The ancients believed the eyes were windows into the soul. They also believed the mouth was the emergency exit. At the moment of death the soul slipped out between your lips and went off looking for better accommodations.
Apparently this was not just poetry. Homer has the psyche fluttering out of the mouth of a dying man, and the Greek word psyche originally meant breath. The Latin spiritus meant breath too. Which may be why we still say a man expired, as though he had simply run out of air. Which, come to think of it, he had.
We now know the mouth performs a good many other useful functions. Chewing. Speaking. Whistling badly at grandchildren. In some societies, mouthing off can still arrange for your soul to leave your body somewhat ahead of schedule.
But there I go again, wandering off the path. Rambling is one of the privileges of age. My family has another word for it.
The mouth came to my attention because of a couple of articles in the newspapers. Laura Landro had a piece in the Wall Street Journal this month, “Your Mouth Could Hold the Secrets to a Longer and Healthier Life,” about scientists linking the bacteria in your mouth to heart disease and cognitive decline, and about a push to treat the mouth as a source of inflammation all through the body. The New York Times ran a companion of sorts, on whether we ought to be using interdental brushes instead of floss.
I read a great many articles about illness in the elderly these days. There was a time when I read them the way one reads about the weather in a country one never intends to visit. That time has passed.
The gist seems to be that what lives in a neglected mouth does not necessarily stay in the mouth.
Now, I was fully prepared to tell you that people with bad breath die sooner than people who look after their teeth. It is a wonderfully tidy sentence. It is also, I regret to report, not what the evidence says.
Bad breath, it turns out, is mostly a tongue problem. Most of it starts in the mouth, and the chief culprit is the coating on the back of the tongue, a thriving neighborhood of bacteria producing hydrogen sulfide and methyl mercaptan. These are exactly as pleasant as they sound. Nobody seems to have shown that bad breath itself shortens your life. It only shortens conversations.
What does seem to go along with dying sooner is gum disease, and missing teeth. A German study followed some three thousand people for thirteen years and found that the worse the gums and the fewer the teeth, the higher the chance of dying of anything at all. Went along with, mind you. Not caused. There is a difference, and at my age I have learned to respect it, having spent a career watching correlations swagger about dressed as causes.
Still, the plumbing of it is not imaginary. Inflamed gums bleed, and a bleeding gum is an open wound with a colony of bacteria sitting on top of it. The bugs do get into the bloodstream, and now and then they settle somewhere inconvenient, a heart valve, say. That part nobody argues about.
What got my attention had nothing to do with the heart. It was pneumonia. Old people quietly breathe in small amounts of their own saliva, and if that saliva is carrying the wrong bacteria, pneumonia is what you get. Somebody pooled the trials and found that in nursing homes, ordinary brushing cut deaths from pneumonia by better than half. A toothbrush, of all things.
The Landro piece quotes a researcher named Frank Scannapieco to similar effect. Patients who had seen a dentist for preventive care in the year before going into hospital had something like ten percent less risk of picking up pneumonia there, and those who had been treated for gum disease within six months, about thirty percent less.
I have decided this is the most persuasive dental statistic I have ever encountered, and I would like it read aloud at my funeral, should the brushing prove insufficient.
So why, I wondered, do we get gingivitis and cavities and wild animals do not? They have no Colgate. No Pepsodent. No floss. No dental plan.
Turns out I had the question backwards. Wild animals get plenty of dental trouble. Somebody went through a museum collection of wild wolves and found gum disease in them. Surveys of wild monkeys and apes turn up cavities, and in one group of chimpanzees close to ten percent of the front teeth were decayed, from fruit and seeds of all things. Bears get cavities. So do bats.
What wild animals really have going for them is grimmer than good hygiene. Most of them die before the bill comes due. An abscess that takes a decade to ruin you is no threat to an animal with eight years in him. Nature does not so much prevent tooth decay as outrun it.
Their diets do help, mind you. Coarse food and bone chewing scour the teeth, and they eat no refined sugar and cook nothing. And sharks really do have fluoride in their teeth. The outer layer is nearly the same mineral you would dig out of the ground. Though I suspect the bigger advantage is that a shark simply grows a new tooth whenever the old one displeases him. I have inquired. This is not available at my dental office.
Don’t get me wrong. I am not suggesting that we live like animals. I am suggesting that they cheat.
You brush twice a day and floss regularly, you say. And you see the hygienist for a proper cleaning. Excellent. But, well, there is always a but.
In 2016 a reporter for the Associated Press went looking for the scientific evidence behind the government’s decades old flossing recommendation, filed a Freedom of Information Act request, and discovered there wasn’t much. The recommendation had quietly vanished from the 2015 Dietary Guidelines. The dental profession was not amused. Half of America declared a holiday.
I am not telling you to throw away your floss. I am telling you that the string you have been dutifully sawing between your molars since the Carter administration may have been oversold.
Which brings us to the latest and greatest, the inter-dental brush. These look like miniature versions of the bottle brushes used to clean the residue out of your grandbaby’s formula bottle, and they go where floss merely slides past. The Cochrane people, who sift through the evidence on everything from cancer drugs to health policy and have no toothbrushes to sell, looked at these in 2019 and concluded that interdental brushes may work better than floss.
May. And they add, in the small print, that the evidence is thin and the studies were short.
Thin evidence. Short studies. At eighty, I am in no position to be sniffy about either.
I ordered some from Amazon. Prime delivery, twenty-four hours, which is faster than I can get a dental appointment. And like Micky Dolenz, who in 1966 sang lead on a Neil Diamond song that sat at number one for seven weeks while the fellow who wrote it thought it was a country tune, I’m a Believer.
I want to live a little longer.
And I am watching my mouth.