Are you at risk for gum disease?
Periodontal disease can wreck more than your smile. Here’s how to stop this common condition before it starts
The dangers of gum disease
When you want to highlight your smile, perhaps you whiten your teeth or choose a flattering shade of lipstick. But what about the health of your gums? After all, inflammation of gum tissue is far from attractive. Even in the early stages of gum disease-which is caused by plaque deposits that aren't removed with proper oral hygiene-you may have bad breath, your teeth may appear to be unnaturally long due to receding gums, and your gums may bleed or look red, puffy and shiny instead of pink, firm and stippled (which means they should look textured with tiny bumps).
"Gum disease is very common," says Dr. Sayed Mirbod, a periodontist in Halifax and president of the Canadian Academy of Periodontology. "It has become the main reason patients lose their teeth, surpassing cavities and the fracture of root canal-treated teeth." Today's advanced dental care is helping us to keep our natural teeth in good condition for longer-but poor gum health can still be our dental downfall. And that's not all: Gum inflammation is also associated with cardiovascular disease, uncontrolled diabetes, lung disease, pneumonia, rheumatoid arthritis and, in women who are pregnant, preterm and low-birthweight babies. Researchers are still looking at some of these causal relationships, but the links are there.
Fully one third of Canadians age 20 or over have early-stage gum disease, which is called gingivitis. Another fifth have periodontitis (moderate to severe gum disease). The prevalence goes up with age, though even children can have what's called aggressive periodontitis; about 70 percent of Canadians will eventually have some degree of gum disease in their lifetime.
Unless you know what symptoms to look for, gum disease can be silent for several years in its early stages. Yet that is when it's most reversible. As untreated gingivitis gets worse-progressing to periodontitis and infecting the bone and tissues holding your teeth in place-you can experience bleeding, pain, loose teeth and gaps between your teeth. Chewing becomes difficult and tooth loss is possible. Once gum disease progresses from gingivitis to this more advanced periodontal disease, it is no longer reversible. At this point, tooth loss is unavoidable, and lifelong maintenance in a dental care office will be required.
Are you at risk?
Fortunately, routine checkups with your dental healthcare professional can detect the subtle early signs of problems such as inflammation, bleeding and receding gums. He or she also recognizes who's at greatest risk, including seniors, smokers and those who are immunocompromised. "Smoking really wreaks havoc in the mouth. That's a big one," says Rocell Gercio-Chad, a registered dental hygienist who has her own practice in Calgary. "And people with type 2 diabetes, especially the ones who can't get their diabetes under control, have a significant increase in periodontal disease." That's because people with uncontrolled diabetes are more susceptible to infection and inflammation. Other factors that play a part include stress, teeth clenching or grinding, poor nutrition or oral health habits, certain medications and genetics.
You can also raise your risk by introducing new sources of foreign bacteria into your mouth-for example, sharing a spoon or letting your dog kiss you. "The bacteria that cause this disease are easily passed along," Gercio-Chad says.
Once periodontitis is identified, it may be held in check-depending on the severity-using a variety of approaches. In your grandparents' generation, advanced infections in the mouth would have been treated by removing whole sections of teeth. Today, the goal is to stop the disease from progressing, repair the tissues and keep the tooth, or teeth, for as long as possible.
The first priority is to stabilize the disease by removing its underlying cause: plaque and tartar buildup. If inflammation of your gums is mild, it may just mean ? stepping up your routine cleanings to every three months, to remove the plaque and tartar and to keep it from recurring.These patients should also be given home oral-care tips, and possibly a prescribed antimicrobial mouthwash. But they may be referred to a periodontist for a four-to six-hour deep cleaning called "root planing," during which the tooth root is scoured and smoothed. More than one session may be required, depending on the severity. "Root planing is more substantial than normal cleaning," says Mirbod. "It's usually done with different instruments than a typical cleaning, and local anesthesia." A low-dosage antibiotic, Periostat, may also be prescribed to slow the disease.
"For some patients, non-surgical therapy like root planing is adequate," says Mirbod. But it's a different story for those with more advanced cases. These may require "pocket reduction" surgery, in which the periodontist lifts a flap of gum tissue, removes tartar from the tooth root, and reattaches the gum in a lower position, reducing the amount of plaque it will trap in the future.
Jawbone that has been damaged by periodontal disease doesn't grow back on its own. But surgery can be used to smooth out rough or pitted bone, making it harder for bacteria to regrow there, and enabling gum tissue to reattach. There are also many surgical procedures to regenerate the bone and supporting fibres around the teeth-including bone grafting and guided tissue regeneration-that have advanced greatly over the past decade. For instance, a periodontist can apply to the root a gel containing proteins that stimulate healthy growth and act as a sort of fertilizer.
Whatever the approach, once the active phase of treatment is over, frequent dental appointments will likely be needed-typically, a cleaning every three months. "The maintenance should be lifelong so that it doesn't recur," says Mirbod.
An ounce of prevention
Want to stop gum disease before it starts? If you smoke, you can reduce your risk by quitting. There are other lifestyle risk factors you can control: Try to deal with the stress in your life, eat a well-balanced diet, invest in a tooth guard if you grind your teeth, use an electric toothbrush and floss. Change bad habits that increase the bacteria (and consequently plaque) in your mouth, such as snacking on sweet, sticky foods without brushing your teeth afterwards. "It could be something as simple as not constantly sipping on a heavily sugared coffee over a prolonged period of time," says Gercio-Chad.
And, of course, care for your teeth and gums properly. Floss every day, and brush at least twice a day half an hour after eating. Ask your dental professional to demonstrate proper techniques.