CHPA Chat - Oral Health: Tackling the ‘Crisis’ in the US

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Episode Summary

On this episode of CHPA Chat, we're talking about oral health and how what’s happening in your mouth can impact the rest of your body. Joining us is Dr. Maria Ryan, Vice President and Chief Clinical Officer at Colgate-Palmolive and the past president of the American Association for Dental Research. She is a staunch advocate of oral health as a critical component of self-care and overall wellness.



Episode Transcript

Anita Brikman: You've probably heard the phrase that a person's eyes can be a window into the soul, but did you know your mouth can be a window to your overall health? It's true. And according to our guest today, we've got an oral health crisis going on around the globe. That's the topic for this episode of CHPA Chat.

Speaker 2: Welcome to CHPA Chat, conversations in the consumer healthcare industry with Anita Brikman.

Anita Brikman: Welcome everybody. Today we're talking about oral health and how problems with your teeth and gums can affect the rest of your body. Brushing and flossing are not just nice to dos folks in your self care routine. They are critical to keeping your heart, body and mind healthy, along with those pearly whites. Joining me to dive into this topic is Dr. Maria Ryan, Vice President and Chief Clinical Officer at Colgate-Palmolive and the past president of the American Association for Dental Research. Can I call you Dr. Maria?

Dr. Maria Emanuel Ryan: Sure, Anita.

Anita Brikman: Well, thank you so much for being here. And I know you've been speaking internationally on this topic for years and have been quoted in various media outlets as saying we have an oral care crisis, a global one on our hands. Talk to me about that?

Dr. Maria Emanuel Ryan: I'd love to, and I really thank you for having me on CHPA Chat to talk about this, because it is a really important issue. And if you think about it being a global health crisis, the World Health Organization has stated that 3.5 billion people in the world suffer from oral diseases. That's half of the world's population and cavities is the most frequent one. They also suffer from periodontal disease or gum disease. And the important thing to really understand is that a healthier future starts with a healthy mouth and oral health is essential to a person's overall health and wellbeing. And just as you talked about the eyes being a mirror to the soul, you can also see systemic diseases when looking in the eyes. I remember the ophthalmologist used to tell me I can pick up heart disease. Well, when you look in someone's mouth, in the oral cavity, we can see changes that can suggest other oral health issues. So it truly is a window into the overall health and wellbeing of a person.

Anita Brikman: I would imagine this problem is greater in developing nations, but what's the state of oral care here in the United States and are some communities more prone to gum disease and cavities than others.

Dr. Maria Emanuel Ryan: Yeah, this is another very good question. And you would think it would be much better here, but unfortunately, the numbers are about the same here, in that about 50% of our population suffers from oral diseases, with the number one most common disease among children in the United States being cavities. And parents who are trying to address this can lose up to three days of work, taking care of children's oral health issues and kids miss up to three days of school a year. And if you think about the general population we have about $45 billion lost in productivity in the United States, because of untreated oral diseases. We know that if you look at the overall population, 65 million Americans have untreated tooth decay, that can end up affecting your overall health and wellbeing. And it's unfortunate because these diseases, we're talking about, cavities, periodontal disease, for the most part, they are preventable diseases.

If you have really, really good oral hygiene, so toothbrushing and flossing, but yet many people either don't know they have the disease, because periodontal disease is often a silent disease and many people may have it and don't know that they have it, or they don't understand why it's so important to have good oral hygiene. As to the second question you asked about whether these diseases disproportionally affect certain communities? They do. There are disparities among ethnic groups by income, by education levels. And the CDC recently found that nearly twice as many non-Hispanic black or Mexican American adults have untreated cavities as people who are white. Among working age US adults, over 40% of low income and non-Hispanic black adults have untreated tooth decay. And according to the CDC, the percentage of children, ages two to five from low income households, have untreated cavities at three times the rate that we see at higher income households.

So, there are these disparities. And in addition to this, we know that patient/practitioner concordance is very important to outcomes. That people like to visit doctors that look like them. And if we look at my profession, we recognize that in dentistry, blacks, Hispanics, and native Americans only represent a combined 9% of all practicing dentists in the industry. And so our company, Colgate, is really committed to increasing diversity among the dental profession. We have a scholarship program called Audacity to Dream, which we have in collaboration with the National Dental Association, which represents black American dentists. We have an endowed scholarship for underrepresented minority students at Harvard School of Dental Medicine. And most recently in 2022, we started what's called Trailblazers in Oral Health Research Scholars of African-American Heritage or our TORCH program, to help increase representation in oral health research and in dental faculty of underrepresented dentists. So, I think that there's a lot of work to be done, but we recognize what the issues are. And we're really working very hard to try and address them as a profession. And for those of us in consumer products, we recognize we have to help.

Anita Brikman: Absolutely. Those are some staggering numbers and you're right. People want to see healthcare practitioners that look like themselves. And so it's clearly a problem that needs to be addressed. I want to go back to cavities as the most common disease in the world. Now I have to say, when I first heard that I was like, wait a minute, cavities as a disease? I just thought of this as something I had to go to the dentist, get a shot that I didn't want to get and have my cavity filled, but cavities are actually disease.

Dr. Maria Emanuel Ryan: Yes, they are. They are disease. And that, if you don't treat that disease, you have, what's called an infection. You know, and we think about an infection anywhere else as something we would have to treat, but cavities is an infection in the tooth and the bacteria that cause it will eventually get to the nerve and the blood supply in the tooth and that's when you get the pain. But those infections need to be treated. And if they're not treated, you eventually get inflammation that goes along with it. And that is infection and inflammation is actually what drives gum disease or periodontal disease. So it's very, very important that infection and inflammation anywhere in the body be treated, particularly in the mouth.

Anita Brikman: So you mentioned that inflammation, the gum disease, periodontal disease, bad stuff happening in the mouth. What does that mean for the rest of the body? We talked about how much oral health can affect other really serious conditions. What's the story?

Dr. Maria Emanuel Ryan: Yeah. To me, really, really important to this discussion is that connection, Anita, in that we know that if you have infection and inflammation in your mouth, it can impact your overall health in that bacteria that are present in your mouth can actually get into the bloodstream. Particularly if you have periodontal disease. So you have pockets around the teeth, you have bone loss around the teeth. So it may not only lead to the tooth becoming loose and coming out, but it may lead to these bacteria getting into the bloodstream and they can be found in atheromatous plaques in the vessels. They can be found in amniotic fluid, increasing a woman's risk for adverse pregnancy outcomes. In addition, we also know that when you have untreated gum disease, you have chronic inflammation. The most common chronic inflammatory disease in the world, is gum disease.

And that chronic inflammation in the mouth can be measured in the blood by a protein called C-reactive protein. If you have chronic inflammation, high sensitivity C-reactive protein will go up. And we know that may be an even better indicator of your risk for heart disease, for stroke than even your lipid levels. We're used to measuring our cholesterol levels, right? And so if you don't treat gum disease, your CRP levels are high. So between the bacteria and the inflammation, we know that untreated gum disease can increase your risk for a heart attack and a stroke by two to three fold. It can increase a woman's risk for adverse pregnancy outcomes. It can increase your risk for developing diabetes. And if you have diabetes and you're trying to get your blood sugar levels down and you have gum disease, it's more difficult for you to do that.

So it's really a two-way street. It may increase your risk for developing diabetes and if you have diabetes, it makes it far more difficult for you to control your diabetes. We also know that the bacteria in the mouth can increase your risk for respiratory diseases like COPD. It can increase your risk for pneumonia. So for people in intensive care units, they often provide oral hygiene to reduce their risk for getting pneumonia. In nursing homes, we know that we have to increase their oral hygiene to prevent their risk for pneumonia. Because what unfortunately most people in a nursing home may die from, is pneumonia. So these oral conditions really, really need to be addressed.

Anita Brikman: Clearly, so much more far reaching than I ever thought. And probably part of the reason your company launched, Know Your OQ. Tell me about this microsite and what you're trying to do?

Dr. Maria Emanuel Ryan: I got together with our corporate communications division and also with our marketing people. And we said, "How can we get people to understand this better?" And they came up with know your oral health quotient, just like people know their IQ or their EQ. And we recognize that oral health literacy throughout the world is very, very poor and that people don't prioritize their oral health, because they really don't understand these links that you and I have been discussing. They don't understand what they can do to help prevent these diseases. So we felt that through Know Your OQ, which we launched this year in February, we could empower people to understand their oral health, the importance of it and how to improve on it. And there's a self-assessment that they can take. It only takes about two to three minutes. It's 10 questions and you could get a zero, which means you've got to read more.

And there's a lot of information on the site to help people to know more about these issues and how to prevent some of these oral diseases. Or you could get a 10, right. Which is great, that means you know everything and you could share it with everyone. And our experience with the visitors to the site is that they're spending a lot of time on it. And so through Know Your OQ, we've been able to engage people. We started in the US, but we have programs now throughout the world where we want to really educate people about why oral health is so important, what they can do and where they can seek help as well.

Anita Brikman: All right. So let's talk about something else that's not sexy, bad breath, or halitosis. That's one of those things that again, embarrassing, certainly a sign that there's something not so good going on. Does brushing your tongue help and what else can people do?

Dr. Maria Emanuel Ryan: Yes, it's also another topic that's not sexy. You're correct. And also, when I practiced for many, many years, I was in practice for 20 years, people would come in and say, "I feel so depressed. People step away from me. They don't want to sit next to me on the train. I have bad breath. Why is that?" Well, sometimes it's because they have periodontal disease and I'm a periodontist. So we will look to see if someone has gum disease. So brushing, flossing, getting in between the areas that are hard to reach in-between the teeth is really important to reducing the levels of bacteria. We also know that if you leave bacteria in the mouth, those bacteria can produce what are called volatile sulfur compounds. And that is one of the main things that drives bad breath.

So, on top of cleaning your teeth, you're correct, your tongue is an area that needs to be cleaned. And there's a lot of crevices in the tongue and you can do that by brushing the tongue. You can use a tongue scraper and you can use mouth wash. Mouth rinses are really, really good for getting to hard-to-reach areas, including the tongue, including the tonsillar crypts, because in the back of the throat, you have those tonsillar crypts, and they can also accumulate bacteria. So you need to really have a clean mouth, in order not to have bad breath. If you do all of these things and you still have bad breath, you should be seeing a practitioner to determine if you might have periodontal disease, which you don't know about, or if you have some other issues within the throat, or in the GI system that could be impacting. But those are not as common as having bacteria on your tongue or having periodontal disease. That's usually the reason why people have bad breath.

Anita Brikman: So another thing that has been debated in my family, is it necessary to have a battery powered or rechargeable toothbrush, or if you're brushing right, is your good old handy manual toothbrush enough? Is it worth investing in one of these, especially now that there's smart technology in toothbrushes, what are your thoughts on that?

Dr. Maria Emanuel Ryan: Yeah, well, a manual toothbrush is the most accessible for people. And I have to tell you, when I used to do a lot of work at the University of Connecticut and in Hartford, we would have families that would have one toothbrush for the whole family and that's not a good thing, right? Because then you're sharing bacteria, it's going all around the family. So, if everyone can have a manual toothbrush and know how to use it, that is great. If you do a great job. However, we do know that powered brushes do improve things. They work by either sonic technology or rotation oscillation, and that will remove more plaque, generally than you can with a manual brush, particularly because these brushes will let you know how much time someone spends. You're supposed to spend two minutes brushing. Most people spend about 45 seconds at the most. And so by having a powered brush, it will keep you on track for the two minutes. It also will keep you on track, some of them, now you talk about smart technologies, that you're supposed to brush, not once a day, but twice a day.

Anita Brikman: Final question, you talked a lot through this entire discussion about the disparities, what people can and can't afford, access to dental care. We know some of these disparities got worse during the pandemic, especially having access to affordable dental care and maybe all the products that a person needs. What can we collectively do to fix it? Inspire our audience, Dr. Maria, about what the consumer healthcare products industry and we, as people can do?

Dr. Maria Emanuel Ryan: Thanks Anita. That's a very important question. And I will tell you the pandemic, one of the things that it did show us, is when it first started, they actually shut down the dental offices. They said it wasn't essential. It wasn't an essential service. I remember seeing that on the news saying, "Oh my God, have these people never had a toothache? Who said that?" And then when people started showing up in the emergency rooms with oral care issues, and they're usually not equipped to manage them, suddenly they realized, "Oh my God, we better open up the dental offices." So, all the dental offices opened up. So we know that oral health is essential, right? We also know that people may not have access for various reasons. And the pandemic only worsened the problem. It took a toll on people's oral care habits. They delayed visiting the dentist. Since the start of the pandemic, over 60% of people have experienced an oral health issue.

And we know that dental care was the number one type of issue that was not addressed. 32% of Medicare beneficiaries reported that they were unable to receive dental care during the outbreak of COVID-19. And more than a quarter of dentists reported an increase in cavities and gum disease among their patients, during the pandemic. So, we really brought to light the issues that we face with regards to access, to care, the importance of oral care. And there's a lot of work that's ongoing to try and improve on that. I worked at a dental school for 20 years before coming to Colgate. And we really were the safety net for millions of people, it was at Stony Brook University. There are 3 million people on Long Island, right outside of New York City, most people don't realize that. And people would drive long, long distances to come to the dental schools to get care.

There are federally qualified health centers that are there to help, there are dentists who do take Medicaid and Medicare is another issue that people are looking into, whether or not there'll be coverage for oral care. You may have heard that on the news, within Medicare for our aging population. The other thing that the pandemic made us realize is that if you have oral health, you are at greater risk for many of the adverse outcomes that we saw in COVID patients, the cytokine storm. And it wasn't a surprise to many of us in the industry because we know that periodontal disease, or gum disease, is a local cytokine storm. It's, somebody's excessive response to the bacteria that are accumulating around their teeth. So they end up breaking down the bone and the connective tissue.

Well it ended up that people who had periodontal disease and got COVID, they were more likely to get the cytokine storm. So when they were exposed to the virus, they were more likely to have that kind of response. We also recognized that the mouth was a portal for entry of the virus. There are a lot of the receptors for the virus in the oral cavity. COVID did a lot of bad things, but it also brought to light a lot of things that we didn't understand as well and needed to understand and one of them being the importance of oral health.

Anita Brikman: Well, I certainly have a much greater appreciation for the importance of oral health. Thanks for joining me.

Speaker 2: Thank you for joining us here at CHPA Chat. For more information, and to hear our entire catalog of shows, please visit



Maria Ryan Headshot
Maria Emanuel Ryan, DDS, PhD
Vice President and Chief Clinical Officer, Colgate-Palmolive Company

The views expressed in this podcast are solely those of the speaker and do not necessarily represent the opinions of the Consumer Healthcare Products Association.

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