Improve your

health today

Oral Health Means Better Health

for you and your family
 32
Why
thirty-two?
That’s how many teeth the
average adult has. Of course,
there are many more reasons
that make staying on top of
your oral health care key to
your overall health.
 The Mouth-Body
Connection®
The Mouth-Body Connection refers to the link between
oral health and overall systemic health, and the role
that the harmful bacteria and inflammation in our
mouths play in chronic, systemic disease. We’ve
known about The Mouth-Body Connection for nearly
two decades, since the Surgeon General’s Report on
Oral Health in America in 2000 (and updated 2021).
The mouth is the window to the rest of the body.

Let’s act on this knowledge together.

 Reason 01: Inflammation 6
02: The 5 biggest, baddest bacteria

Reason 03: Brain Health 8

S

04: Tooth truth

05: Before you forget
T

06: The dental mental dilemma

07: Hard-to-pronounce bacteria
N

Reason 08: Heart Health 14

E

09: Talk to the mouth

1 0: Toothbrushing and heart health
T

1 1: Save on heart attacks

1 2: Regular checkups
N

Reason 13: Diabetic Health 20

O

14: Toothbrushing and diabetes

15: Gum disease and diabetes
C

16: Dentistry makes a difference

17: Spit expectations
F

Reason 18: Maternal Health 26

19: Preterm, low-weight babies
O

20: Preeclampsia and miscarriage

21: Healthier pregnancy
22: Hormones and your mouth
E

Reason 23: Cancer 32

24: Cancel oral cancer
L

25: Head and neck cancers

B

26: Early detection

27: Teeth, tobacco, and alcohol
A

Reason 28: The Economics 38

T

29: Gum disease globally

30: Preventative oral healthcare savings
3 1: Good financial hygiene
32: Oral health = better health

©2022 Smile Generation. All rights reserved.

Smile Generation® and The Mouth-Body Connection® are registered
trademarks of Pacific Dental Services®.
 R E A S O N 0 1

Inflammation is
the root cause of all
major diseases.
Scientists from around the world now agree
that inflammation is the root cause of all
major diseases: cancer, heart disease, and
diabetes—even Alzheimer’s.1

– Harvard Medical School, 2020

6 32 Reasons You Need to Know More About The Mouth-Body Connection®

R E A S O N 0 2

The 5 biggest,
baddest bacteria:
1. Aggregatibacter actinomycetemcomitans (Aa)
2. Porphyromonas gingivalis (Pg)
3. Tannerella forsythia (Tf)
4. Treponema denticola (Td)
5. Fusobacterium nucleatum (Fn)

The five biggest, baddest bacteria (a.k.a. periodontal

pathogens) travel from the mouth throughout
the body contributing to heart disease, diabetes,
pregnancy complications, cancer and Alzheimer’s.
Salivary diagnostic testing can measure the levels of
these bad bacteria and identify your individual risk
factors, putting you on the path to better health.2

Improve your health today. | Smile Generation® 7

 What do my
teeth have to do
What
with mydobrain?
my
teeth have to do
R E A S O N 0 3

with my brain?
Chronic gum inflammation increases the risk of
developing Alzheimer’s disease. As oral bacteria
R E A S O N 0 3
breaks into the bloodstream through the gums,
it can travel to organs throughout the body,
including the brain.3

The most common bacteria associated

with Alzheimer’s disease and dementia,
Pg, can now be identified through a
simple salivary diagnostic test that you
can take in the dental office.*

Ask your dentist about it today.

* The diagnostic test, sent to an external lab, measures 11 types of bacteria
(a.k.a. periodontal pathogens) known to cause gum disease.

8 32 Reasons You Need to Know More About The Mouth-Body Connection®

Improve your health today. | Smile Generation® 9
10 32 Reasons You Need to Know More About The Mouth-Body Connection®
R E A S O N 0 4

Tooth loss.
Memory loss.
Losing more than half your teeth by age 60 may
more than double your risk of Alzheimer’s disease.4

R E A S O N 0 5

Before you forget.

For participants in a case study, the most
common cause of tooth loss was periodontal
disease occurring 20 to 30 years prior to the
onset of dementia.5

– Inside Dentistry, 2015

– Journal of American Dental Association, 2007

Improve your health today. | Smile Generation® 11

 R E A S O N 0 6

The dental mental

dilemma.
People with dementia and Alzheimer’s tend
to decline in their oral hygiene. This creates a
vicious cycle of periodontal disease, which leads
to dementia, further declines in oral hygiene, and
then worsened periodontal disease.6

12 32 Reasons You Need to Know More About The Mouth-Body Connection®

 R E A S O N 0 7

Porphyromonas
gingivalis
(We know. That's a lot of syllables.
Trust us: That can be some really bad stuff.)

Research shows that oral bacteria

Porphyromonas gingivalis (Pg), the main pathogen
in chronic gum disease, has been identified in the
brain of Alzheimer’s disease patients.7

– Science Advances, 2021

Want to know your oral health numbers?

Ask your dentist about salivary diagnostic exams.
 Can dental
problems affect
my heart?
R E A S O N 0 8

Research has shown that people with periodontal

(gum) disease are two to three times more likely
to suffer from a heart attack or other serious
cardiovascular issue.8

– Harvard University, 2019

The most common bacteria associated

with heart disease (Aa, Pg, Tf, Td, and Fn)
can now be identified through a simple
salivary diagnostic test that you can take in
the dental office.*

Ask your dentist about it today.

* The diagnostic test, sent to an external lab, measures 11 types of bacteria
(a.k.a. periodontal pathogens) known to cause gum disease.

14 32 Reasons You Need to Know More About The Mouth-Body Connection®

Improve your health today. | Smile Generation® 15
 R E A S O N 0 9

Your mouth has

something to say your
heart needs to hear.
(Actually, two things.)
1) 50% of heart attacks may be triggered by an infection
found in the mouth. 2) Studies show the adverse effects
on your heart from gum disease are due to five high-risk
oral bacteria (a.k.a. the five biggest, baddest bacteria we
told you about earlier).9

– Circulation, 2013
– Postgraduate Medical Journal, 2016
R E A S O N 1 0

A healthier heart
and smile in just two
minutes a day?
Yes, please!
A study presented at the American Heart
Association’s Scientific Sessions in 2018 showed that
brushing your teeth with fluoride toothpaste twice a
day for at least two minutes could lower the risk of
developing cardiovascular disease.10

Improve your health today. | Smile Generation® 17

 R E A S O N 1 1

Spend on dental
cleanings. Save on
heart care costs.
Patients with heart disease who received dental
services spent 31.1% less on healthcare costs.
Additionally, heart disease patients who completed
periodontal treatment and maintenance saw a
28.6% reduction in annual hospitalizations.11

18 32 Reasons You Need to Know More About The Mouth-Body Connection®

R E A S O N 1 2

Regular dental
checkups for a
healthier heart.
A study out of Sweden suggests that “dental
screening programs including regular check-ups
and education on proper dental hygiene may help
to prevent first and subsequent heart events.” 12
(In other words, see your dentist.)

Improve your health today. | Smile Generation® 19

 How can
healthy gums
reduce the risk
of diabetes?
R E A S O N 1 3

Chronic gum disease may cause your blood

sugar level to rise, which makes diabetes more
difficult to manage. Regular dental cleanings can
help improve blood sugar control.13 But findings
on the following pages show how oral health can
help reduce the risk of developing diabetes in
the first place.

The five bad bacteria are associated with

insulin resistance, prediabetes and diabetes,
and can now be identified through a simple
salivary diagnostic test that you can take in
the dental office.*

Ask your dentist about it today.

* The diagnostic test, sent to an external lab, measures 11 types of bacteria
(a.k.a. periodontal pathogens) known to cause gum disease.

20 32 Reasons You Need to Know More About The Mouth-Body Connection®

Improve your health today. | Smile Generation® 21
 R E A S O N 1 4

More brushing.
Less diabetes?
Researchers in Europe found that brushing teeth
three times a day or more is linked to an 8% lower
risk of developing diabetes. Additionally, just having
periodontal disease is associated with a 9% increased
risk of developing diabetes. For people missing 15 or
more teeth, this risk increases to 21%.14

22 32 Reasons You Need to Know More About The Mouth-Body Connection®

 R E A S O N 1 5

Did you know?

A recent study found that nearly one in
five people with severe gum disease had
Type 2 diabetes and didn’t know it.15

– American Diabetes Association, 2017

 R E A S O N 1 6

A difference in
managing diabetes.
Researchers in Spain found that diabetic
patients who received advanced oral treatment
and other oral health interventions were able to
maintain better blood sugar levels than those
who received basic dental care.16

24 32 Reasons You Need to Know More About The Mouth-Body Connection®

 R E A S O N 1 7

Expect more from

your spit.
Some oral conditions are more common in people
with diabetes, such as dry mouth. Saliva protects
teeth from cavities. If not enough saliva is being
produced, the food, drink or bacteria in your mouth
won’t get washed away as easily. Plus, it can cause
further tooth decay, soreness or infections. 17

– American Diabetes Assosciation

 Can my gum
health affect
my pregnancy?
R E A S O N 1 8

Almost 20% of the pre-term, low-weight births

occurring each year might be attributable to
periodontal disease.18

– Journal of the American Dental Association

Elevated levels of Fn are associated with

pregnancy complications and can now be
identified through a simple salivary diagnostic
test that you can take in the dental office.*

Ask your dentist about it today.

* The diagnostic test, sent to an external lab, measures 11 types of bacteria
(a.k.a. periodontal pathogens) known to cause gum disease.

26 32 Reasons You Need to Know More About The Mouth-Body Connection®

Improve your health today. | Smile Generation® 27
 R E A S O N 1 9

Reduce the number of

preterm, low-weight
babies by 80%.
Treating periodontal disease prior to the second
trimester has been shown to reduce the number
of pre-term, low-weight babies by 80%.19

– Journal of Periodontology, 2002

28 32 Reasons You Need to Know More About The Mouth-Body Connection®

 R E A S O N 2 0

40% of
pregnant women
have some form of periodontal disease,
which may also contribute to preeclampsia
and miscarriage. 20

– Journal of Periodontology, 2004

 R E A S O N 2 1

Healthier pregnancy.
Healthy savings.
Pregnant patients who completed periodontal
treatment and maintenance saved $2,433 in
annual medical costs. 21

– United Concordia Dental, 2014

R E A S O N 2 2

Hormones can wreak

havoc on your gums.
Hormone changes occur during pregnancy and
later during menopause. The hormone levels
increase the blood flow to the gums, making the
tissue swollen and more susceptible to plaque and,
consequently, gum disease.22

Improve your health today. | Smile Generation® 31

 Is there a
connection
between cancer
and gum health?
R E A S O N 2 3

According to the Centers for Disease Control and

Prevention, cancer is the second leading cause
of death in the United States, exceeded only by
heart disease. Better oral care and treatment
promises to help eliminate cancer-causing
microbes in the mouth .23

The most common bacteria associated

with cancer (Aa, Pg, Tf, Td, and Fn) can
now be identified through a simple salivary
diagnostic test that you can take in the
dental office.*

Ask your dentist about it today.

* The diagnostic test, sent to an external lab, measures 11 types of bacteria
(a.k.a. periodontal pathogens) known to cause gum disease.

32 32 Reasons You Need to Know More About The Mouth-Body Connection®

Improve your health today. | Smile Generation® 33
 R E A S O N 2 4

Cancel oral cancer

with advanced, proven
technology.
Oral cancer kills about one person per hour,
24 hours a day.24 Oral cancer screenings
accompanied with devices like VELscope®
can help with early identification of
abnormalities not visible to the naked eye.

34 32 Reasons You Need to Know More About The Mouth-Body Connection®

 R E A S O N 2 5

$4.5 billion is
spent each year
in the U.S. on
treatment of head
and neck cancers. 25

– Oral Cancer Foundation

 R E A S O N 2 6

Early detection with

salivary diagnostics.*
A study published in 2022 linked gum disease
with an increased risk of colorectal cancer—all
the more reason for salivary diagnostic testing,
which analyzes saliva to identify biomarkers for
systemic cancers and other conditions.26
* The diagnostic test, sent to an external lab, measures 11 types of bacteria
(a.k.a. periodontal pathogens) known to cause gum disease.

R E A S O N 2 7

Tobacco,
alcohol and poor oral
hygiene—oh my!
Several case-control studies have found tobacco,
alcohol, and poor oral hygiene contribute to tooth
loss which is associated with a higher cancer risk.27

36 32 Reasons You Need to Know More About The Mouth-Body Connection®

Improve your health today. | Smile Generation® 37
 Good oral
hygiene is good
for your wallet.
R E A S O N 2 8

Oral health doesn’t just mean better overall health;

it means better financial health, too. Simply
treating gum disease could lower annual costs for:

• Diabetes by $2,840 per person

• Heart disease by $1,090 per person
• Stroke by $5,681 per person
• Pregnancy by $2,433 per person28

–United Concordia Dental, 2014

38 32 Reasons You Need to Know More About The Mouth-Body Connection®

Improve your health today. | Smile Generation® 39
 R E A S O N 2 9

Gum disease
is the sixth-
most prevalent
health condition
worldwide.
It accounts for more years lost to disability than
any other condition, and has been linked to more
than 50 non-communicable diseases. 29

–The Economist Intelligence Unit, 2021

 R E A S O N 3 0

The savings resulting from preventative

oral healthcare from 2016 to 2025 are
estimated at over

$
63 billion.
30

– Avalere Health Research Study, 2016

R E A S O N 3 1

The estimated cost of treating periodontal

disease from 2016 to 2025 is

$
7.2 billion.
31

– Avalere Health Research Study, 2016

 Oral health
means better
health.
R E A S O N 3 2

The link is clear. The question should

be clear, too: now that you know,
what will you do? Simple. Brush,
floss and schedule an appointment
with your dentist.32

– The Mayo Clinic, 2022

42 32 Reasons You Need to Know More About The Mouth-Body Connection®

 Hold the mayo,
please.
Preventive dental care is strongly associated with
significant savings for patients with diabetes or
coronary artery disease. 32

– The Mayo Clinic, 2022

 It’s time we
talked about more
than your teeth.
The Inflammation Conversation:

What’s on your mind about what’s in your

mouth? Bad breath? Good news. There’s
help for that. Swollen gums? Bleeding
gums? Sensitive teeth? Loose teeth? Bite not
right? These are all signs that are telling you
something important. And so are we.

The five baddest bacteria are busy in your

body and you know what that means? It’s
time for The Inflammation Conversation.

Talk with your dentist today.

 C I T A
Reason 1
Watson, S. (2020, June 15). All about inflammation. Harvard Health Publishing,
Harvard Medical School. https://www.health.harvard.edu/staying-healthy/
all-about-inflammation/
Reason 2
American Academy of Periodontology. (2015, June 23). More Than a Quarter
of U.S. Adults are Dishonest with Dentists about How Often They Floss Their
Teeth [Press release]. https://new-media-release.com/aap/love_the_gums_
youre_with/
National Institutes of Health. Oral Health in America: Advances and Challenges.
Bethesda, MD: US Department of Health and Human Services, National Institutes
of Health, National Institute of Dental and Craniofacial Research, 2021.
Reason 3
Chen, C., Wu, Y. & Chang, Y. (2017). Association between chronic periodontitis and
the risk of Alzheimer’s disease: a retrospective, population-based, matched-co-
hort study. Alzheimer's Research & Therapy, 9(56). https://doi.org/10.1186/
s13195-017-0282-6
Reason 4 & 5
Stein, P., Desrosiers, M., Donegan, S., et al. (2007). Tooth loss, dementia and
neuropathology in the Nun Study. Journal of the American Dental Association,
138(10), 1314-1322. https://jada.ada.org/article/S0002-8177(14)63215-3/
fulltext
Reason 6
Shaik, M., Ahmad, S., Gan, S., et al. (2014). How do periodontal infections affect
the onset and progression of Alzheimer’s disease? CNS & Neurological Disorders
Drug Targets, 13(3), 460-466. https://doi.org/10.2174/18715273113126660152
Reason 7
Dominy, S., Lynch, C., Ermini, F., et al. (2019). Porphyromonas gingivalis in
Alzheimer's disease brains: Evidence for disease causation and treatment with
small-molecule inhibitors. Science Advances, 5(1). https://doi.org/10.1126/
sciadv.aau3333
Reason 8
Gum disease and heart disease: The common thread. (2021, February 15). Harvard
Health Publishing, Harvard Medical School. https://www.health.harvard.edu/
heart-health/gum-disease-and-heart-disease-the-common-thread
Reason 9
Pessi, T., Karhunen, V., Karjalainen, P., et al. (2013). Bacterial signatures in
thrombosis aspirates of patients with myocardial infarction. Circulation, 127(11),
1219-1228. https://doi.org/10.1161/circulationaha.112.001254
Bale, B. et al. (2016, Nov.). High-risk periodontal pathogens contribute to the
pathogenesis of atherosclerosis. Postgraduate Medical Journal, 93(1098).
215-220 https://pmj.bmj.com/content/93/1098/215
Reason 10
Matsui, S., Higashi, Y., Hashimoto, H., et al. (2018, Nov.). Abstract 12781: Associ-
ation of Poor Tooth Brushing Behavior With Cardiovascular Outcome: Two-Year
Follow-Up Prospective Observational Study. Circulation, 138(Suppl_1). https://
www.ahajournals.org/doi/10.1161/circ.138.suppl_1.12781
Reason 11
Mugiishi, M. (2018, September). HMSA: Integrating oral health for total health
[Conference presentation]. Harvard School of Dental Medicine 2018 Leadership
Forum, Boston, MA, United States. https://oralhealth.hsdm.harvard.edu/files/
oralhealth/files/mark_mugiishi.pdf
United Concordia Dental. (2014). The Mouth: The Missing Piece to Overall
Wellness and Lower Medical Costs [White paper]. www.unitedconcordia.com/
docs/united concordia oral health whitepaper.pdf
Reason 12
European Society of Cardiology. (2021, Aug. 25). Gum disease linked with new
onset heart disease [Press release]. https://www.escardio.org/The-ESC/
Press-Office/Press-releases/Gum-disease-linked-with-new-onset-heart-
disease
Reason 13
Diabetes and dental care: Guide to a healthy mouth. (2020, Nov. 3). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes/
art-20043848
Reason 14
Chang, Y., Lee, J., Lee, K. et al. (2020). Improved oral hygiene is associated with
decreased risk of new-onset diabetes: a nationwide population-based cohort
study. Diabetologia, 63, 924–933. https://doi.org/10.1007/s00125-020-05112-9
T I O N S
Reason 15
Teeuw, W., Kosho, M., Poland, D., et al. (2017). Periodontitis as a possible early
sign of diabetes mellitus. BMJ Open Diabetes Research and Care, 5.
http://dx.doi.org/10.1136/bmjdrc-2016-000326
Reason 16
Mauri-Obradors, E., Merlos, A., Estrugo-Devesa, A. et al. (2017). Benefits of
non-surgical periodontal treatment in patients with type 2 diabetes mellitus
and chronic periodontitis: A randomized controlled trial. Journal of Clinical
Periodontology, 45(3). 345-353. https://doi.org/10.1111/jcpe.12858
Reason 17
Diabetes and Oral Health. (n.d.). Diabetes.org. https://www.diabetes.org/
diabetes/keeping-your-mouth-healthy
Reason 18
McGaw, T. (2002). Periodontal Disease and Preterm Delivery of Low-Birth-
Weight Infants. The Journal of the Canadian Dental Association, 68(3), 165-169.
http://www.cda-adc.ca/jcda/vol-68/issue-3/165.pdf
Reason 19
López, N., Smith, P., Gutierrez, J. (2002, Aug.). Periodontal therapy may reduce
the risk of preterm low birth weight in women with periodontal disease: a
randomized controlled trial. Journal of Periodontology, 73(8), 911-24. https://
pubmed.ncbi.nlm.nih.gov/12211502/
Reason 20
Lieff, S., Boggess, K., Murtha, A., et al. (2004, Jan.). The oral conditions and
pregnancy study: periodontal status of a cohort of pregnant women. Journal of
Periodontology, 75(1), 116-126. https://doi.org/10.1902/jop.2004.75.1.116
Reason 21
United Concordia Dental. (2014). The Mouth: The Missing Piece to Overall
Wellness and Lower Medical Costs [White paper]. www.unitedconcordia.com/
docs/united concordia oral health whitepaper.pdf
Reason 22
Hormones and Dental Health: What Every Woman Needs to Know. (n.d.). Mouth
Healthy. https://www.mouthhealthy.org/en/az-topics/h/hormones
Reason 23
Murpy, S., Kochanek, K., Xu, J., Arias, E. (2021, Dec.). Mortality in the United
States, 2020 (Report No. 427). Centers for Disease Control and Prevention,
National Center for Health Statistics, U.S. Department of Health and Human
Services.
Meurman, J.(2010, Aug.). Oral microbiota and cancer. Journal of Oral
Microbiology, 2(5195). https://doi.org/10.3402/jom.v2i0.5195
Reason 24 & 25
Oral Cancer Facts. (n.d.). The Oral Cancer Foundation.
https://oralcancerfoundation.org/facts
Reason 26
Janati, A., et al. (2022, Jan. 26). Periodontal disease as a risk factor for sporadic
colorectal cancer: results from COLDENT study. Cancer Causes & Control, 33.
463-472. https://doi.org/10.1007/s10552-021-01541-y
Reason 27
Nagpal, R., Yamashiro, Y., Izumi, Y. (2015). The two-way association of
periodontal infection with systemic disorders: An overview. Mediators of
Inflammation, 2015(793898). http://dx.doi.org/10.1155/2015/793898
Reason 28
United Concordia Dental. (2014). The Mouth: The Missing Piece to Overall
Wellness and Lower Medical Costs [White paper]. www.unitedconcordia.com/
docs/united concordia oral health whitepaper.pdf
Reason 29
The Economist Intelligence Unit. (2021). Time to take gum disease seriously: The
societal and economic impact of periodontitis [White paper]. https://impact.
economist.com/perspectives/sites/default/files/eiu-efp-oralb-gum-disease.pdf
Reason 30 & 31
Avalere Health. (2016, Jan. 4). Evaluation of Cost Savings Associated with
Periodontal Disease Treatment Benefits [White paper]. https://oralhealth.hsdm.
harvard.edu/files/oralhealth/files/avalere_health_estimated_impact_of_
medicare_periodontal_coverage.pdf
Reason 32
Oral health: A window to your overall health. (2021, Oct. 28). Mayo Clinic.
https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/
art-20047475
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