Why You Really Need to Floss
Each time you brush and floss, you’re doing more than freshening your breath and preserving your smile. Research suggests you may also be improving your overall health—and maybe even extending your lifespan.
People often see dentistry largely as a cosmetic specialty, says Anita Aminoshariae, a professor of endodontics at the Case Western Reserve University School of Dental Medicine. But “the mouth is not disconnected from the rest of the body,” she says. Quite the opposite: studies suggest that oral health is associated with everything from heart health to lifespan, even if many people don’t realize it.
Oral health goes beyond the mouth
Researchers call this phenomenon the “oral-systemic link,” and it’s been showing up in studies for years. Some of the earliest findings on this topic were about links between oral health and diabetes, and it’s now well-established that diabetic patients’ blood sugar levels may improve when they’re treated for gum disease—and that their gum disease may worsen if their diabetes does.
Oral health also seems related to other measures of cardiometabolic health, including patients’ likelihood of developing or dying from heart disease. In a recent research review, Aminoshariae and her co-authors found that people with very poor oral health—those with 10 or fewer natural teeth left in their mouths—were about 66% more likely to die from cardiovascular disease than people with more robust smiles. And another recent study, co-authored by Yau-Hua Yu, an associate professor of periodontology at the Tufts University School of Dental Medicine, found that people who describe their oral health as fair or poor are at increased risk of dying and may also be more likely to have cardiovascular disease, osteoporosis, and diabetes.
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Like most research on the oral-systemic link, these studies can’t prove cause and effect. It’s possible the relationship actually works the other way around: that people in poor health are more likely to have bad dental wellness, Yu says. Other factors, like socioeconomic status and access to nutritious food, may also play a role, she says.
But Aminoshariae believes oral health does directly influence overall wellness. She thinks of the teeth like sand dunes. Just as dunes protect inland areas from the sea, Aminoshariae believes the teeth shield the body from foreign substances that could cause disease. “Once they’re gone,” she says, “it’s like a free for all.”
The microbiome, the name for the legions of bacteria, viruses, and other microbes coursing through the human body, is another possible explanation, Yu says. When you don’t clean your teeth properly, allowing food and other debris to sit on and in between the teeth, the bacterial communities in your mouth can change, potentially contributing to gingivitis and gum disease over time, she explains.
When gum health suffers, the consequences can be wide-ranging. The blood vessels in the gums are “leaky,” explains Yvonne Kapila, a professor and associate dean of research at the University of California, Los Angeles School of Dentistry. When someone’s gums are inflamed or diseased, “this leakiness allows bacteria, viruses, and all these other things that are in the outside world to enter your body” and potentially spread throughout it via the bloodstream, she explains.
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In some cases, pieces of bacteria or other microbes may travel from the gums into the bloodstream and cause disease or inflammation in other organs, Kapila says. Bacterial matter from the mouth has been found in cancerous tumors, diseased heart valves and livers, and brain tissue of people who died from Alzheimer’s disease, to name a few notable examples. And, Kapila says, animal studies conducted by her team and others suggest that tweaking the mouth’s microbiome, such as by treating gum disease, may help reverse some of those issues, signaling a true cause-and-effect relationship between oral and overall health.
How to take care of your oral health
The good news is, most people already know what they should be doing to keep their mouth healthy: eat a nutritious diet, brush each morning and night, and floss regularly. Yu’s research suggests inadequate flossing is associated with a higher risk of death, while other studies show that good flossing practices lower the chances of developing gum disease. Brushing for at least two minutes, twice a day, also reduces the chances of developing cardiovascular diseases, according to other research.
“Like you shower every day, you have to brush your teeth every day and clean the gaps [in between] every day,” Yu says. “That is basic stuff.”
Finally, keep up with your twice-yearly dental appointments so a professional can assess your tooth and gum health and intervene, if necessary, before a situation grows serious. “Prevention, prevention, prevention is so critical,” Kapila says.