Generations of Smiles | Issue 23

23

issue

aug ‘26

Generations of Smiles Oral Health Means Better Health At Every Age and Every Stage

A Window Into Women's Health

Diana Do -Yabut, DMD

Haley Southwick, Nurse Practitioner

Quality care from sea to shining sea.

Empowering Women’s Health: From First Teeth To Flourishing In this special issue of Generations of Smiles, we highlight women’s health at every stage, starting by exploring the good habits in childhood that lay the foundation for decades to come. Dr. Kelly Kim offers a practical guide to flossing for the whole family, while Drs. Kim and Ashley Abrams share expert advice on guiding teenagers as they make the vital transition from a pediatric dentist to a general dentist.

In "Smile Your Way to 100: The Oral Health Habits Women Need for Life," Dr. Deepika Dhama highlights the crucial connection between oral hygiene and a healthy lifespan for women. Shifting estrogen levels play a key role, underscoring the power of the Mouth-Body Connection®. Preparation is just as vital before pregnancy. Dr. Abrams reveals how oral health impacts fertility and offers steps to protect your preconception wellness.

From those first baby teeth to welcoming your first baby and beyond, women experience a lifetime of hormonal changes that affect overall wellbeing. Making oral care an integral part of your whole-body health will pay dividends for a lifetime and help ensure a strong, vibrant smile through every chapter ahead.

Until next time,

Carolyn Ghazal, DDS

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Healthy smiles start before the first step.

Contents Smile Your Way to 100: The Oral Health Habits Women Need for Life Discover how shifting hormones impact women's oral health across every decade—and why regular dental checkups are a secret weapon for whole-body health.

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Your Mouth Might Be a Chapter in Your Fertility Story Learn how gum inflammation can impact reproductive health, and why lowering your oral bacterial load belongs on your preconception checklist.

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A New Beginning: Switching from Kids' Dentist to a General Dentist A step-by-step roadmap from our clinical team to help your teen transition from pediatric to general dentistry with confidence.

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Making Flossing a Habit: Tips for Every Age Brushing cleans only 60% of a tooth's surface. Here is a practical guide to turning flossing into a daily habit for the whole family.

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What’s Going on in Your Mouth, with Ruthie Toothie Meet Ruthie Toothie! This fun, kid-friendly guide walks children through their dental milestones from baby teeth to braces.

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Smile Your Way to 100:

The Oral Health Habits Women Need for Life

By Deepika Dhama, DDS

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Childhood and Teens

One of the fastest growing demographics cut their teeth during the Coolidge administration. More than 100,000 Americans have reached their 100th birthday – a number expected to quadruple by 2054.

What's their secret? Researchers say the key to a long lifespan is a strong health span – preventing or conquering chronic illness through exercise, healthy diet and strong social connections. Longevity experts say oral health is linked to all three.

But maintaining oral health over 10 decades can be challenging – particularly for women, whose lifetime of hormonal changes can affect gum and tooth health.

What Is Oral Health?

Oral health goes well beyond avoiding or filling cavities. As we get older, we become susceptible to "oral frailty" – think fewer teeth, reduced chewing ability and even difficulty swallowing.

These add up to poorer nutrition and increased inflammation that has been linked to mobility issues, heart issues, cancer and cognitive decline. What do you need to do today to keep your smile healthy for decades to come?

In an extensive study, Japanese researchers found that early oral health habits help people build a kind of "health reserve" over time. Think of it like a retirement savings account, but for your heart, brain and oral health.

20s and 30s Your dentist may recommend a salivary screening, which can reveal your risk of developing oral and systemic diseases. The same bacteria found in infected gums has been found elsewhere in the body – including in the plaque that can cause heart disease, and in the brain, where it may increase a person's risk of dementia.

Fighting that plaque today may reduce your risk of illness later.

Pregnancy adds another layer:

Hormonal surges can trigger "pregnancy gingivitis," and untreated gum disease has been linked to preterm birth and low birth weight.

Finding a dentist and a primary care doctor who understand the MouthBody Connection® creates a lifelong collaboration between your dental and medical professionals that emphasizes the role your oral health plays in healthy aging.

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Menopause and beyond

40s and Perimenopause Estrogen starts to drop in these decades, leaving the teeth and gums up to 60% more susceptible to periodontal deterioration and disease. Reduced estrogen also accelerates bone loss – including the jawbone that anchors your teeth. As women are more likely to develop osteoporosis, this connection between bone loss and oral health is important for women to keep in mind. Be sure to tell your dentist about any bone-density medications, as some can affect dental procedures.

During these decades of hormonal shifts, your dentist may recommend more frequent and deeper teeth cleanings, known as scaling and root planing, to prevent periodontitis down the road.

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Bone density. Brain and heart health.

Strength and balance. Even if a lifetime of good oral health habits pays off with healthy aging, don't skip out on preventive care now: The rate of tooth decay in people over 65 outpaces that of schoolchildren!

Oral bacteria during these decades may contribute to tooth loss and other issues with chewing that could affect nutrition and physical strength.

One often-overlooked challenge in these years is dry mouth (xerostomia). Decreased estrogen slows saliva production, and many medications women commonly take later in life – for blood pressure, mood or other conditions – make it worse. Less saliva means more cavities, more gum irritation and more difficulty chewing. Working with your dentist to maintain your smile helps you to eat well and stay socially connected – and strong social ties are one of the pillars of a long, healthy life.

What Does a Healthy Centenarian Mouth Look Like?

Most things change over time, but the benefit of preventive care never does.

Healthy 100-year-old women still need to see their dentists twice a year and maintain good oral hygiene. (But they're probably wise enough to know this by now.)

While there is no guaranteed roadmap to hitting 100, taking care of your health – including your oral health – just may improve your odds. And one day, as you tell your grandchildren all about the "good old days" of the early 21st century, you will be able to greet their wide-eyed fascination with a big, healthy smile.

Deepika Dhama, DDS, is a seasoned clinician with nearly 30 years of experience and a leader in dental-medical integration (DMI).

Could Gum Disease Bacteria Fuel Breast Cancer?

A study out of Johns Hopkins Kimmel Cancer Center in Baltimore on mice found an oral bacteria associated with gum disease may play a role in kickstarting breast cancer.

While the study focused on mice, it adds to a growing body of research about the Mouth-Body Connection® – the association between oral health and overall wellbeing.

Researcher Dipali Sharma, MS, PhD, and her team studied bacteria associated with gum disease and found that it promoted breast cancer initiation and tumor growth and spread by causing DNA damage and altering cancer cell behavior in mice.

“The key takeaway is that this oral microbe can reside in breast tissue and that there is a connection between this pathogen and breast cancer,” Sharma said on the BreastCancer.org podcast.

While more research is needed to draw definitive conclusions, she explained that her team’s study was inspired by the growing body of evidence associating gum disease with breast cancer.

“I think we should all be more aware of that association and take care of oral health.”

Sharma said.

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Your Mouth might be a Chapter in Your

Fertility Story

By Ashley Abrams, DDS

When women prepare to get pregnant, there’s plenty of advice on what to do for their body. Take certain vitamins. Cut back on alcohol.

Eat healthier.

But make sure they don’t have gum disease? It’s rarely mentioned.

If you’re planning to have a baby in the near future, it’s important to know that there’s a growing body of research linking gum disease and women’s ability to conceive.

Although scientists are still studying the extent and nature of that relationship, there’s still good reason to take care of your gums and teeth.

When Gum Disease Goes Unchecked It’s normal for your mouth to have bacteria. Problems begin, though, when bacteria pile up in a film along the teeth and gumline and that plaque is not removed. Your gums may react by bleeding and becoming swollen and red, which are symptoms of gingivitis, a type of gum disease.

When that infection moves below the gumline and affects the bone and ligament anchoring your teeth to your jaw, you might develop periodontitis, a more serious condition. Gingivitis can be reversed, while periodontitis is treatable but not reversible.

The Mouth is a Gateway Here's the part that connects the mouth problem to the fertility question. Your body views an infection in your mouth as an attack, triggering your immune system to defend your health by deploying a battalion of cytokines, which are chemical messengers that organize an attack against the infection. These messengers can travel through the bloodstream from the mouth to reach your ovaries and the lining of your uterus.

Scientists studying fertility have found associations between this kind of persistent immune activity and several conception issues: the lining of the uterus that's less prepared to support implantation of an embryo, irregular ovulation, and changes in the quality of eggs being released. More studies are needed, but a working theory is that the same chemical signals meant to fight bacteria in your mouth cross wires with the hormonal signals of your body that regulate your menstrual cycle and support a pregnancy in its earliest, most fragile days.

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Bacteria On The Move Bacteria in the mouth can travel to other parts of the body. In some cases, the bacteria causing gum infections have been found in the fluid in the uterus. The likely route for bacteria is to pass through inflamed and bleeding gums into the bloodstream and travel to the uterus. There, they can cause inflammation, which may make it harder for an embryo to attach and grow, or may create problems further along in a pregnancy.

Some studies have tracked how long it takes women with periodontal disease to become pregnant compared to women with healthy gums, adjusting for other factors that affect fertility like age and smoking. The pattern that emerges again and again: Women with gum disease tend to take longer to conceive.

None of this means that by itself, gum disease is the reason a woman struggles to get pregnant. An enormous range of factors influence fertility and pregnancy, including age, hormone balance, body weight, stress levels, and underlying health conditions. But the link between gum disease and fertility has been repeated often enough across independent research that there’s every reason to include a dental visit as a sound step in getting ready for pregnancy.

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What You Can Do Before Trying To Conceive: Book a preconception visit: Schedule a baseline

checkup just like you would with your doctor.

Focus on the gumline: Brush twice daily for two

minutes, targeting where plaque collects fast.

Unlike age or genetic history, gum disease is something you can act on.

Having healthy gums and teeth before trying to get pregnant may lower the overall inflammatory load your body is carrying at the exact moment your reproductive system needs to function smoothly. It is also one of the more manageable pieces of your overall fertility picture.

Brushing twice daily, flossing every day, and visiting your dentist for a check-up two times a year are a regular part of maintaining your overall health. Now, these habits may have the added benefit of supporting your efforts to get pregnant.

Floss every single day: It's the most reliable way to prevent gum disease between teeth.

Don't ignore bleeding: Bleeding gums are an

early warning sign of gingivitis— tell your dentist.

Get your partner on board: Oral bacteria transfers through saliva; fertility is a team sport.

Seek proactive care: Ensure your dentist actively

manages inflammation and gum disease.

Ask about salivary screening: Test bacteria

levels, genetic risk, and gum breakdown.

Watch the sugar: Plaque thrives on sugar, so swap

in whole, calcium-rich foods.

Quit smoking: Smoking is a major risk factor for

both periodontal disease and fertility issues.

Manage health conditions: Keep conditions like

diabetes in check, as they directly impact gum health.

Keep up cleanings: Stay consistent with regular professional dental visits throughout the process.

Ashley Abrams, DDS has been practicing dentistry since 2013 and is dedicated to exceptional care with a focus on whole-body health.

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A NEW BEGINNING

Switching from a Kids’ Dentist to a General Dentist

By Kelly Kim, DDS and Ashley Abrams, DDS

Since age one, your child has been visiting a kids’ dentist, accustomed to the familiarity of their kids’ dentist’s office — the colorful waiting room, the friendly faces of the dental team, and the smaller instruments used for children’s smaller mouths. Now that your child is in high school, they’ll eventually switch to seeing a general dentist who can care for their oral health through adulthood.

There is no precise age when that change should occur. It’s a transition that takes time based on your teen’s readiness. Here are practical tips to help your teen make this change confidently.

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1.

Treat it as a window, not a deadline Most teens make this move often around the last year of high school. Think of this time frame as a window that opens gradually, rather than targeting an exact age. Your teen might already be independent, attending their dental appointment without you in the office. Others benefit from staying put a little longer, especially if they're in the middle of orthodontic treatment, have significant dental anxiety, or have a chronic health condition or disability that requires specialized, coordinated care.

2.

Start the conversation early Bring the topic up naturally about a year or two before you need to act on it. Ask your teen how they feel about their dentist’s office—do they still enjoy it or feel like it's for little kids? Starting the conversation early gives your teen a say in the decision.

3.

Loop in the pediatric dentist Your teen's current dental team has watched them grow up and knows their full history. At a regular checkup, ask the pediatric dentist if it’s time to start considering a general dentist. Pediatric practices can offer an opinion based on your teen's maturity and alert you to any unfinished treatment plans that should wrap up before switching offices.

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4.

Evaluate the new provider Ask your teen’s dentist for a referral to a general practitioner. Your child’s dentist knows and understands your teen and will be a great resource in recommending a dentist who fits your child’s needs.

When you start looking for a general dentist, check the following: • • •

6.

Brief your teen before the first visit Let your teen know that the appointment will feel different and focus on the positive grown-up experience. In some cases, it’s best to keep the statement about the difference simple and let them know you’re available to answer any questions.

If the practice accepts your insurance and new patients Whether office hours are compatible with your teen's schedule The dentist’s experience in treating young adult patients, including monitoring wisdom teeth

5.

Request or arrange to send dental records Once you have selected a new dentist, arrange for your teen’s records to be transferred from the pediatric office before the first visit with the general dentist. This helps the new dentist view your teen’s X-rays and review treatment history. Having the dental records also can help prevent repeat X-rays.

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7.

Build independence Depending on their maturity, confidence and readiness, consider having them: • • • •

Schedule their own appointment Fill out the new patient forms Ask their own questions during the exam Keep track of their next cleaning

8.

Plan for special needs and considerations If your teen has a developmental disability, complex medical condition, or significant dental anxiety that has required specialized management, plan for a longer, carefully planned transition. Choose a general dentist with experience in your teen's needs or trained in special care dentistry. Consider a get-acquainted visit before committing to a full exam. Ask your teen’s pediatric dentist for a summary of accommodations that have worked well to share with the new provider.

9.

Expect your young adult’s dentist to check for gum disease This includes taking gum measurements at every exam to give the dentist insight into your young adult’s gum health. They are not painful but may cause slight sensitivity in areas where gums are inflamed. Gingivitis is common in teens and young adults and can lead to periodontal disease. Saliva screenings that measure collagen breakdown or bacteria levels may be offered to treat gingivitis or periodontal disease proactively.

Kelly Kim, DDS

earned her pediatric dentistry degree from USC and provides exceptional care for growing smiles.

10.

Expect monitoring of your young adult’s wisdom teeth These third molars typically appear between the ages of 17 and 21 and need to be tracked to make sure they are emerging properly and not impacting other teeth. The dentist may take a 3D Cone Beam Computed Tomography (CBCT) to view your child’s jawbone and teeth, the wisdom teeth placement, and any potential teeth and gum problems and infections.

Ashley Abrams, DDS

has been practicing dentistry since 2013 and is dedicated to exceptional care with a focus on whole-body health.

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Making Flossing a Habit: Tips for Every Age

By Kelly Kim, DDS Let’s face it: Flossing daily is a habit that kids would rather skip. In fact, a national poll of parents showed that only a quarter of kids in the U.S. floss daily, which is bad for children’s health. Flossing and brushing are important in preventing gum disease that impacts overall health.

Here are some tips for helping your child turn flossing into a daily habit.

Throughout childhood: • Pair flossing with another daily routine—before brushing and before a bedtime story. Once at night is fine.

• Use the right tool for the age: floss picks are easier for small mouths and hands than string floss.

• Model it every day. Your child is far more likely to floss if they see you do it.

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By age group: Start early. When two of your child's teeth touch each other, food and plaque can lodge between them. It’s important to floss even before all their teeth come in. Start flossing the front teeth when your child is one year old and the molars at three years. Having your toddler lie down will make it easier for you to access their teeth and gums.

Toddlers and preschoolers (ages 2–5): You'll need to floss for them at this stage. Continue to have them lie down so you can reach their teeth and gums easily. Floss during a calm moment, such as after bath time. Make it playful: let them pick a flavored floss, count their teeth or sing a tooth or floss song.

Elementary (ages 6–9): Floss picks are easier for children to use. Floss together. Let your child hold the floss picks and "have a turn" first at their teeth before you finish the job. You can also say they’ll floss the front teeth and you’ll take care of the teeth in the back of the mouth. Keep helping because despite kids’ best efforts, their hand coordination usually isn't ready to floss adequately. Floss picks for adults are easier to use between teeth than kids’ versions, so if your child can tolerate the adult versions, use those.

Tweens (ages 10–12): This is often when kids can start flossing solo. String floss gets the job done better so have your tweens switch to that.

Demonstrate proper technique with string floss. Check in, ask them to show you their technique, and offer gentle reminders.

This is also the stage when teens start wearing braces. Your tween’s orthodontist will recommend orthodontic floss, a special category of floss that enables tweens to get under the wire of braces and reach the teeth.

The orthodontist’s team will show how to use that.

Teens: Independence is the goal.

Continue to reinforce healthy habits by keeping floss visible and always stocked in the bathroom. Tie flossing reminders to things they care about, such as fresh breath and whiter smile.

Kelly Kim, DDS is a pediatric dentist and believes in exceeding expectations when caring for her patients throughout their childhood.

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What’s Going on in Your Mouth, with Ruthie Toothie Hi there! I’m Ruthie. I’m a tooth. Maybe I look a lot like one of your teeth! I want to tell you a secret: Teeth like me LOVE going to the dentist.

Why? Because the dentist takes great care of us. They keep teeth clean, healthy, and strong. They even take cool pictures of your teeth. The pictures are called X-rays!

What is a kids’ dentist?

A kids’ dentist has a big name. It is a pediatric dentist (say it like “pee-deeYA-trick”). This is a dentist who went to extra years of school. They learned all about kids’ teeth. And guess what?

They are super nice!

When do I see the dentist?

You might have seen the dentist before you turned one! That is because all 20 of your baby teeth were hiding under your gums when you were born.

As you grew, your teeth popped up to say hello. Your dentist has helped them stay healthy the whole time.

Let me show you how teeth grow up!

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When you were a tiny baby Can you brush a tooth if you have no teeth yet?

Yes, you can! A grownup uses a soft, wet cloth to wipe a baby’s gums. This wipes away the yucky stuff called germs. It also starts a good habit early.

When you were a little bigger Way before your first birthday, your baby teeth started to come in. Your dentist wants them to have no cavities. A cavity is a little hole in a tooth. Ouch! Seeing the dentist two times a year helps keep cavities away.

When you were a toddler and kindergartener Now is the time for great habits! Eat fewer sweets, brush twice a day, and floss those sneaky spots between teeth. It’s also time to bid farewell to pacifiers and thumb-sucking so your new adult teeth—also called permanent teeth—grow in big and strong!

When you're 6 to 8 years old Permanent teeth start coming in! Yay! Brush twice daily with fluoride (say it: FLOOR-eyed) toothpaste—a special helper that makes teeth strong.

Your dentist may also introduce an orthodontist to help your smile grow in nice and straight!

When you’re 9 to 14 years old Some big kids need a little help with their teeth. They might get braces to make their teeth straight and tall. If that is you, a special dentist can help your grownup teeth look their best.

And of course, your dentist still wants to see you every six months. That keeps your teeth and gums happy and strong, just the way I like it!

Looking for a kids’ dentist near you? My friends at Smile Generation can help you find the perfect fit. Keep smiling!

Ruthie Toothie your teeth’s buddy who helps you keep your teeth and gums clean, healthy and strong.

Big Smiles, Smarter Savings!

Did you know there’s a simple way to save on your child’s dental care? The Smile Generation Dental Plan Kids helps your family save up to 70% on routine cleanings and pediatric visits—with no deductibles or waiting periods.

Find a kids' dentist now at SmileGeneration.com and ask how you can save on your next visit!

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•

"Healthcare can be fragmented," said Dr. Drew.

"Dentistry's in one place, medicine in another, and patients are stuck right in the middle". Dr. Ashley Abrams, DDS, discusses oral health's connection to hormonal changes, including pregnancy.

Catch the conversation at

SmileGeneration.com

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Ready, set, brush!

Grab your free Tooth Brushing Chart and level up your daily smile routine!

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Ready, set, COLOR!

Download a fun coloring story written by one of our doctors to build healthy habits!

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Sources Smile Your Way to 100: The Oral Health Habits Women Need for Life • Pew Research Center: U.S. Centenarian Population Is Projected to Quadruple Over the • • • • • • •

Next 30 Years Harvard Health Publishing Longevity: Lifestyle strategies for living a healthy, long life National Institutes of Health: Oral health for achieving longevity National Institutes of Health Nutritional Determinants of Mobility More than just teeth: How oral health can affect the heart Oral hygiene and cancer Poor Oral Health Linked with Higher Risk of Alzheimer’s Disease Oral Health for Achieving Longevity

Your Mouth Might Be a Chapter in Your Fertility Story • Cytokines in Gingivitis and Periodontitis: From Pathogenesis to Therapeutic Targets, “Frontiers in Immunology”

• Porphyromonas Gingivalis May Interfere With Conception in Women, “Journal of Oral Microbiology”

• Periodontal Disease: Could This be a Further Factor Leading to Subfertility and is There a Case for a Prepregnancy Dental Check-up? “Women's Health”

• Is There an Association Between Periodontal Disease and Infertility? A Systematic Review, “Medicina Oral, Patología Oral y Cirugía Bucal”

• Periodontitis, Female Fertility and Conception (Review)

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A New Beginning: Switching from a Kids’ Dentist to a General Dentist • Adolescent Oral Health Care • Policy on Transitioning from a Pediatric to an Adult Dental Home for Individuals with Special

Could Gum Disease Bacteria Fuel Breast Cancer?

• • • • •

Oral Bacterium May Promote Breast Cancer Development and Spread SmileGeneration.com, The Mouth-Body Connection® Is Breast Cancer Linked to Certain Bacteria?

The Root of the Matter: Linking Oral Health to Chronic Diseases Prevention Connection Between Oral Health and Chronic Diseases

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Healthie Happi Generations of Smiles A Smile Generation Magazine

LET'S DO THIS AGAIN! Smile Generation exists to connect you with trusted dentists in your area and to offer education on the critical link between oral and overall health. We’d love to know what you think of our magazine.

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