In my previous article on gum health, we explored the what, why and what to do when you have bleeding gums. In this blog article, we will go a bit deeper into the gums, and explore periodontal disease, also known as periodontitis or gum disease.
What is periodontal disease?
It’s a bit of an incorrect term to call it “Gum disease” because periodontal disease is one of the tissues surrounding a tooth (Peri = Near, Dontal = Tooth). This does include the gums, but more importantly it is a disease which affects the jawbone.
How does periodontal disease start?
Periodontal disease, like gingivitis, is started by the presence of bacteria near the gum line. The bacteria cause inflammation to happen, the gums swell up full of blood, and start to bleed as they become fragile. They can be extremely sore to touch which results in patients avoiding touching them. Often patients are unaware that they have periodontal disease until the very late stages, when the problems are more difficult to treat. This is why we recommend regular check-ups of your teeth and gums so we can help to catch the problem early.
What happens if it is untreated?
Over time, untreated chronic inflammation causes the body to reject the tooth entirely, reducing the amount of jawbone which holds the tooth in place. This takes place over several years and you will imagine as that more jawbone is lost around the tooth, the tooth can become more mobile leading to it falling out naturally or needing to be removed by a dentist. Once jawbone is lost, it is unlikely to grow back on its own.
Does it affect all people?
Periodontal disease does not affect all people the same – some will be naturally highly resistant to it, but others are highly susceptible. In fact, around 30% of adults are affected by periodontal disease to differing degrees. There is a strong genetic link, and many patients tell me that their parents or grandparents had gum disease. Some report that their relatives had “pyorrhoea” and had most or all their teeth removed and replaced with dentures. Thankfully our understanding of the disease has improved over the years, and we are able to help patients keep their own teeth for many years.
How do I stop it?
Periodontal disease is not something you can catch from other people, but nor is it curable. It is a lifestyle disease, and it is important to say that as dental professionals, we can help monitor, advise, and make it easier for you to clean at home, but we cannot cure the disease. What we can do is advise you where the problems are, show you how to clean the gums at home more effectively, clean away hard deposits on your teeth and nasty bacteria which lie deep under the gums. However, it is important for a patient to take control of the lifestyle factors which contribute to the disease. These are changes which need to be made for life, and the problem will return if the cofactors are not maintained forever.
What is my role?
Although the genetic element cannot be changed, patients can help reduce the risk of periodontal disease by maintaining the controllable factors. These are:
- Oral hygiene at home. Effective cleaning under the gum line is mandatory for success in tackling periodontal disease. Without immaculate oral homecare, the disease will not stop and treatment by a dental professional is futile. We can help demonstrate effective oral hygiene aids for your use at home and show you where you need to give further attention. As a patient with gum disease, you must be much better than the average person at cleaning.
- Smoking and vaping. Smoking reduces blood volume to the extremities, which includes the gums. This prevents the body from bringing defence cells to the gums and creates an environment where gum disease-causing bacteria thrive. Patients who have stopped smoking respond as well as non-smokers to periodontal therapy. E-cigarette use is thought to be less risky than cigarettes for general health as they contain fewer of the chemicals which pose danger. However recent studies show that e-cigarettes are not completely without risk.
- When your body is worn down by stress, it must focus on managing the increased levels of a hormone called cortisol and forgets to look after its own defence systems. This means that bacteria are left to wreak havoc on your gums and do much more damage than in a low stress environment. Stress management techniques such as yoga and relaxation can help to reduce the risk of periodontal disease.
- A diet which is low in essential vitamins and minerals can mean the body does not have a sufficient defence mechanism to combat the bacteria. In addition, a diet high in sugar will give fuel to the bacteria in the mouth, encouraging them to multiply in higher numbers. A diet low in sugars and saturated fats, with enough essential vitamins and minerals will help to reduce risk of periodontal disease.
- Diabetes and other inflammatory diseases. There is a strong link with inflammatory diseases such as diabetes mellitus, cardiovascular disease, rheumatoid arthritis, Inflammatory Bowel Disease (IBD), Alzheimer’s disease and fatty liver disease. By improving and controlling these diseases, periodontal disease will improve and vice versa.
At the practice, we have treated patients with periodontitis for many years and regular appointments with the dentist and dental hygienist can help to monitor, prevent and treat the problem before it worsens.
Richard Staincliffe, BDS, MSc, Dip.FFGDP (UK) RCS Eng, Dip.MILM, PgCME
Richard is a partner at Duston Dental Practice, graduating from Sheffield University in 2003, and has worked in UK General Dental Practice since. He has a distinction in his Master’s in Advanced General Dental Practice from Birmingham University, and has been teaching undergraduate and postgraduate dentists since 2008.