unfortunately, not all dental practitioners routinely perform full-mouth periodontal probing. During a comprehensive periodontal assessment, each tooth is measured in six specific areas: front, middle, and back on both the outer (lip) and inner (tongue or palate) surfaces. Without this systematic approach, early disease may go undetected until significant damage has occurred.

When to Seek Professional Care

Occasional bleeding during brushing or flossing may not always signal disease, for example, it might result from brushing too hard or a minor oral injury. However, persistent bleeding that continues for more than a few days to two weeks should never be ignored.

Individuals who notice repeated bleeding, swollen gums, or discomfort should promptly schedule a dental evaluation. For those without any evident dental issues, an annual check-up may suffice. However, those with a history of cavities, gum irritation, or systemic health risks such as diabetes should consider biannual visits.

Maintaining oral health requires the same consistency as other preventive practices, like regular exercise or medical checkups. While dental appointments are seldom enjoyable, they are crucial in preventing long-term complications. As Dr. Lochner notes, “You may not love spending 45 minutes in the dental chair, but it’s far preferable to losing teeth later in life.”

Managing Early Gum Disease

The good news is that early-stage gum disease (gingivitis) is both reversible and inexpensive to treat. Professional cleaning by a dentist or hygienist removes soft plaque and early calcified deposits, allowing the gums to heal and inflammation to subside.

However, ongoing care is essential. Bacteria recolonize quickly, much like weeds returning to a garden shortly after it’s been cleared. Within days, soft plaque can begin to reform, and if left unchecked, it matures into a harmful biofilm that fosters disease.

Not everyone’s mouth harbors the same bacterial composition. Some individuals possess predominantly “good” bacteria and are less genetically prone to inflammation, while others carry more aggressive strains that trigger rapid tissue destruction. For patients in the latter category, frequent professional cleanings are vital to keeping the condition under control.

The Fundamentals of Daily Oral Care

When it comes to maintaining oral health, consistency and correct technique are far more important than complicated routines or expensive products. According to Dr. Lochner, the foundation of gum and tooth health lies in brushing twice daily and flossing once a day.

While many people admit that flossing is time-consuming or uncomfortable, it remains one of the most effective ways to prevent gum disease.

Brushing Technique: Focus on the Gum Line

A common mistake many people make is focusing solely on the teeth themselves and neglecting the gum margin, the narrow groove where the tooth meets the gum. This is precisely where bacteria accumulate and where gum infections begin.

To clean effectively:

• Use a gentle circular motion rather than harsh, horizontal scrubbing.

• Angle the brush slightly toward the gum line to massage and clean the groove between the tooth and gum.

• Ensure you brush both teeth and gums, not just the tooth surface.

For individuals who struggle with manual dexterity or who have difficulty maintaining proper technique, electric toothbrushes can be an excellent investment. However, it is essential to use them correctly, not merely as a “tooth brush,” but as a tooth-and-gum brush.

The Importance of Correct Flossing

Flossing is not just about removing food particles. Its true purpose is to disrupt bacterial colonies that form in the narrow spaces between teeth and below the gum line. The floss should be gently curved around each tooth, moving slightly beneath the gum edge to clean the sulcus (the natural groove around the tooth).

Bleeding during flossing is often misinterpreted as a sign to stop. In fact, it usually indicates inflammation due to plaque buildup. Dr. Lochner cautions, “The worst thing you can do when your gums bleed is to stop cleaning. That bleeding is your body’s way of saying it needs more attention, not less.”

Similarly, patients are sometimes told that their gums are “receding because they brush too hard.” While overzealous brushing can indeed cause mechanical damage, many cases of gum recession actually stem from inadequate cleaning and bacterial buildup. The solution lies not in avoiding brushing, but in brushing correctly and gently.

The Role (and Limitations) of Mouthwash

Mouthwash is one of the most misunderstood components of oral care. Although it can be refreshing and occasionally therapeutic, it is not a substitute for proper brushing and flossing.

There are two main categories of mouthwashes:

1. Fluoride-based rinses - Recommended for individuals prone to tooth decay. Fluoride strengthens enamel and helps prevent cavities, especially in patients with a history of dental caries.

2. Antibacterial rinses - Containing ingredients such as chlorhexidine digluconate (found in brands like Corsodyl, Paroex, or Meridol), these are typically prescribed for patients with advanced gum infections or following oral surgery.

However, overuse of antibacterial mouthwashes can disrupt the mouth’s natural microbiome by killing both harmful and beneficial bacteria. Furthermore, mouthwashes can only penetrate 2-3 millimeters below the gum surface, making them ineffective for cleaning deeper periodontal pockets where bacteria thrive.

While mouthwash may temporarily reduce inflammation or mask bad breath, it does not remove the bacterial biofilm that causes gum disease. “Giving a patient mouthwash without cleaning the teeth,” Dr. Lochner explains, “is like spraying perfume over dirt, it hides the problem without addressing it.”

Another drawback is tooth discoloration, a common side effect of long-term mouthwash use. This often necessitates professional polishing, something that could be avoided with consistent brushing and professional cleanings.

The Central Role of the Oral Hygienist

For most patients, the oral hygienist serves as the first line of defense against gum disease. Hygienists are trained to detect early signs of inflammation, perform professional cleanings and refer patients for further evaluation when necessary.

In South Africa, as Dr. Lochner notes, hygienists are highly skilled and widely accessible, often more so than dentists. Regular visits to a hygienist every six months can significantly reduce the risk of developing advanced periodontal disease.

If no issues are detected, an annual check-up may suffice. However, if early disease is identified, more frequent visits are advised, similar to how follow-up intervals for other medical screenings (such as colonoscopies) depend on the findings.

Ultimately, the message is clear: preventive care is far more effective and far less invasive than treatment after the fact. Brushing, flossing and professional cleanings remain the foundation of lifelong oral health.

When Should Preventive Dental Care Begin?

One of the most common questions patients ask is: When should routine dental hygiene visits begin? The answer depends on both genetic and lifestyle factors.

There is no universal starting age, rather, parents should consider family history. If one or both parents, or even grandparents, have struggled with tooth loss or gum disease, the likelihood of their children developing similar issues increases. These individuals should begin routine dental hygiene check-ups as early as possible, ideally during adolescence.

For most children, significant periodontal problems before age 14 are rare. Gingivitis (early gum inflammation) can occur, but it is usually managed by a general dentist rather than a specialist. However, once a young adult finishes university or enters the workforce, that is the ideal time to establish a regular relationship with a dentist or oral hygienist.

Dr. Lochner likens this to “investing in compound interest.” Preventive cleanings early in life save enormous time, cost, and discomfort later. Gum disease develops slowly, sometimes over five to ten years but once it progresses, treatment becomes far more complex.

The Systemic Impact of Gum Disease

A key takeaway from the discussion is that gum health is deeply connected to overall systemic health. The small grooves surrounding the teeth, when inflamed or infected, act as microscopic entry points into the bloodstream. These areas are highly vascular, meaning bacteria and toxins can easily circulate throughout the body, triggering widespread inflammation.

Dr. Lochner highlights three particularly vulnerable patient groups:

1. Cardiovascular patients - Chronic oral inflammation can exacerbate heart disease and arterial plaque formation.

2. Pregnant women - Research shows a clear association between untreated gum disease and an increased risk of preterm births and low birth weight infants.

3. Diabetic patients - Poorly controlled diabetes accelerates gum disease, and conversely, treating periodontal inflammation can improve blood sugar control and reduce medication needs.

This interconnectedness underscores why oral health should be viewed as an essential part of preventive medicine, not merely a cosmetic concern.

Why Antibiotics Alone Are Not Enough

Many people assume that a course of antibiotics will clear gum infections, but this is a misconception. Periodontal disease involves a biofilm, a complex colony of bacteria that adheres to tooth surfaces below the gum line. Antibiotics cannot penetrate this biofilm effectively; they only kill bacteria on the outer layers. Once the medication stops, the infection rapidly recolonizes.

Effective treatment requires mechanical removal, professional cleaning and debridement to disrupt and eliminate bacterial buildup. Only in acute cases, such as abscesses accompanied by swelling or fever, are antibiotics used as an adjunct to mechanical therapy.

As Dr. Lochner explains, “You can pour disinfectant into a dirty pipe, but unless you scrub it clean, the bacteria will return.”

The Role of Nutrition and Systemic Factors

While diet alone does not directly cause periodontal disease, systemic conditions such as diabetes, obesity and poor nutritional status can influence its severity. Imbalanced blood sugar levels, vitamin D deficiency, and iron deficiency are all associated with reduced immune resilience and greater susceptibility to gum infection.

Dr. Lochner routinely screens his patients for diabetes, vitamin D, iron, B12 and folate levels, as deficiencies in these markers are often linked to poor tissue health and delayed healing. Low iron and anemia, for instance, reduce oxygen delivery to gum tissues, making them more vulnerable to bacterial attack.

This holistic perspective, connecting oral, metabolic, and nutritional health, reflects a growing understanding that the mouth is not separate from the rest of the body but a critical indicator of systemic wellbeing.

The Overlooked Cornerstone of Longevity

Perhaps the most striking statistic shared in the conversation is that up to 90% of people experience some form of periodontal disease in their lifetime, although only 10-15% progress to severe forms. The good news is that early intervention can halt or even reverse much of the damage.

Dr. Lochner’s closing advice is simple yet powerful:

“If you want to live long and live well, to be a strong, healthy 80-year-old, start by looking after your gums. A six-monthly visit to your oral hygienist or dentist is a small step with a massive long-term reward.”

Maintaining your natural teeth is not merely a matter of appearance. It is a cornerstone of overall health, confidence, and quality of life. The teeth you start with are free, keeping them for life is one of the most valuable investments you can make in yourself.

In Conclusion:

Oral health is far more than a matter of appearance, it is a vital component of overall wellbeing. Gum disease develops quietly, yet its effects can influence the heart, brain and metabolic systems for years. Regular professional cleanings, proper daily care and awareness of genetic or systemic risks can prevent most serious dental complications. By prioritizing gum health as part of a holistic approach to longevity, we not only preserve our smiles but also strengthen the foundation of lifelong health.

If you would like to get in touch with Dr. Lochner, you can contact him through the following website: 🔗 www.johannlochner.com

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