Periodontal Conditions

GINGIVITIS

The great news about gingivitis is that with good home oral hygiene techniques and frequency, it is reversible. This is a mild form of gum disease. It is an inflammatory condition that affects the supporting soft tissue and bone around our teeth. It occurs as a result of our body’s immune response against toxins that are produced by the bacteria that live on our teeth and gums. Common signs and symptoms are:

Visible redness and swelling
Sensitivity and tenderness
Bleeding when brushing or flossing

Without good homecare practices however, gingivitis can progress and become periodontitis. Periodontitis is the inflammatory breakdown of supporting bone and connective tissue. Periodontitis is not reversible.

BLEEDING GUMS

Sometimes our gums bleed because of repetitive trauma from an aggressive tooth brushing technique. Other times our gums might bleed because we haven’t flossed in a long while and we’ve just started the flossing routine again. Still other times they may bleed due to taking certain medications.

The most common cause of bleeding gums is gingivitis, a mild and reversible form of gum disease. If it is left untreated however, gingivitis will progress into periodontitis, which is irreversible destruction of tooth-supporting bone and connective tissue.
Although a proper brushing and flossing technique and frequency is always recommended, the only way to actually find out what is causing your gums to bleed is to see a Periodontist.

SWOLLEN GUMS

Swelling of the gums is usually caused by the body’s inflammatory response to the presence of persistent plaque at the gum line. This happens when the plaque, instead of being removed at regular time intervals through daily brushing and flossing, remains at the gum line for days on end. Once inflamed, the gums become noticeably red, swollen, tender to the touch, and prone to bleeding on brushing or flossing.

Swelling of the gums are most often an early indictor of gingivitis, which is a completely reversible condition. If daily home oral hygiene practices are not improved, however, the gingivitis will progress into periodontitis, an irreversible condition that results in the loss of supporting bone. Sometimes a localized gum swelling may be the result of a gum abscess affecting one particular tooth. This is a dangerous condition that can lead to relatively rapid tooth loss.

Swelling of the gums is a reversible condition. The following are recommended:

A consultation with a Periodontist: they will put a comprehensive plan together to help treat the condition and prevent if from ever reoccurring
Practice thorough daily home brushing and flossing
As a temporary solution before seeing a professional, you can try rinsing your mouth with a ¼ teaspoon of salt in a warm glass of water, to help reduce the discomfort

RECEEDING GUMS

Figure 1

The most common cause of receding gums is trauma

Figure 2

Trauma can occur by way of an improper tooth brushing technique, the use of a hard-bristle toothbrush, an improper flossing technique

Figure 3

and habits such as grinding and clenching. When bacterial plaque accumulates on a tooth, the resulting inflammation may also cause recession

Figure 4

Recession may also be caused by periodontitis

For more information please visit the following online link to an article published in Oral Health, one of our national dental journals, written by Dr. Valentin Dabuleanu

PERIODONTITIS

Periodontitis is a chronic infection that destroys the structure of our tooth support, the gums and bone. If this disease goes on untreated, it may eventually lead to the loss of our teeth. Periodontitis has been associated with diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD) and pneumonia. The quicker a Periodontist can detect it, the quicker they can refer patients to their physicians for general assessment, and provide periodontal treatment to help resolve the condition.

Swelling of the gums are most often an early indictor of gingivitis, which is a completely reversible condition. If daily home oral hygiene practices are not improved, however, the gingivitis will progress into periodontitis, an irreversible condition that results in the loss of supporting bone. Sometimes a localized gum swelling may be the result of a gum abscess affecting one particular tooth. This is a dangerous condition that can lead to relatively rapid tooth loss.

Some signs and symptoms associated with periodontitis include:

Red or purplish gums
Receding gums
Bleeding when brushing or flossing
Teeth that feel loose
Shifting teeth
Bad breath

BAD BREATH

Bad breath is a common oral hygiene condition. Although there are many different possible causes, it is usually caused by the smelly gases released by the bacteria that coat our teeth, gums, and tongue.

Some of the bacteria found in the plaque that coats our teeth and gums also cause gum disease and tooth decay. One of the warning signs of periodontitis is persistent bad breath, or having a bad taste in your mouth.

Other causes of bad breath include dry mouth (xerostomia) a condition that results in a decreased production of saliva. Instead of being washed away, bacteria build up in the mouth and this may lead to bad breath. A large number of medicines including antihypertensives, antidepressants, and antihistamines may also cause dry mouth, and thus also lead to bad breath. Still another cause of dry mouth is continuously breathing through your mouth, instead of your nose. The rate at which saliva is produced generally decreases with age.

A Periodontist may perform a comprehensive exam for you and will be able to confirm or rule out periodontitis. If periodontitis is ruled out, they will be able to help diagnose other potential causes, and suggest treatments, including artificial saliva products to help manage dry mouth. When indicated they will help refer you to an appropriate medical professional for treatment.

Bad breath can be prevented through a combination of the following:

A thorough daily home brushing and flossing regimen, including the use of a tongue cleaner
Regular dental checkups and cleanings
Consultation with a Periodontist to help rule out periodontitis
A healthy daily consumption of water to make sure your mouth produces enough saliva

THE MOUTH-BODY RELATIONSHIP

Periodontics is one of the most heavily researched disciplines in dentistry. The American Academy of Periodontology (AAP) has produced a series of clinical and scientific papers which summarize their statements, positions, parameters of care, and reviews on important topics in periodontics (Link to AAP). Periodontology 2000 is a well-recognized periodontal journal that produces in-depth review articles on every topic within the periodontal specialty (Link to Periodontology 2000).

The prevalence of periodontal disease among people 30 years of age or older is 47.2% with 8.7% having mild, 30% having moderate, and 8.5% having severe disease.1 There is a strong relationship between periodontal disease and systemic conditions such as cardiovascular disease, diabetes, and osteoporosis. This is because periodontal infections have the potential to spread to the bloodstream and cause multiple systemic issues. The collective research provides enough evidence to indicate that both the prevention and treatment of periodontal disease may reduce our chances of experiencing other health problems.

Respiratory Disease

Patients with periodontal disease are about 1.2x more likely than those with healthy gums to develop coronary artery disease.2 Periodontal bacteria have the ability to invade the cells of our gums and blood vessels. They may then gain access to our bloodstream, and cause inflammation within distant sites, including arteries. Some bacteria may attach to fatty plaques, which build up on artery walls, causing them to narrow. This constricts blood flow. Oxygen may then become restricted from reaching the heart, which may lead to heart failure.3

1 in 12, or 8% of Canadian adults 20 years of age or older live with diagnosed heart disease. Coronary artery disease is the most common type of heart disease. Heart disease is the 2nd leading cause of death in the Canada.4 Obtaining treatment for periodontal problems can help prevent us from developing this unfortunate condition. Professional treatment must be combined with proper home oral hygiene techniques and frequency, and regular professional hygiene maintenance visits with a dental hygienist.

Diabetes

Patients with diabetes are 2.8x more likely to have periodontal disease than patients with normal glycemic control, even after controlling for confounding variables such as age and oral hygiene measures. Diabetes causes blood vessel walls to thicken due to excess collagen formation. Circulation within our gums is slowed down, allowing periodontal disease-causing bacteria to thrive and colonize, unchecked by our immune system. This results in periodontal infections.5

1 in 10, or 10% of Canadian adults 20 years of age or older live with diagnosed diabetes. Type 2 diabetes is the most common type of diabetes. If left uncontrolled, diabetes results in consistently high blood sugar levels (hyperglycemia), which can lead to many serious complications, such as heart disease.6 Proper home oral hygiene measures, including daily brushing and flossing, as well as regular visits with the dentist for dental cleanings are important for everyone, but these measures are especially essential for diabetics.

Respiratory Disease

Patients with periodontal disease are about 1.2x more likely than those with healthy gums to develop lung cancer. Inflammation is a critical part of cancer progression. Periodontal disease, in and of itself, is a chronic inflammatory disease. The oral cavity has a close anatomic proximity to the lungs.7

Lung cancer is the most common cancer in Canada. 1 in 11 men (9%) and 1 in 14 women (7%) will be diagnosed with lung cancer in their lifetime. 98% of lung cancers occur in adults 50 years of age or older.8 Obtaining treatment for periodontal problems can help prevent us from developing this unfortunate condition.

Osteoporosis

Patients with periodontal disease are about 1.5x more likely than those with healthy gums to develop osteoporosis. Chronic inflammation again provides the connection. Our immune system responds to periodontal pathogens and in an effort to protect our gums from bacterial invasion, it may also cause bone loss to occur around our teeth by activating osteoclasts, which break down bone. An excess of these osteoclasts in our bloodstream may lead to an excess of the break down of our skeletal bone.9

1 in 10, or 10% of Canadian adults 40 years of age or older have osteoporosis. Women are 4x more likely to have osteoporosis than men. One possible explanation for this is that women start with lower bone density and they lose bone mass more quickly as they age, due to a drop in estrogen during menopause.10 Obtaining treatment for periodontal problems can help prevent us from developing this unfortunate condition.

Pregnancy

Pregnant female patients with periodontal disease are about 2.1x more likely than those with healthy gums to develop pre-term birth, less than 37 weeks.11 A normal gestation period is 37-41 weeks. Babies born pre-term are at a higher risk of various medical problems such as respiratory distress syndrome, chronic lung disease, cardiovascular disorder, asthma, as well as hearing and vision loss.12 Similar to the other mechanisms discussed, it has been proposed that the chronic inflammatory state in the oral cavity, produced by the presence of periodontal pathogens, leads to increased levels of pro-inflammatory prostaglandins and cytokines in our bloodstream, which act in a complex manner that leads to pre-term birth.13

7 in 100, or 7% of all births in Canada are pre-term.12 The question of whether or not periodontal treatment during pregnancy reduces this event from occurring has been heavily researched. A recent comprehensive review of all studies available has failed to show a clear benefit of periodontal treatment on reducing the chances of pre-term birth.13 Research on this topic is still ongoing. If you are pregnant, it is important to practice effective home oral hygiene care for preventing gum disease. Obtaining treatment for periodontal problems during pregnancy may still help to prevent pregnant patients from encountering this unfortunate event.

References

GENERAL GUM CARE

Proper home oral hygiene care will help to prevent you from getting 2 diseases:

Cavities
Gum disease

The key is persistence. The combination of a proper home oral habit and professional hygiene care will lead to both your gums and teeth looking and feeling better for a lifetime.

Keys to good home oral hygiene care:

Brush twice daily using a soft bristle toothbrush (see below)
Floss daily to remove trapped food particles and plaque from between your teeth. Waxed floss is recommended as it is easier to use
Anti-plaque mouth rinses, approved by the American Dental Association, contain agents that may help to prevent signs of early gum disease from occurring. The key remains brushing and flossing however
Avoid sugary and starchy foods that can create unwanted acidity. This will help to prevent cavities
Visit your dentist twice a year for regular cleanings and checkups

BRUSHING TECHNIQUE

Brush twice daily using a soft bristle toothbrush. Use the Modified Bass brushing technique (Link to Youtube Video):

Hold the toothbrush such that the bristles are aimed at a 45 degree angle to the tooth and gum line
Use very small circular strokes to remove plaque. Imagine that you are “wiggling” away to get the bristles down between the teeth and under the gum line (Figure 1)
Slowly move across all the teeth and repeat the circular strokes
As you return back to the first tooth, roll the head of the brush down and away from your teeth (Figure 2)