Like most people, I brush my teeth every day. But flossing? It is a bit annoying. That is why I suspect that only a third of us do this regularly. And a third of the population admits never flossing.
I was in this group until a few years ago I read a research article suggesting that flossing not only reduces the risk of gum disease, but perhaps also reduces my risk of heart attack.
So I started flossing every night. My enthusiasm for flossing has been stimulated by recent studies that suggest that it is not only good for your gums and heart, but can also reduce your risk of dementia.
So what connects oral health with these diseases? The answer is inflammation. The same bacteria that cause the gums to become swollen and sore can also travel through the blood to other organs, where they cause damage over time.
The inbetweener: Dr. Michael Mosley goes through his dental routine to reduce harmful inflammation. Unless dental plaque is removed by brushing and flossing, the bacteria in the dental plaque form acid that destroys the enamel of your teeth. It also produces toxins, to which the immune system responds and causes inflammation
It is currently a very topical subject in medical research – so topical that I gave a speech last week at a major conference in Sydney, Australia, dedicated to the subject.
A quick, informal investigation of the scientists who were there showed that the majority are flossing. And one reason why the scientists I spoke at this conference were so enthusiastic is that it's a proven way to reduce inflammation.
The link to bacteria in gums and Alzheimer's
Inflammation is something we are all familiar with. If you cut your finger, your immune system mobilizes and sends white cells to the area to attack and destroy incoming harmful microbes.
As part of this reaction you will see redness, swelling and feel pain around the site of the injury.
Acute inflammation such as this is absolutely essential for our survival because it creates an inhospitable environment that kills invading bacteria, viruses and the like. And it passes quickly.
Chronic inflammation plays an important role in diseases ranging from heart disease and cancer to dementia and depression. Some people claim that chronic inflammation itself causes aging. (File photo)
But sometimes inflammation, once activated, is not turned off. Instead, it goes on and on. It becomes chronic.
Instead of protecting you, your body starts attacking itself.
Chronic inflammation plays an important role in diseases ranging from heart disease and cancer to dementia and depression. Some people claim that chronic inflammation itself causes aging.
One of the things that is known to cause chronic inflammation is a persistent source of infection that keeps your immune system alert. And that's where flossing comes in.
Your mouth is full of billions of bacteria, most of which are harmless. However, some combine with leftover pieces of food to form a stick, which sticks to your teeth.
Unless the plaque is removed by brushing and flossing, the bacteria in the plaque form acid that destroys the enamel of your teeth.
It also produces toxins, to which the immune system responds and causes inflammation.
What starts as inflammation of the gums, also known as gingivitis, can become periodontitis – chronic infection of the tissues that support the gums. This in turn can lead to destruction of the bone.
But that is not the end of the story, because if you have many of those harmful bacteria in your mouth, there is a risk that some will escape into your blood and travel through your bloodstream through your body, causing further damage.
As I said before, we have known for a while that there is a connection between infection of your gums and damage to arteries and your heart. Numerous studies have shown that people with periodontitis develop heart disease more often than people with better oral hygiene.
But what about the brain? A study published earlier this year provided the first convincing evidence that inflammation in the mouth can increase your risk of Alzheimer's.
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For this study, researchers at the University of Louisville School of Dentistry in the US examined the brains of people who died of Alzheimer's disease and compared them with people who died at the same age, but without any signs of dementia.
They discovered that the brains of people who died with Alzheimer's were much more likely to be infected with bacteria called Porphyromonas gingivalis, which are a common cause of severe gum disease.
They also discovered the presence of toxins produced by the bacteria called gingipains.
The scientists further demonstrated, at least in mice, that these bacteria cannot only travel from the mouth to the brain, but once they are there they destroy brain tissue.
The brain, in an effort to defend itself, then produces amyloid plaques, a common feature of Alzheimer's.
By lifting these ideas to a higher level, the scientists created a drug that blocks the action of the gingipains toxin.
Human research is ongoing to see if this helps prevent or delay the onset of Alzheimer's.
The danger in your belly fat
In addition to infection, other common causes of chronic inflammation are smoking, being stressed, and carrying too much fat around your belly.
We tend to regard belly fat as a bit of jelly; it wobbles around, often does not look so good, but is otherwise harmless.
Nothing is further from the truth. Fat, especially around the intestine, is surprisingly active.
One of the things it does is interact with your immune system and produce inflammatory chemicals that then spread throughout your body.
This helps explain why having too much intestinal fat (also known as visceral fat) increases your risk of heart disease, type 2 diabetes, high cholesterol and blood pressure.
People who are obese are also more often depressed and develop dementia.
Seven years ago, when I first discovered that I had type 2 diabetes, I also discovered that my cholesterol and blood pressure were much too high. In addition, I had high levels of an inflammatory marker called C-reactive protein, or CRP.
I put myself on the 5: 2 diet, lost 19lb and 4in around my waist, and then all my different biomarkers improved enormously, bringing me back to the healthy range.
Because chronic inflammation is such a major cause of serious illnesses, there is a lot of research going on, looking for drugs that can dampen it.
And it's not just new medicines.
Old drugs such as aspirin and statins, which have potent anti-inflammatory properties, are now being investigated to help combat diseases such as cancer and dementia.
Unfortunately, taking aspirin daily can also lead to stomach bleeding, which is dangerous. It can therefore only be taken in the long term if it has been prescribed by a doctor.
The big question: do you have to brush or floss first?
In a study, dentists discovered that the floss-than-brush approach removed much more plaque than the other way around. (File photo)
Flossing makes no sense unless you do it right.
According to my dentist, you have to let the dental floss slide as far as possible into the holes between your teeth and then bend around the base of each tooth, ensuring that you go straight in and under the gum line.
You then slide up and down to remove food and paste.
I floss first and then brush my teeth. My wife, Clare, does it the other way around. So who's right?
In one study, dentists randomly assigned 25 students to flossing and then brushing or brushing and then flossing.
They examined them afterwards and discovered that the flos-then-brush approach removed much more plaque than the other way around. So I'm right!
Oh, and don't waste your money on mouthwash.
Not only will it destroy the good bacteria in your mouth that protect your teeth, but it will dry out your mouth, making tooth decay worse.
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