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Gum disease is very common and problematic—and often preventable

As we brush and floss, we’re often focused on our teeth and ensuring a clean, fresh mouth. Healthy teeth, however, are connected to healthy gums. Unfortunately, gum disease is the most common dental problem. Seven out of 10 Canadians will develop this disease at some point in their lives.

Causes

Gum disease frequently develops slowly and painlessly, and often one lone bacteria under the right conditions can cause significant problems. “I often tell patients that periodontal disease, or gum disease, is the result of having the wrong germs in the wrong mouth at the wrong time,” says Dr. Brian Rinehart, a periodontist in Fredericton, NB. (A periodontist is a dentist who has done a two- to three-year residency and specializes in treating periodontal disease.)

Healthy gums and bone hold teeth firmly in place. Bacteria can irritate the gums and lead to gingivitis, which causes redness and swelling. The gums may also bleed during brushing. The bacterial toxins become an irritant to the bone underlying the gums. The bone then responds by resorbing, or shrinking away, notes Dr. Rinehart. “Once you start to lose bone, the gum will either shrink away with the bone and be seen as gum recession, or the bone will shrink away and gums stay high on the teeth. This results in deep pockets that cannot be cleaned by the patient on a daily basis and complicates the problems even more.”

Dr. Rinehart, who has unique training in that he is also an orthodontist and treats dental irregularities including bad bites, compares periodontal disease to a post buried in the ground. “If you jiggle this, it won’t make a difference. But if you do this all day, every day, it will loosen. As the dirt or bone in the case of periodontal disease weakens, it is weaker and not held as tight as it needs to be.”

Effects

Once periodontal disease starts to invade the tooth’s foundation, the tooth is vulnerable to looseness, infections and even extraction. Periodontal disease begins with plaque, which is clear, sticky and rife with bacteria. The Newfoundland and Labrador Dental Association points out that plaque forms on teeth every day, and it also forms where the teeth and gums meet. If this plaque is not removed regularly by brushing and flossing on a 24-hour basis, it travels into the small gully known as a sulcus around the teeth and hardens into what is called tartar or calculus, which can lead to an infection at the point where the gums attach to the teeth.

Treatment

The best way to deal with periodontal disease, of course, is to prevent it. This requires regular and proper brushing and flossing. The latter is not optional, notes Dr. Rinehart. “You can brush 20 times a day and it will not be as beneficial as one good brushing and one good flossing a day.”

It is also important to keep stress exerted on the teeth and bone to a minimum. “We live in a stressed society. This leads to a high incidence of clenching and grinding, and this can keep the bone around the teeth in a weakened state, and it is more easily broken down by the bacterial toxins,” says Dr. Rinehart.

Regular check-ups are essential to help prevent and effectively treat periodontal disease because in its early stages, the disease is very hard to detect. You may not know that you have a problem, but every time you have a dental exam, your dentist checks for signs of infection. “The key to the treatment of periodontal disease is getting it early and addressing all the factors that contribute to bone loss,” says Dr. Rinehart. “The more bone the tooth loses, the harder it is to fix.”

Maintaining good general health is also important in preserving periodontal health, he says, adding that people with a family history of some disorders, such as diabetes, can make them genetically predisposed to gum disease.

To assess the extent of periodontal disease, one of the main reasons adults lose teeth, your dentist may use a tool called a periodontal probe to measure where the gums attach to the teeth. Healthy gums attach to teeth just below the edge of the gum. If your gums attach to your teeth below this point, it is a sign of disease. X-rays also show how much bone is around your teeth.

“If you have gum disease, getting rid of plaque and tartar gives your gums a chance to get better. The best approach is to stabilize the disease as well as long-term management of the factors that cause periodontal problems,” says Dr. Rinehart.

As periodontal disease gets worse, you will notice swelling, bleeding or colour changes in your gums. Your dentist may refer you to a periodontist to help stabilize the gums and bone. In some cases, it is possible to restore, enhance or regenerate bone and gum tissue that have been lost because of the disease. Possible treatments include root planing, often called a deep cleaning, and in some cases, periodontal surgery to reduce the pockets beneath the gum line. In some situations it may be possible to regenerate or enhance damaged tissue.

Periodontal disease is more than an irritant of the mouth, stresses Dr. Rinehart. “Untreated periodontal disease is essentially a low-grade infection sustained over a long period of time. Studies have found people with this low-grade infection had a much higher incidence of heart disease and stroke because it stimulates a response in the blood vessels of the body, which is a form of hardening of the arteries. This complication is strongly supported in the cardiovascular literature and many studies have shown that patients with untreated periodontal disease are at a significantly higher risk of heart attacks and/or strokes.”

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