HEALTH The Crystal Ball
By James Battaglio

The following article was published in the July edition of Hartford Magazine and was authored by medical columnist James Battaglio:

Romantics tell us that the eyes are the windows to the soul. Whether we believe this or not, we like hearing it and we like saying it even more. An even truer axiom, however, is, "The oral cavity is the crystal ball to the body's overall health." 

Hardly the stuff from which poetic verse emanates. 

For the past half-century the medical profession has judged the oral cavity as a victim in the aftermath of disease and infection. Here's how they saw it: First we get a disease or an infection. Once that's treated, the mouth, teeth or gums frequently develop a problem, undoubtedly due to the aforementioned malady. That was the traffic pattern for many years. When it came to diseases, the oral cavity was viewed as the medical caboose, rather than the engine. 

Still, there were just as many dentists and periodontists who argued that science was tracing disease in a reverse direction, and that one's oral health was a key component of overall health. Connecticut Oral Health Initiative, an organization whose mission is to improve and enhance the oral health of Connecticut children and families, for example, states on its Web-site (http://www.ctoralhealth.org), "Oral disease contributes to malnutrition, speech problems and social and emotional distress. It has been implicated in systemic disorders, including heart disease, reproductive dysfunction and toddlers' failure to thrive." 

This theory has not only been validated, but expanded upon, thanks to a new study recently presented before an audience at the University of Connecticut Health Center by Dr. Marjorie Jeffcoat, a professor of dental research and chairwoman of the Department of Periodontology at the University of Alabama, Birmingham. As a result of Jeffcoat's research findings, future patients may be the benefactors of an alliance forged between dentists, internists, obstetricians and surgeons who will work in tandem, particularly as it applies to pregnant women. 

The findings revealed definite evidence that a fetus can fall victim to its mother's poor oral health. Low birth weight and even premature delivery seem to go hand-in-glove with poor oral health, and may actually start in the oral cavity.

Addressing a diverse audience of obstetricians, dentists, periodontists, dental students and members of Hartford's Hispanic Health Council, Jeffcoat cites somewhat shocking examples of premature births in mothers with terrible gum diseases and/or overall poor oral health. 

"It's almost like the baby is saying 'Let me outta here!'" she says. "It's like the baby knows a bad infection is circulating within the body, and nature's way of protecting the fetus is to get it away from further harm. Even a procedure as simple as having teeth cleaned or scaled may reduce low-birth-weight problems." 

Also editor-in-chief of The Journal of the American Dental Association, Jeffcoat says that earlier studies showed a three- to eight-time greater risk of premature births among women with periodontal disease, versus those with healthy gums. Wanting to test the study further and to see if treating gum disease could reduce the rate of premature births, the new study shows that simple cleaning, scaling and root planing reduces infections that result in early labor. The same could not be said about antibiotic treatment, however. When antibiotics were used, they seemed to negate the benefits of scaling and root planing, and premature births were not reduced. 

Calling for tighter bonds between dentists and obstetricians during a patient's pregnancy, Jeffcoat believes that a newly diagnosed mother-to-be should make a dental checkup one of her top priorities, soon after confirming her pregnancy. "Her dentist needs to know she's pregnant and needs to advise her of any problems she might have with her mouth, teeth or gums," says Jeffcoat. If problems exist, the link between dentist and obstetrician should be established early on and continue throughout the pregnancy or until the patient is deemed cured of her oral problem.

My Mouth, My Enemy

To quote Marlon Brando in The Godfather: "How did things get so bad?" The cause of organ and joint infections emanating from the mouth is actually quite simple, and not without irony. While the act of cleaning our mouth and teeth, regardless of the instrument used to accomplish this-electric or manual toothbrush, water pick or even a toothpick-removes plaque and bacteria from the teeth, some of the bacteria naturally enters the body. We're brushing back and forth, up and down, and ingesting saliva mixed with plaque. In this regard, that which we are doing in the name of good oral hygiene is actually creating part of the problem. 

However, cleaning one's teeth is by far the lesser of two evils when compared to poor oral hygiene. To not brush and floss is 1,000 times worse, and leads to infections on a monumental proportion, impacting the body in more ways than medical science has yet to discover. 

"Think of bacteria or infection as seeds," explains Dr. Mike Deren, a thoracic surgeon and chairman of the Department of Surgery at Lawrence & Memorial Hospital in New London. "Now think of the human body as ground or earth in which to grow the seeds. Keep throwing these seeds-which, in this case, are very nasty organisms-on the ground, and eventually they'll take, or grow. If you have a mouth or gum infection, and you swallow puss from the mouth, it can actually create lung and/or brain abscesses. While the exact origin of these lung or brain abscesses is hard to prove, it's been shown that the bacteria within these abscesses are consistent with those found in the mouth-anaerobic and non-anaerobic germs." 

Anaerobic and non-anaerobic germs? The mouth, human or otherwise, actually serves as a clubhouse for two gangs of germs, both of which are real bad actors: anaerobic germs, those that can live in the absence of oxygen, and their non-anaerobic cousins, those that thrive on oxygen. 

"We've all heard that dogs have the cleanest mouths in the animal kingdom," says Deren. "There's some truth to this, simply because dogs pant, forcing air in and out of their mouth. In doing so, all this air kills the non-anaerobic germs dependent on air to live. Thus, the dog destroys much of the air-dependent bacterium found in the oral cavity. As humans, we don't go around panting, so our mouth serves as host to both types of germs." 

Strongly supporting the "my mouth/my enemy" theory is Dr. Henry B. C. Low, world-renowned and now-retired chief of cardiovascular surgery at Hartford Hospital. Over the years Low shocked many patients faced with the prospect of cardiac prosthesis implantation - a heart valve replacement using an artificial valve - with his mandate: "You've got to see your dentist before I'll perform your surgery." 

"The mouth is the dirtiest part of the body. It can cause abscess in bone, which leads to infections and diseases, and it can be the cause of infections in joints," says Low. "If a patient had bad teeth, I ordered those teeth removed before I'd do elective surgery. Once you determine the need for a prosthetic implant, the next thing you check is the patient's mouth. If bacteria land on an artificial heart valve, outside the bloodstream, the blood can't fight it. Horrible infections … very hard to treat, especially if the patient is compromised. The mouth is a real dirty port of entry to the body." There's that non-romantic reference to the mouth as a crystal ball again. 

Male or female, pregnant or otherwise, transit bacteria in the mouth does not discriminate. It goes into the bloodstream, where sometimes the body wins and we are never the wiser; or sometimes the bacteria wins and causes an infection or disease, miles away from the mouth, baffling us with our ailment's origin. 

All in all, the poets are going to have to work real hard to make this sound pretty.