Dental diseases can be broadly classified as tooth decay and gum disease that result from bacterial infection. Gum diseases comprise gingivitis (gum inflammation) and periodontitis. Periodontitis suggests inflammation and destruction of the tooth-supporting structures. Gum disease and tooth decay have ill effects on oral and body health. Tooth decay and missing teeth can prevent proper chewing and food digestion. On the other hand, gum diseases can result in more severe effects on one’s general health.
What Is Gum Disease?
Gum disease is the infection and inflammation of the gums that can progress further. Gingivitis (gum inflammation) is the earliest stage. The chief causes are plaque and calculus (tartar) accumulation.
Plaque: Plaque is a soft and sticky deposit of dirt containing food debris, microorganisms, and saliva accumulating between the teeth and gums. As a result, swelling, bleeding, and redness of gums occur. Eventually, bone loss occurs. When left uncleaned, plaque hardens to become calculus. Both plaque and calculus infect gums.
Calculus: Dental calculus is mineralized and calcified plaque. Calculus contributes to gum diseases due to the retention of dental plaque owing to its rough surface. Calculus is supragingival (above the gums) and subgingival (below the gums). Studies show that subgingival calculus removal results in the healing of gum disease and the maintenance of healthy tissues.
What Are the Symptoms of Gum Disease?
Gum diseases are a gradual process. One can identify the signs and symptoms of gum disease early and get treatment to prevent complications. Symptoms of gum disease include redness of the gums, swollen gums, gum pain, bleeding gums (while brushing or eating), bad breath, metallic taste, loose teeth, and pain while chewing. An important symptom is pocket formation (spaces surrounding the teeth under the gums).
Are Gum Health and Overall Health Interlinked?
Gum diseases harm the body's overall health. However, many believe the effects are limited only to the oral cavity. In recent years, many researchers have shown that gum disease can increase the risk and severity of heart disease, stroke, diabetes mellitus, respiratory diseases, preterm low birth weight (premature delivery), and Alzheimer’s disease.
What Are the Risk Factors of Gum Disease?
Certain factors increase the risk of gum disease. These include smoking (most common), diabetes mellitus, poor oral hygiene, stress, genetics, crowded teeth, and hormonal changes in females.
A recent (2020) study was done in India regarding the prevalence (a common condition) of periodontal disease among adults. The authors found that the overall prevalence of periodontal disease was 51 percent and gingivitis was 46.6 percent. Individuals 65 years or above had the highest percentage of severe periodontitis. Furthermore, males had a higher prevalence (34.4 percent) than females (42.2 percent).
How Does Gum Disease Affect Overall Health?
Different chemical mediators are released by the body in response to bacterial infection in gum disease. These chemical mediators facilitate the process of bacteria removal, but along with their primary function, they can also damage normal cells. Various diseases linked to gum diseases are:
1) Cardiovascular Disease (Heart Disease): The chemical mediators produced by our body during gum disease help in the formation of atheroma (plaque formation) in the coronary artery (arteries supplying blood to the heart). When the blood vessels get narrowed (due to atheroma), there is an insufficient blood supply to the heart muscles. Furthermore, if the narrowing occurs in the brain's arteries, it may result in a stroke.
2) Diabetes Mellitus: The chemical mediators also affect the blood glucose level. In known diabetics, these mediators increase the cell resistance to insulin (insulin mediates glucose transport into the cells). As a result, glucose is not used by the cells resulting in increased blood glucose levels. Numerous studies have shown that after treating gum disease, diabetic patients can keep their blood glucose levels under control. Gum disease and diabetes mellitus are mutually related. Studies show people with gum disease have higher HbA1c levels (HbA1c measures blood glucose levels over the past three months). Hence, diabetic people with optimum HbA1c levels have better improvement of their gum disease after oral health management measures.
3) Preterm Birth or Low Birth Weight: It is known that premature babies can suffer from many diseases in their lives. The causes of premature delivery may be many. However, studies reveal gum disease as one of the causes. Any infection in the body produces numerous chemical mediators in the body. Some of these chemical mediators (prostaglandins) can induce preterm labor. Gum disease also increases the prostaglandins in the blood circulation, causing preterm delivery and low birth weight babies.
4) Respiratory Diseases: Very few studies support the relationship between gum disease and respiratory disease. However, it is possible to aspirate the bacteria present in the mouth into the lungs. Therefore, the consequences can be respiratory diseases such as pneumonia.
5) Alzheimer’s Disease: A link between Alzheimer’s and gum disease also exists. It is believed that the bacteria from the diseased gums reach the brain. As a result, they can intensify the progression of Alzheimer’s disease. Amyloid beta (a key biomarker found in the cerebrospinal fluid in Alzheimer’s disease patients) is raised in older people with marked gum disease.
How to Prevent Gum Diseases?
Gum diseases can be prevented through various steps.
The first and essential step is to practice proper oral hygiene methods. People should brush their teeth twice daily (morning and night).
Floss in between the teeth.
Use of chlorhexidine mouthwash thirty minutes after brushing teeth is advocated.
Regular meeting with a dentist for screening and oral prophylaxis (prevention) is essential. It is because dental diseases show symptoms (that the patient notices) only after the condition has started to progress. Hence, it should be done once every six months.
Calculus requires thorough cleaning (called scaling). The complete treatment includes scaling and root debridement (involves teeth and the parts of the root). As gingivitis and periodontitis are infectious diseases, the dentist may prescribe oral antibiotics. Another option is placing a topical (local) antibiotic underneath the gums.
In severe gum disease, flap surgery is required. A flap surgery removes bacteria, facilitates easy cleaning of teeth, reshapes the bone around teeth, and prevents future gum damage.
Gum diseases are a pandemic and a global health problem. Early detection and thorough treatment can minimize the systemic effects of gum disease. The best way to prevent it is to have regular scaling and practice good oral hygiene at home. However, people prone to periodontitis may require more frequent scaling than those without periodontitis.
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