Paula Vassallo, consultant at the Dental Public Health Unit, details the risk factors associated with gum disease, one of the most common diseases among humans, and gives tips on how one can prevent it.
Gum disease is one of the most common diseases seen in humans. There are two main forms of gum disease: gingivitis and periodontal disease. Gingivitis is an inflammation of the gums where they become red and swollen. Often the swollen gums bleed when they are brushed.
Long-standing gingivitis can turn into periodontal disease, which is a serious gum infection that damages the soft tissue and destroys the bone that supports the teeth making the teeth loose. The gums pull away from the teeth and form spaces (called ‘pockets’).
If not treated, the bones, gums, and tissue that support the teeth are destroyed. By eventually becoming loose, the teeth may have to be removed. Periodontitis affects about half of all adults and as many as 85 per cent of people over 65 years of age.
Many people may not know they have gum disease since it does not usually cause pain. However, you may note some of the most common signs
All forms of gum disease are caused by plaque. Our mouths are full of bacteria which, along with mucus and other particles, constantly form a sticky layer on the teeth which is referred to as plaque. If this is not removed it can harden and form tartar or calculus that brushing cannot clean. Being cavity-free doesn’t ensure you are in the clear where gum disease is concerned.
Risk factors
There are various risk factors to gum disease:
Smoking: Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.
Hormonal changes in women: These changes can make gums more sensitive and make it easier for gingivitis to develop.
Diabetes: People with diabetes have a higher risk of developing infections and gum disease. Likewise, the presence of gum disease may make blood sugar control more difficult to achieve.
Stress, other illnesses and their treatments: Diseases and their treatments can also negatively affect the health of gums, as can treatments for cancer.
Medications: Many medications reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to gum disease.
Genetic susceptibility: Some people are genetically more prone to severe gum disease than others.
Unfortunately many people may not know they have gum disease since it does not usually cause pain. However, you may note some of the common signs such as:
• gums that bleed easily;
• red, swollen, tender gums;
• gums that have pulled away from the teeth;
• persistent bad breath or bad taste;
• permanent teeth that are loose or separating;
• Change in the way the teeth fit together when biting;
• Change in the fit of partial dentures;
• Not everyone has all these signs; you may have only one.
Prevention
To prevent gum disease one needs to make sure to remove all the plaque from the teeth every day.
Brush your teeth (or dentures) twice a day, ideally last thing at night plus a minimum of one other occasion. It is usually recommended that adults use a toothbrush with a small- to medium-sized head with multi-tufted, soft to medium filaments (bristles). Manual toothbrushes should be replaced every one to three months.
While there is evidence that some powered toothbrushes (with a rotation, oscillation action) can be more effective for plaque control than manual tooth brushes, more important is that the brush, manual or powered, is used effectively twice daily. Thorough cleaning may take at least two minutes. If you have arthritis you may find it difficult to grip a toothbrush handle, but you can get handle adapters.
Electric or power toothbrushes are also ideal for people with limited movement.
Clean between the teeth. Brushing alone only cleans three of the five surfaces of your teeth, so it is important that you also clean in between your teeth at least once a day using interdental brushes or dental floss.
Interdental brushes are generally colour-coded for the different-sized gaps between your teeth. There are several different types of dental floss or tape, including mint-flavoured, wax-coated and ones containing fluoride. You can also get floss ‘harps’. These have the floss attached to a handle to make it easier to use. Water jets are another way of cleaning in-between the teeth using a high-pressure jet of water. Some people with bridges and implants find them particularly useful.
In addition to all this, some mouthwashes contain an anti-bacterial ingredient to help reduce plaque and prevent gum disease.
Plaque can also be stained and in such case, there are special ‘disclosing tablets’. These are harmless and will show any areas of your mouth that you are missing when brushing. The dye can easily be removed afterwards by brushing.
Visit your dentist regularly.
Treatment
The earliest stage of gum disease is reversible and the main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease.
Any type of treatment requires that the patient keeps up good daily care at home.
Quitting smoking is also necessary to improve treatment outcome.
Deep cleaning (scaling and root planing): Your dentist may remove the plaque and bacteria that contribute to the disease through a deep-cleaning method called scaling and root planing. Through scaling, the tartar is scraped off from above and below the gum line, while through root planing the rough spots on the tooth root where the germs gather are removed.
Research between oral health and general health is ongoing. There is increasing evidence that severe gum disease may be associated with several other health conditions such as stroke or cardiovascular disease, poor pregnancy outcomes and even dementia.
This reinforces the importance of oral health.
Remember, you don’t have to lose teeth to gum disease. Brush your teeth twice a day, clean between your teeth daily, eat a balanced diet and schedule regular dental visits for a lifetime of healthy smiles.
Age is not a barrier to good periodontal health.