How common is periodontal disease?
In adults, periodontal disease is the top cause of tooth loss, which affected over three-fourths of all people, regardless of nationality, race, or even socioeconomic level. In fact, nearly half of all 20 year olds in the world have at least one periodontal pocket. The good news is that the earlier periodontal disease is detected, the more successful the treatment results.
What’s the big deal if I lose a tooth?
Besides helping us look good, teeth are important for a host of other reasons. For one, strong firm teeth enable us to chew our food a lot more comfortably. Food that is properly masticated makes for better digestion. Everyone loves a bright, healthy smile. First impressions count. Asides from making you feel and look good, teeth help us to speak clearly. People who have had the misfortune of losing all their teeth and wearing dentures can have difficulty speaking. They also can’t eat all the things they want, are frequently self-conscious about their “choppers,” complain that they cannot taste their food as well as they used to, and may even have trouble breathing when they sleep. Those are enough reasons to keep our teeth, and the best way to start is with good oral hygiene.
What is periodontal disease?
Periodontal disease affects the gums and structures that support your teeth. One of the first warning signs that there’s a problem is when the rim of the gums next to the teeth becomes red and swollen, & bleeds more easily when touched. Most often, there’s no discomfort at this stage, yet the disease has gained a foothold and is now referred to as “gingivitis.” Gingivitis’s reversible with professional cleaning and oral hygiene techniques (that are improved). However, if left untreated, the danger exists that it’ll lead to a periodontal condition that’s irreversible – periodontitis – that harms the bone and gums surrounding the teeth.
Periodontitis is a more advanced disease. Bone and tissues supporting the teeth are destroyed, yet still, an individual may be unaware of the problem existing in their mouth. When this happens, the gum attachment starts to separate from the teeth, and create “pockets.” These pockets contain millions of bacteria that are trapped in a plaque that sticks to the teeth. Unfortunately for us, the mouth is a perfect incubator. It is warm, dark, and moist, with tons of “food” for the bacteria to metabolize. The net result’s that the bacterial plaque thrives & matures.
Some people are more prone to periodontal disease than others. Some get a minor form, while others get a severe case. Why? It is likely we inherit a genetic predisposition to periodontal disease, and this influences how severely we will be affected by it.
What causes periodontal disease?
As stated above, bacteria that are trapped in a film that stick to the teeth – known as plaque – initiate the early changes to the gums. As the plaque is maturing on the teeth, the disease becomes more known to the point where it starts becoming irreversible. Though almost three-fourths of the population of the world has some form of periodontal disease, a genetic predisposition’s the single biggest determinant as to how serious each case gets. Once periodontal disease is diagnosed, a variety of factors can affect it.
What makes my periodontal condition worse?
Dentists have always known that stress affects the gums. As far back as World War I, the influence of stress was noted in the soldiers fighting in the trenches. Their gums became infected acutely to the point where the tips between the teeth, known as papillae, eroded away, which a leaves loss of bone and disfiguring craters. Teeth became loose, and in severe cases, need to be removed. This so-called “trench mouth,” has a more formal name: Acute Necrotizing Ulcerative Gingivitis. ANUG is also known as Vincents Disease, and is a stress-related disease.
Hormones also modify periodontal disease. It is commonly known that during pregnancies, some women’s gums become swollen and sore, and bleed more easily. On rare occasions, large swellings occur, known as pregnancy tumors. These benign growths may need to be removed if they get in the way of chewing or become unsightly. When a woman gives birth, most problems reverse themselves and leave no lasting marks. However, in certain cases, pregnant women that are suffering from periodontal disease might find their condition in fact worse post-partum. Teeth might feel loose or spaces may be present between teeth that weren’t there before pregnancy. When these symptoms occur, professional help is required.
To some extent, some women realize that their gums get puffy & bleed with the smallest touch right prior to the beginning of their menstrual cycle. These symptoms start disappearing a few days after menses has started. Women on hormone replacement therapy can also observe subtle changes in their gums.
So what’s going on? Stress? Pregnancy? Bleeding gums and the menstrual cycle? Trench mouth? What’s the connection? Estradiols.
About twenty years ago, it was learned that some bacteria implicated as a cause of periodontal disease prefer to metabolize estradiols, rather than carbohydrates. The English translation? Bugs in the mouth cause gum disease to grow fast and furious when bombarded with estradiols. They love to eat the stuff. So, what are estradiols?
Estradiols are hormones that circulate in our bloodstream. The three most common are: adrenaline, cortisone, and estrogen. Their amounts increase in our circulation for a variety of reasons, and when they do, provide a fertile environment for the bacteria to multiply and cause periodontal damage.
It’s often observed that gums bleed more during pregnancy. Some women sense their gums bleed more just before their menstruation begins. These are two examples of how increased circulating estrogen affects the gums. But there are other conditions that affect men as well as women.
As mentioned before, stress is a main concern. When individuals suffer any sort of personal crisis – job loss, marital problems, a debilitating disease affecting a loved one, or death of a family member – the chances exist that their circulating estradiols will increase. Specifically, adrenaline and cortisone. When this happens in the face of an already existing periodontal condition, chances are the problem will get worse.
Is there anything else that can affect periodontal disease?
Plenty. The worst offender is smoking. Study after study shows that in the face of a known periodontal condition, smokers have even worse gums. Not only do they have deeper pockets and more bone loss, but they don’t heal as well as non-smokers do. This is especially germane when periodontists and oral surgeons place dental implants in smokers. Smokers can successfully have implants, but they tend to heal slowly, have more infections, and experience more problems with their implants.
To a lesser extent, what we eat and the vitamins we take, affect the gums. Individuals who are overweight, and those consuming carbohydrates in high amounts – especially in sugared drinks, cakes, and candies – adversely affect their gums and teeth. Constant sucking on hard candies and cough drops helps the bacteria metabolize a lot quicker, and in high numbers. This causes a greater risk of dental decay and more inflamed gums.
On the vitamin front, if an individual has anywhere near a healthy diet, then the gums will not be affected. Periodontal disease is not affected by Vitamin C or calcium supplements, and taking these supplements will have no effect on gum disease.
Lastly, many disease states affect the gums. The most notable is diabetes. Diabetics need to take good care of their teeth and gums because they are prone to more infections and greater problems than non-diabetics.
Medications affect the gums. One drug group that concerns periodontists is calcium channel blockers. These medicines – Verapamil, Procardia, Cardizem, plus others – are utilized in treating certain heart conditions. Though they don’t affect every person the same way, and in fact, don’t affect all who take them, calcium channel blockers sometimes cause the gums to swell. These gum swellings happen between the teeth and make brushing and flossing difficult. In some instances, the gums swell so large they can only be managed with surgery. In this category, if you take drugs and are experiencing bleeding and swollen gums, you might want to search for professional help.
Be aware of a common side effect of many medications: dry mouth. When the salivary flow starts to decrease, better oral hygiene is required since inflammation and decay may increase. If you sense your mouth is dry, clean your mouth frequently, and swish often with water.
What are the signs of gum disease?
There are many signs of gum disease.
- Gums bleeding when brushing the teeth
- Swollen and red gums
- Tender gums
- Gums get pulled away from the teeth, having roots exposed & creating recessions
- Pus between gums and teeth. Unexpected swellings that are so painful to the touch
- Loose teeth, or spaces start to appear between teeth all of a sudden
- Teeth starting to flare out
- A change in the ways your teeth fit together/a different bite
It is important to note you may have periodontal disease and not experience any of these symptoms rarely. Periodontal disease is chronic and silent, giving an advanced warning that tissue destruction’s happening. That’s why it’s vital to have regular dental check-ups.
How is gum disease diagnosed?
During an exam, the dentist or hygienist inspects the color and firmness of the gums. Teeth are tested for looseness. The bite is checked. At some point, a small measuring instrument – actually it’s a millimeter ruler – is gently inserted between the tooth and gum to measure the depth of the pockets. If the depths are greater than the norm of 1-3 millimeters, improved oral hygiene measures and more deliberate therapy may be suggested. This “periodontal” exam should be done at frequent intervals for all adults, especially when there’s a history of periodontal disease in the immediate family (like a parent requiring dentures by age 40).
X-rays should be taken at appropriate times to evaluate changes in the bone supporting the teeth. X-rays also reveal dental decay and can be useful in detecting a variety of abnormalities.
How can gum disease be prevented?
You are an integral player on the team charged with caring for your teeth. Without your steady involvement, the hygienist and dentist/periodontist are fighting an uphill battle. When a patient asks how frequently they really have to floss, it’s been answered somewhat tongue n cheek, “Floss only the days you want to keep them!”
Regular dental visits are essential for good dental health. Despite oral hygiene measures daily, calculus (tartar) still forms nevertheless. Professional cleaning by a hygienist or dentist will have the hardened calculus removed from the teeth. Why bother if it only forms again? Because calculus acts much the way coral reefs do. It serves as a hiding place, with all its microscopic nooks and crannies, for the millions of bacteria hovering about the teeth. Remove the tartar, and flossing and brushing will be that much more effective in removing plaque.
After my gums have been treated, am I done with periodontists forever?
In most cases, not really. As previously mentioned, periodontal disease’s a chronic condition that’s not cured but can be stabilized and maintained. Periodontists have a great track record when it comes to getting periodontal conditions under control. Once the initial treatment has been completed, maintenance care is essential for future good oral health.
Often, periodontal disease follows specific patterns. Usually, pockets & bone loss begin in the maxillary (upper) molars, and then the mandibular (lower) molars. It’ll involve other teeth in time, as well. Once formed, periodontal pockets don’t get worsen on a daily basis. Rather, pockets can stay stagnant for extended periods of time, only to have short bursts of issues when they get worse, only to become stabilized again. We call this periodontal breakdown “episodic.” Along the way, abscesses can occur, and pockets and bone loss can progress to the point that teeth need to be removed. Treatment retards and, in many instances, can even stop this progressive gum/bone deterioration.
Who should get their gums checked?
Everyone would benefit from having a periodontal examination. Make certain your dentist or hygienist checks your pockets the next time you get your teeth cleaned. It’s to your advantage to have subtle changes picked up before they become serious. Come and visit our practice for a consultation to find out the best way to take care of your smile!