By David A. Albert, D.D.S., M.P.H.
Columbia University College of Dental Medicine

Periodontal (gum) disease has been linked to a growing list of health concerns. These include diabetes, strokes, heart disease, low birth weight and premature births.

It is not unusual today for an obstetrician to refer a pregnant woman to the dentist for treatment of periodontal disease. Also, some physicians suggest that their patients see a dentist for a check-up to improve their oral and overall health.

Dentists and dental hygienists have always stressed the need to maintain healthy gums. Periodontal disease harms the overall health and function of your mouth. As periodontal disease gets worse, bone that holds the teeth in place is lost. Teeth become loose and can fall out. For adults, periodontal disease is a major cause of tooth loss.

Dental providers often tell their patients to floss their teeth or lose them. This is good advice. A little prevention goes a long way. It can help to preserve your teeth and make sure that the bone supporting them is healthy and strong.

Can maintaining our teeth also improve our overall health? Is it time to change the phrase "floss or lose your teeth" to "floss for good health"?

Let's look at the current evidence. Research has focused on periodontal health as it may relate to pregnancy and childbirth, heart disease and diabetes.

Many studies have linked gum disease and premature birth. Other studies have not found this link. Larger studies that follow women who are pregnant have had mixed results.

One study looked at the effects of periodontal cleanings during pregnancy. The article was published in the New England Journal of Medicine in 2006. It showed that women who had cleanings did not have better birth outcomes than women who did not have cleanings.

Another study was published in the British Journal of Obstetrics and Gynecology in 2011. This study found that periodontal treatment during pregnancy reduced the rate of preterm birth.

Many studies have looked at the impact of periodontal treatment during pregnancy. Periodontal disease usually lasts for many years. Therefore, this type of treatment may be "too little too late" to improve a pregnant woman's oral health. This may be the reason that some studies have shown no improvement in birth outcomes when pregnant women receive periodontal treatment.

If you are pregnant or plan to become pregnant, what should you do? My advice is to keep your teeth and gums healthy. Visit a dentist on a regular basis. Make sure you take good care of your oral health at home.

All of this makes good sense. You will reduce the number of bacteria and the amount of inflammation in your mouth. This will reduce the stress on your body and may contribute to better birth outcomes.

It is very likely that a real link exists between gum disease and birth outcomes. At present, we don't know for certain whether having cleanings or periodontal treatments during pregnancy will improve birth outcomes. But certainly your oral health will benefit. So will your appearance and self-confidence.

You may have also heard that periodontal health has been linked to strokes and heart disease. Many studies show that heart disease and stroke are more common in people with periodontal disease. However, other studies have found no link.

A study from Columbia University was reported in the journal Circulation in 2005. Researchers examined people's carotid arteries. These are the large blood vessels on the sides of your neck. Blockages (plaques) in the carotid artery wall are known to be linked with strokes.

In the study, patients with periodontal disease had thicker walls in the carotid arteries than patients without this disease. Researchers also found the bacteria that cause periodontal disease in the arteries of people who had the disease.

Another study found that patients had improved blood flow after a periodontal cleaning. The New England Journal of Medicine published the study in 2007.

These are interesting findings. Do they mean that you should have a periodontal cleaning if you have heart disease or have had a stroke? Will frequent cleanings reduce your risk of a heart attack or stroke?

At this time, we don't have enough proof to say that you will definitely benefit. What we do know is that regular cleanings and treatment of periodontal disease will maintain your oral health and preserve your teeth.

In the United States, diabetes is a major concern. More than 20 million Americans have diabetes. Diabetics have more periodontal disease than people without diabetes. This is an important finding.

People who have pre-diabetes (above-normal blood sugar, but not as high as in diabetes) also are at higher risk. Diabetics therefore are urged to see their dentist and dental hygienist regularly to keep their teeth and gums healthy.

Evidence also suggests that people with diabetes do not control their blood sugar as well if they also have periodontal disease. This is because periodontal disease is a type of infection. Infections tend to raise blood sugar. Researchers have found a strong link between diabetes and periodontal disease.

Periodontal treatment is important for diabetics because periodontal disease can increase blood sugar levels. For diabetics, improving periodontal health can also improve overall health.

If your physician recommends that you see your dentist, follow this good advice. For some diseases, such as diabetes, the link with periodontal disease is clear. In other cases, such as birth outcomes, heart disease and stroke, links have been found. However, more research is needed to see if treatment will improve overall health.

Currently, the best advice to follow is to maintain your oral health to preserve your teeth. You may benefit your overall health as well, but you certainly will help to maintain your teeth and keep your mouth healthy for a lifetime.

David A. Albert, D.D.S., M.P.H., is an associate professor and associate director of community health at the Columbia University College of Dental Medicine. He also holds an appointment in the Joseph Mailman School of Public Health at Columbia University. He maintains a practice within the ambulatory care network of the Columbia DentCare program in the community of Washington Heights/Inwood in Northern Manhattan.