MIAMI -- Johanna Evers, 6, has a routine each morning and night: She brushes her teeth, flosses and rinses with fluoridated mouthwash.
She also has been visiting a dentist for twice-yearly cleanings since she was 2.
"I'm thinking of my daughter's future," said her mother, Brigid McKeon, 43, who takes Johanna to Miami Children's Hospital's Pediatric Dental Center in Doral, Fla. "I want her to be able to carry it on when she gets older and has her own family."
Dental hygiene is a vital part of overall health, dentists and doctors say. According to the Surgeon General's Report on Oral Health in America, oral diseases and disorders affect health and wellbeing throughout one's life.
In fact, a research study -- in which doctors at the University of Miami Miller School of Medicine participated -- has linked periodontal (gum) disease to a heightened risk of heart attack and stroke. Other research has linked poor dental health to Alzheimer's disease.
It all points to the importance of brushing, flossing and visiting a dentist regularly, starting in infancy.
"Cavities can happen as early as nine months of age," said Dr. Rosie Roldan, director of the Pediatric Dental Center at Miami Children's Hospital and director of its pediatric dental residency program. "The teeth start erupting at six months, so they haven't been in the mouth three months before we can start seeing cavities."
Roldan advises parents to bring their children to the dentist beginning at 12 months, and every six months after that. Parents should also ensure that their children's teeth are brushed twice a day, as soon as the first tooth appears. That creates a habit, so children grow up to not be resistant to brushing.
"Prevention is key," Roldan said. "We want to see them early, teach about properly brushing teeth and give fluoride supplementation to get fluoride incorporated into the teeth, if needed."
Baby teeth are space holders for permanent teeth. They aid in speech development and are necessary for chewing. Aesthetically, they also play a key role, she said.
"A lot of kids know exactly how they look and how they smile," Roldan said. "And it's important to develop the self-esteem of the child."
Parents need to be aware that an enemy is brewing in bacteria that develops in the mouth, and thrives during the night when the saliva is thick.
"If the last thing you eat is sugar, which is what bacteria live on, the bacteria will use that medium to grow and produce acid," Roldan said. "They'll have a party on your teeth every night if you don't brush."
When very young children develop dental problems, they can wind up in the operating room. Roldan said her center sees 700 patients in the operating room for dental work each year. The majority are under 4.
Children can even require root canals and extractions.
In the worst case, when problems are left untreated, an abscess, or accumulation of pus, can result. The pus can migrate and move to the brain or eyes, leading to a periorbital (eye) infection, or a brain abscess, which can be potentially fatal.
For adults, health risks associated with oral health are particularly significant.
Researchers from the University of Central Lancashire in the United Kingdom last year found that people with poor oral hygiene or gum disease could be at higher risk of developing Alzheimer's, compared with those who have healthy teeth.
The researchers discovered the presence of a bacterium called Porphyromonas gingivalis in the brains of patients who had dementia when they were alive. The bacteria are usually associated with chronic periodontal (gum) disease.
Earlier research, conducted by New York University in 2010, revealed long-term evidence that linked gum inflammation and Alzheimer's disease, finding that gum disease could increase the risk of cognitive dysfunction.
Having healthy gums can also be good for your heart, new research shows.
Researchers at Columbia University's Mailman School of Public Health and the University of Miami Miller School of Medicine have found that periodontal disease is associated with greater thickness of the arterial wall. That means possibly greater risk of atherosclerosis and greater risk of heart disease and stroke, said Dr. Tatjana Rundek, professor of Neurology and Vice Chair, Clinical Translational Research in Neurology, at the University of Miami Miller School of Medicine.
Dentists can determine the presence of periodontal disease, she said, by probing the depths of pockets in the gums.
Rundek said that researchers also found for the first time late last year that as gum health improves, atherosclerosis also improves. Atherosclerosis, or the narrowing of arteries through build-up of plaque, is a major risk factor for heart disease, stroke or death. Rundek participated in conducting the research; the principal investigator was Dr. Moise Desvarieux, professor of epidemiology at Columbia University.
"Intervention, even brushing your teeth, can reduce atherosclerosis," Rundek said. "So you reduce the load of bacteria and reduce pocket depths and reduce periodontal disease."
More research on the link between atherosclerosis is under way in a clinical trial at Columbia, as doctors continue to explore the connections between oral health and overall health.
"The advice is to take good care of your teeth. Oral health is really important, because this is the first time we have proof that there is a link between oral health and atherosclerosis," Rundek said. "So regular checkups with a dentist, regular teeth-cleaning, treating if periodontal disease is present, and most of all, brushing the teeth every day -- several times if possible, especially for kids."