Periodontal (Gum) Disease and keeping your teeth

By Dr. Christine Liu

Gum disease is a persistent condition that affects the tissues that surround (and support) a person’s teeth. In the early stages of the problem, the gums become swollen, red, and can bleed when touched. This happens during both eating and brushing. In a more advanced stage, the gums pull away from the supported tooth, and the bone structure around the tooth deteriorates. This can cause a tooth to eventually loosen and even fall out. Gum disease can fairly get the blame as the main cause of tooth loss.

When you see bleeding during brushing or flossing, this means a build-up of plaque or tartar is taking place underneath, or along the gum line. Plaque and tartar allow bacteria to grow rapidly, and this is the beginning stage of a gum disease problem.

Gum diseases are quite common, and the condition affects 20-50% of the global population. If you are a smoker and have poor oral hygiene, you are in a high risk category for gum disease. Diabetes, certain medications, advanced age and higher than normal stress levels, can also contribute to periodontal problems.

Research has shown that gum disease causes a 44% increase in the risk of cardiovascular disease among individuals aged 65 years and over. Individuals with type II diabetes, also have three times greater mortality risk compared with individuals with no gum disease signs. All good reasons to be vigilant against this problem.

Bacteria under the gums can be a concern for the whole family. This bacteria can be spread to others though saliva. If one of your family members has gum disease, then sharing eating utensils (or anything that comes in contact with saliva) their gum problems can be passed on to other family members. So, if you notice the signs of the disease in a family member (bad breath or swollen, red, or bleeding gums) it’s a good idea to suggest that they see a dentist for an exam as soon as possible. In the interim period, take care to ensure that you minimize any eating utensil contact amongst family members.

Some denture wearers are mistaken in the belief that they can’t get periodontal disease if they have dentures. But, the same bacteria that causes gum disease can attack the gums whether you have your adult teeth, or they have been removed. The disease also causes gums to become inflamed and painful, and this can make wearing dentures uncomfortable as well.

Periodontal inflammation is progressive, but the rate of progression can vary between individuals. Progression speed depends on the attack strength of the bacterial plaque, and on the efficiency of an individual’s immune system. It is common for more severe forms of the problem, and more rapid progression to present in individuals with a compromised immune system, such as diabetes type I & II, or other immune system compromises.

Along with bleeding at the gum line, here are some symptoms that concerning and likely to lead to a positive diagnosis; bad breath that won’t go away, red/swollen gums, tender gums, painful chewing, loose teeth, sensitive teeth, receding gums or longer than normal teeth. Gum disease is a silent disease. It does not cause intolerable pain, and can progress unnoticed in some cases.

In the early stages, bleeding gums during tooth brushing may be the only sign. Many are not alarmed at this, and no action is taken. But, as the disease advances, and gums keep deteriorating, what can be reassuring to the afflicted is that the bleeding may stop. Patients then get lulled into a false sense of security. There may be no other obvious progression signs until teeth suddenly start to feel loose. This is why recommended dental checkups, and X-rays are so important.

During regular dental exams, the dentist or hygienist will look at the amount of bleeding around the gum line, and measure whether the gums have started to pull away from any teeth. These precise measurements can tell the dentist whether or not a patient has gum disease, and what stage it is in.

Once discovered, plaque control is the most important method of limiting the disease progression and helping patients to maintain healthy gums. Treatment includes professional scaling (scraping off tartar from above and below the gum line). Root planning can also remove rough spots on the tooth root where bacteria and germs can gather, and helps remove bacteria that can contribute to the issue.

When the problem is advanced, surgical flap treatment may be needed. This involves lifting back the gums and removing the tartar. After surgery, gums will heal and fit more tightly around the teeth giving the patient a real second chance.
Additional solutions to advanced problems could also include bone and tissue grafts.

A bone graft is the placement of natural or synthetic bone in the area of bone loss. It can help promote bone growth. If bone loss has happened, it usually cannot be reversed, but progression can be stopped with treatment.

While some of these advanced treatments are comprehensive, the good news is that the vast majority of gum disease can be easily prevented by thorough daily plaque removal through proper brushing and flossing. Regular professional dental cleanings, two to four times a year, also intercept starting conditions. Avoiding risk factors such as smoking, stress, and poor diet will also keep you on safe ground.