Thursday 14 December 2017

15 things you need to know about gum disease and how it can affect your health

President of the Irish Society of Periodontology Ronan Allen gives our reporter the lowdown on gum disease, which affects eight out of 10 people over the age of 35

Gum disease can begin in the teenage years
Gum disease can begin in the teenage years
To prevent problems, the average patient should see his or her dentist twice a year

Áilín Quinlan

Gum disease or periodontitis, which affects 80% of people over the age of 35, is a serious disease of the mouth, but, according to research, there's now evidence of links between gum disease and diabetes, cardiovascular disease and other chronic conditions.

According to Professor Filippo Graziani, co-ordinator of  European Gum Health Day 2017, gum disease is chronic, serious -  and one of the most common adult diseases in Ireland and the rest of Europe.


Periodontitis, often known as 'gum disease', is one of the most common chronic diseases in humans. The condition affects eight out of 10 people over the age of 35. Periodontitis is an inflammation of the gums and supporting structures of the teeth. This inflammation results in swollen, red and bleeding gums and is the body's defence against certain bacteria that have been allowed to collect on the surface of teeth. If the bacteria are not removed regularly by brushing, the inflammation spreads below the gum line, destroying the supporting structures of the teeth, which are bone and ligaments, potentially leading to tooth loss.

To prevent problems, the average patient should see his or her dentist twice a year
To prevent problems, the average patient should see his or her dentist twice a year

2 What Causes Periodontitis?

The initial cause of periodontitis is a certain group of bacteria (known as periodontal bacteria). These organisms live together in a sticky plaque which adheres to tooth surfaces, causing inflammation. When gums are healthy and cleaned regularly, these bacteria live in a harmonious relationship with the mouth's immune system. They are only harmful when conditions allow them to grow in large numbers. This may happen when oral hygiene is stopped or when there is a change in the normal functioning of the immune system.

3 How does it happen?

If the disease is allowed to continue - something which normally happens quite slowly - a pocket develops in the gum beside the tooth. This pocket provides the perfect environment for more dangerous anaerobic bacteria (bacteria which don't need oxygen) to thrive and multiply. Large numbers of these anaerobic bacteria produce even more harmful by-products such as acids, which in turn cause even more inflammation.

4 There's more than one kind of Gum Disease!

There are many different forms of gum disease, but the most frequent are gingivitis and chronic periodontitis. When plaque bacteria are not removed from the gumline by regular brushing, a treatable inflammatory process known as gingivitis will occur. This inflammation causes the gums to become red, swollen and bleed easily.

Once the plaque is removed by regular brushing, the gums revert back to normal and no permanent damage occurs. However, if gingivitis goes untreated and is complicated by other factors, such as family history, smoking or diabetes, then periodontitis - the more destructive irreversible disease - will occur. The chronic inflammation caused by periodontitis causes the bone of the jaw to be destroyed and the teeth to be lost. Frequently, this is a slow process that takes place over many years and, if identified and treated properly, may be arrested. However, occasionally children and young adults may suffer very aggressive forms of the disease, which causes rapid bone destruction and multiple tooth loss.

5 How do I know if I'm at risk of gum disease?

Gingivitis may progress to periodontitis without any obvious signs to alert you. However, you might experience symptoms such as bad breath, lengthening of the teeth, changes in the positioning of the teeth in the jaws, increased bleeding from the gums, which may be provoked by brushing or eating, or even spontaneous, redness of gums. Pain is uncommon, says Dr Allen, and bleeding from the gums, he warns, may be less noticeable in smokers because nicotine reduces blood supply to the gums.

6 How do I know if I have gum disease?

Periodontitis is always preceded by gingivitis or inflammation of the gums. The obvious first sign of this is bleeding from the gums when you brush your teeth. The gums may appear red and swollen, and you might notice a layer of hard material on the surface of the teeth next to the gum. This is calcified plaque known as tartar.

7 How quickly does gum disease develop?

Due to the slow nature of its progression, this disease may begin in the teenage years and go unrecognised by an individual until he or she is 40 or 50 years of age - by which time a great deal of damage may have occurred. "This is why it is essential to regularly visit your dentist so he or she can detect early signs of the disease and initiate treatment and prevention strategies," warns Dr Allen.

8 Risk Factors

The speed at which periodontitis will progress depends upon the balance of a number of factors, including the number and type of bacteria on the surface of the tooth, the health of an individual's immune system and the presence or absence of certain risk factors, such as family history, poor oral hygiene, smoking, diabetes, stress, alcohol, obesity and hormonal changes such as menopause and pregnancy. Certain medications, such as blood pressure medication or cancer treatment, can be another factor.

9 How do I prevent periodontitis?

Gingivitis and periodontitis can be prevented with good oral hygiene habits and regular visits to your dentist or hygienist for professional examinations, early diagnosis, prevention and effective treatment.

10 How do I perform good oral hygiene?

Prevention is better than cure, warns Dr Allen - brushing and flossing are your prevention mainstay, he warns. "Clean the top surfaces (chewing surfaces) and sides of the teeth twice a day with a medium or soft toothbrush and toothpaste. Clean the spaces between the teeth once per day where the toothbrush bristles cannot reach, using an interdental brush or floss if the space is too tight," he advises.

Even more particular care should be taken to thoroughly remove plaque if teeth are crowded or have crowns, fillings or dentures close to them, because plaque accumulates more readily in these sites.

11 Other effects of periodontal disease

Periodontitis can have different consequences - not only can it cause problems for the mouth and teeth, but it can also increase the risk of other significant health problems. The large numbers of pathogenic bacteria under the gums, which are a hallmark of the condition, can pass into the bloodstream and, either directly or indirectly, affect other parts of the body.

It has been demonstrated that periodontitis significantly increases the risk of cardiovascular disease and stroke, adversely affects the management of diabetes and may also raise the risk of premature birth in some pregnant women.

12 How is periodontitis treated?

Initially, your dentist or hygienist will demonstrate how to keep your teeth and gums clean and healthy by correct brushing or flossing. The next phase is professional cleaning where your dentist will remove all deposits of bacteria and tartar from the tooth surfaces, which, in certain cases, will require the use of local anaesthetic.

13 What happens when I have a severe case of gum disease?

When gum disease does not respond to standard treatment as outlined above, you may be prescribed antibiotics to help deal with persistent or aggressive gum infections. Very occasionally, due to the severity of your disease, minor surgery may be needed to better access tooth surfaces so plaque deposits can be removed.

14 Maintaining your Oral Health

Keeping your gums healthy depends on your own efforts with oral hygiene at home and regular visits to the dentist. At each check-up, your dentist/hygienist will review the condition of your gums to ensure there is no inflammation, which is bleeding and swelling of the gums.

15 How often do I need to see my dentist?

An average patient - one who has healthy teeth and gums - should see his or her dentist twice a year to ensure prevention of any problems, both from a gum-health point of view as well as identifying any problems with tooth decay. However, if you have a family history of gum disease, it is recommended to talk to your dentist and advise him or her of this risk factor, which will predispose you to gum disease.

Once you have been diagnosed with gum disease and treated for the condition, the frequency of your follow-up appointments depends on the severity of disease and your individual risk factors, such as family history or smoking. Normally, check-ups are scheduled for every three to six months with professional cleaning at each visit to ensure inflammation is as low as possible.

* 'Fighting Periodontal Disease Together' is the slogan for European Gum Health Day 2017, which will be celebrated on May 12 to raise public awareness of the importance of keeping healthy gums throughout life.

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