Periodontal disease and your health [Archives:2008/1144/Health]

April 7 2008

Dr. Essam Dhaifullah, periodontology department chairman
Sana'a University, Faculty of Dentistry

The majority of people coming to our dental faculty have no idea that they have periodontal disease, also known as gum disease, including gingivitis and periodontitis, which are infections of the gum and bone that hold teeth in place. It is often painless and you may not be aware that you have a problem until your gums and the supporting bone are seriously damaged. The word periodontal literally means “structures around the tooth.” These include supporting tissues which attach teeth to the jawbone, such as gums, periodontal ligaments and alveolar bone. The prevalence of gingivitis is especially high for males aged 13 to 17. Also, males have worse cases of gingivitis than females, especially in younger age groups. Although the reason for the existence of these gender differences is not known, poorer plaque control among males could likely explain much of the higher prevalence and extent of gum disease among them.

What's gingivitis?

It is an inflammation of the gums ) the initial stage of periodontal disease. At this early stage in gum disease, damage can be reversed, since the bone and connective tissues that hold the teeth in place are not yet affected. The classic signs and symptoms of gingivitis include red, swollen, tender gums that may bleed when you brush. The direct cause of gingivitis is bacteria found in dental plaque, which are soft deposits that form a biofilm adhering to the tooth surface or other hard surfaces in the oral cavity. Food products are an important source of nutrients for bacteria. Dental plaque accumulates and persists, especially in crevices and spaces or around rough or broken fillings. If the plaque is not removed by daily brushing and flossing, bacteria in the plaque produces toxins that can irritate the gum tissue, causing gingivitis. Plaque that stays on your teeth longer than two or three days can harden under your gum line into tartar (calculus), a white substance that makes plaque more difficult to remove and that acts as a reservoir for bacteria. Unfortunately, brushing and flossing can't eliminate tartar ) only a dentist can remove it.

Left untreated, however, gingivitis can become periodontitis, a serious infection that destroys the soft tissue and bone that support your teeth. In time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque stimulate a chronic inflammatory response in which the body turns on itself and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed.

Symptoms of periodontal disease include:

– gum swelling and redness

– ease of bleeding, particularly when brushing teeth

– tender gums

– receding gums, making your teeth look longer than normal

– New spaces developing between your teeth

– Loose teeth or a change in the way your teeth fit together when you bite

Another possible symptom of gingivitis and periodontitis is halitosis, commonly known as bad breath. While most people think that gingivitis is an oral disorder for adults, studies have shown that it is an almost universal occurrence in children.

Another cause of gingivitis is poor nutrition. If you suffer from a diet poor in calcium and vitamins B and C, you've unfortunately made gingivitis more likely to strike you.

Tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, but studies also demonstrate that smoking is the most significant risk factor for periodontal disease. Smoking in any form damages your immune system, putting you at greater risk of periodontal infection. It also creates a favorable environment for harmful bacteria and interferes with the normal mechanisms for limiting bacterial growth in your mouth. Because smoking impairs healing, smokers are less likely to respond to treatment than nonsmokers are.

A number of health problems can take a toll on your gums. One of the most significant of these is diabetes, which makes you more prone to many infections, including gum infections. But the relationship between diabetes and periodontal disease doesn't end there. Gingivitis and periodontitis impair your body's ability to utilize insulin, making diabetes harder to control. And because diabetes and periodontal disease may make you more susceptible to a heart attack or stroke, having both conditions increases your risk of cardiovascular disease. Hormonal changes which occur during pregnancy, menopause or even menstruation can make your gums more susceptible to periodontal disease.

How can I prevent gingivitis?

Prevention includes a good daily oral hygiene routine. The toothbrush is a most important tool for plaque removal. You can help stop gingivitis before it develops by:

– properly brushing and flossing to remove plaque, debris and control tartar buildup

– eating right to ensure proper nutrition for your jawbone and teeth

– avoiding cigarettes and other forms of tobacco

– regular checkups with your dentist

Brush your teeth regularly, preferably in the morning and before bed, and floss your teeth at least once a day. Make sure that you use a soft toothbrush and that the bristles reach the gum line when you brush. Have your teeth professionally cleaned every six months to a year to prevent plaque from becoming tartar and remove any tartar that may have already formed.

Children need to be taught how to practice good hygiene early by brushing and flossing to avoid oral disorders in the future. If you are a parent, practice good oral hygiene habits yourself as part of educating your child. Being a good role model is extremely beneficial to both you and your child. Remember that oral hygiene also involves the dentist, so it is important to schedule regular check-ups and cleanings.