Flossing for Fertility

Following is an article that might be useful for you to post in your reception area or to give to your patients especially if you know they are trying to start a family.

Flossing for Fertility
Pay Attention to Oral Health When You’re Trying to Conceive

By Kelly Burgess
Published by iParenting Media

When a woman is dealing with infertility, how much she flosses is probably the last thing on her mind, but that may be about to change. Recent research is providing some fascinating, albeit preliminary, indications that oral health is impacted negatively by some infertility treatments, and poor oral hygiene may actually be a factor in infertility.

While these studies are in their infancy, the conclusions, added to other evidence about how oral health impacts general health, join a body of research that may lead to a complete overhaul of the way the health and insurance industries view the link between oral health and overall health – including fertility issues. When this happens, good dental health is going to be on everyone’s mind.

Following a Hunch
About six years ago, Dr. Cenk Haytac and his wife were undergoing infertility treatments. During the course of these treatments, Dr. Haytac’s wife often complained of sensitive and bleeding gums. Most husbands would probably have paid little attention to this seemingly trivial problem, but Dr. Haytac is a highly respected dental researcher based at Cukurova University in Turkey. He knew that his wife had excellent oral hygiene, and there was no apparent reason for her symptoms. He also noted that these symptoms seemed to appear only during the phases when she was taking clomiphene (a drug that stimulates the production of hormones and induces ovulation). Curious, he decided to look for a connection.

Dr. Haytac went on to perform oral exams on 79 women, who received one of four infertility treatments, and 20 women who were not receiving fertility treatments. This sample included women who were being treated with clomiphene for various lengths of time and in combination with other common infertility drugs. The results indicated that women who received fertility treatments for more than three menstrual cycles had higher levels of gum inflammation and bleeding compared with women not receiving fertility treatment and those treated for no more than three menstrual cycles. His findings were published in the June 2004 issue of the Journal of Periodontology

“There seems to be a direct correlation between the rise in the levels of progesterone and estrogen and the level of gingival inflammation,” says Dr. Haytac. “Gingiva is a target tissue for estrogen, since it contains specific high-affinity estrogen receptors.”

Oral Health and Estrogen
The effect of a rise in levels of progesterone and estrogen and an increase in levels of gingival inflammation is not a new finding, says Dr. Haytac. Although it’s not known why, elevated levels of these hormones during puberty and pregnancy and with the use of oral contraceptives have all been associated with periodontal issues. The concern is that these problems remain confined to these specific triggers and don’t cause long-term oral health problems.

“Sometimes you can’t avoid these problems,” says Dr. Michael P. Rethman of Honolulu, Hawaii. “When you’re on hormonal manipulation, your gums become hypersensitive, so in some cases, people even with terrific oral hygiene may experience some problems. This may occur even to a small degree during monthly cycles.”

While these problems are usually of finite length, ongoing gingival inflammation can lead to a more severe condition, periodontitis, which can result in bone loss and tooth loss.

For women who are experiencing gingival inflammation, which may include sensitive or bleeding gums, Dr. Rethman, president of the American Academy of Periodontology, recommends stepping up oral hygiene, which can prevent more severe problems down the road. This should start with an evaluation by a dentit, perhaps even a periodontist. More frequent professional cleanings may help – even monthly cleanings if covered by insurance. At home, Dr. Rethman says to make sure and clean each tooth “360 degrees.” In other words, it’s necessary to brush and floss.

Although there have been no definitive studies showing the superiority of power toothbrushes over traditional toothbrushes, Dr. Rethman feels that the power toothbrushes do a better job of cleaning. He particularly recommends higher-end products, but says even the less expensive models are fine. He also notes that ads by Listerine that claim using Listerine is equal to flossing have merit, but says everyone should floss regardless of how great their mouthwash is.

The bottom line is that the problems caused by elevated hormone levels, assuming excellent dental hygiene is maintained, are generally short term and will resolve themselves when the hormone levels return to normal.

Beyond Healthy Teeth
he most fascinating parts of this study are some of the other conclusions being drawn, namely that poor oral health can actually be a causative factor in infertility.

“The ultimate result of our study is that ‘the drugs used for infertility management may cause and/or worsen gingival problems,'” says Dr. Haytac. “The other statement – poor oral health can negatively affect fertility – is just a suggestion, but it is a very reasonable suggestion. Periodontal diseases are infectious in nature and lead to systemic release of highly pathogenic microorganisms and/or their products.”

In other words, if the body is struggling with a low level of systemic infection via an undiagnosed periodontal condition, it can affect overall health, which can adversely affect fertility. This view is even more reasonable considering that periodontal diseases have been linked in studies to cardiovascular diseases, diabetes mellitus, pulmonary diseases and adverse pregnancy outcomes such as pre-term deliveries and low birth weight.

According to Dr. Rethman, insurance companies are taking notice of the evidence of a strong link between dental health and the conditions listed above. He thinks in the next 10 to 15 years dental coverage will expand not only to identify people at risk for diseases that have been linked to periodontal diseases, but to provide for more aggressive preventive dental care to those who need it.

“Insurance companies recognize that preventing disease is a lot more cost-effective than treating it,” he says. “They’re beginning to realize that it makes more economic sense to provide very good dental care than to deal with problems associated with poor dental care.”

The Poster Ape for Dental Health
Koko, a 300-pound gorilla who resides at the Gorilla Foundation in Woodside, Calif., is famous for her ability to communicate in American Sign Language. With an impressive vocabulary of more than 1,000 signs, she was more than capable of letting her handlers know that she was suffering from a bad toothache. Since the dental care had to be done while Koko was under general anesthetic, her handlers took the opportunity for a full physical exam. What they were really looking for was the reason for Koko’s infertility. She and her mate, Ndume, have been trying unsuccessfully for 11 years to have a baby.

When Dr. Rethman heard that Koko had been treated for periodontal disease, he sent a congratulatory letter on behalf of the American Periodontal Association. He also let Koko’s handlers know that periodontal disease has been implicated in infertility and expressed his hopes that resolving Koko’s dental issues might result in a pregnancy. It hasn’t even been a month since Koko’s appointment, but it will be interesting to see if she does get pregnant now that her periodontitis has been resolved. If she does, Koko will become a compelling example of the importance of good oral health.