Yes, we cannot focus on the teeth and forget about the gums. There are something like 160,000 dental hygienists in the US who would all get very upset with me if I didn't discuss the health of our gums!
Gum Disease- Periodontal Disease in our technical lingo- is a painless bacterial infection of the gums and bone around the teeth. This infection can destroy the bone around your teeth. Periodontal disease has been known to create certain health risks. Good "periodontal health" is a key component of a healthy body. A periodontist is a specialist within dentistry who treats gum disease and, in many cases, places implants that replace missing teeth and bone.
It takes three things for peridontal disease to happen. We need a "host", that's the person. We need germs- there are around 14 different types that can potentially cause periodontal disease in humans. At least, that's as of the last time I spoke to one of my academic friends about it- they keep re-naming the germs every time I turn around. I'm told that there are excellent reasons for this re-naming process having to do with DNA sequencing and the better understanding that it gives to the classification of bacteria, but sometimes I suspect that there are conferences in Gstaad, Switzerland where periodontal researchers ski and drink beer until the wee hours of the morning and then say, "Let's play a cruel joke on the dental students and rename all of our bacteria..."
Sorry for the digression! So, the third thing that is involved in periodontal disease is that pesky biofilm that you may recall from our discussion of cavities. To recap: “A biofilm is a structured community of microorganisms encapsulated within a self-developed polymeric matrix and adherent to a living or inert surface.”
So we have germs inhabiting a biofilm around the roots of the teeth in a person. If the person's immune system is susceptible to some of the different types of germs then a great deal of inflammation results in a little band of tissue around the neck of each tooth. The inflammation acts up, then calms down, then acts up again and goes through these cycles many times until the jawbone is damaged and even, to an extent, lost. At later stages of this process, loose teeth and receding, bleeding gums can result. We mustn't be lulled into complacency by either the small size of that band of gums, or the lack of pain during the early and middle stages of this process. Periodontal disease can be devastating to one's appearance, ability to taste and chew, and even to one's overall health.
Here's how periodontal disease affects overall health:
-18% of all preterm low birth weight babies are attributable to periodontal disease.
-There is a correlation between cardiovascular incidents (heart attacks, strokes) and periodontal disease.
-There is an even higher (but as yet not fully studied) correlation between pulmonary disease and gum disease- because patients with this condition are aspirating harmful germs into their lungs 24x7.
Genetic susceptibility is very important to consider. It turns out that 65% of the population are fairly resistant to periodontal disease. This does not mean that we should be complacent; if the system is overloaded, so to speak, with vast amounts of tartar and the mouth is not clean, then gum disease will still occur. There are then 35% of the population that are susceptible to periodontal disease, 15% being highly susceptible. Dr. Sam Low of the University of Florida classifies patients as "Green Dots" and "Red Dots", referring to the stickers that they place on the outside of patient charts. Bottom line: if you're a "Red Dot", you are disease-prone and you had better keep up with your "home care", the way that you clean your teeth daily on your own, and you'd better be seeing your dentist and perhaps your periodontist four times per year. If you're a "Green Dot", then the same level of home care will still keep you free of disease, and will also help prevent cavities, ensure that food tastes better, and improve your breath. These techniques are healthful for everyone; it's just that "Red Dots" have to be hypervigilant and will run downhill very very quickly if they go off the wagon, so to speak.
In future posts we need to discuss home care measures and risk factors like smoking. For now please remember that periodontal disease is a preventable disease, it's one that is generally painless yet very serious (like hypertension or glaucoma), and success in fighting it is much more up to the patient than the dentist. It's a disease of patient compliance or non-compliance, unfortunately.
And next time you're in Gstaad skiing, (I don't ski), please stop by the periodontal conference and tell them that I like the current bacterial names just fine, thank you very much. I'm getting too old to memorize five names for the same thing!