Ask Dr Gary: Maintain your dental health

As an emergency doctor, I treat patients with dental problems almost daily: gum disease, dental abscesses swelling cheeks to the size of ping-pong balls, cavities eroding teeth down to the gum line. Many people tell me they can't afford expensive dental work like crowns, caps and root canals, which can run into the thousands of dollars. I tell them to get cheap, basic dental care, even if it's just cleanings, fillings, or extractions. It's far better for their health to have a missing tooth than diseased teeth. Rotten teeth and unhealthy gums serve as a gateway for bacteria to enter the bloodstream and have been linked with problems ranging from sepsis to heart attacks.

While absolute proof that dental disease causes heart attacks is still lacking, we can cite a lot of circumstantial evidence linking the two.

For decades we've known that gingivitis causes the same type of inflammation found in coronary artery disease. Smouldering dental infections cause inflammatory debris to leak into our blood vessels, thickening and damaging them.

Strong evidence for this has come since the advent of DNA testing, which has demonstrated oral bacteria living and growing in the walls of our coronary arteries, inside the fatty plaques called atheromas that can rupture blocking blood vessels and cause heart attacks.

At the other end of the spectrum from DNA, we have big population-based studies involving thousands of patients showing that oral disease is a risk factor for heart disease independent of things such as age, sex, obesity and other medical problems. Some researchers believe that dental disease is as big of a risk factor for heart disease as hypertension.

So what can we do? We can cut out soda and smoking, both of which are horrible for our oral health. Brush and floss every day. Invest in basic dental care such as fillings, cleanings, and extractions, and add fluoride to our drinking water to strengthen and preserve our teeth's enamel. And if cost is an issue, we can look into subsidised community dental services offered through our DHB, browse online coupon services like Grabone for discounts or work out payment plans with a dentist.