The Specialist

Why you get gum disease

Do your gums bleed when you brush or for no reason at all?

Have you ever been told you have gum disease?

Do you have shaky teeth or know family members who suffer from early tooth loss?

Over many years of practice, I have discovered that more often than not, many Bahamians would say yes to these questions. Today, however, the greatest challenge is that many of us suffer from lack of information and lack of appropriate treatment.

Several of our patients at Center for Specialized Dentistry (CSD) are being seen for follow-up care many years after gum treatment. It warms my heart to hear our patients commend us for “saving my teeth” because they remember how severe their condition was at the time of their initial visit.

Also, we are now seeing some of the children of our long-term patients. They refer them because they know that knowledge is power and an empowered patient is more likely to have successful outcomes.

Gum disease

Gum disease is an infection caused by bacterial plaque. About 70 to 80 percent of Bahamians have some form of gum disease. The scientific terminologies are called gingivitis and periodontitis. Gingivitis is a mild swelling with bleeding around the gums however there is no bone loss. Gingivitis is the earliest stage of the disease and is therefore reversible. Why is this? It’s because there is no bone loss with gingivitis, so if the bacteria are removed effectively then the inflammation is controlled. Since the majority of Bahamians have some form of gingivitis, many products advertised on TV like mouth rinses and toothpaste products do help to some degree.

Periodontitis, on the other hand, results in loss of bone support around your teeth. Despite the hundreds of products advertised, none claim to arrest periodontitis.

So, despite the many products that we see on the shelves and on our screens, they really do not get to the source of your periodontal disease, which is the bacteria within the pocket. Since at least 50 percent of our population suffer from periodontitis (bone loss) it is therefore critical that a skilled dentist manage your disease.

Leading causes of periodontitis (loss of bone support)

• Genetics.

• Smoking.

• Bacterial plaque.

Genetic factors: A family history of periodontal disease makes you more prone to getting gum disease. It is proven that genetic factors impair inflammatory and immune responses during periodontal disease thereby making you more susceptible to disease progression. This also makes the progression of the disease more aggressive. Your genetics, which have nothing to do with you, actually predisposes you to the disease.

Smoking: If you are a smoker or have a history of smoking you probably know the hazards to your overall health.

Smoking is a well-established risk factor for periodontal disease. Smoking changes the colony of the germs making them more aggressive and relentless, causing considerable damage to your cells. Also, your immune system becomes compromised thereby making you more susceptible to further bone loss. Further, the toxic compounds in the smoke damage your oral tissues and dampen the normal inflammatory response.

Bacterial plaque: Plaque is bacteria that colonizes on your teeth and around your gum line. It forms as a sticky film of millions of bugs forming a colony. It feeds on other bacteria, sugar and their waste.

A periodontist or a skilled dentist is able to remove the build-up of these bugs through a comprehensive treatment plan. If it is not removed in a timely fashion, the plaque hardens on the root surface below the gum line. The hardened plaque is called calculus. Calculus is rough and therefore collects more plaque. These plaque feed on the other bacteria, dietary sugars and their waste. The result is bone loss and pocket development. A pocket is a space filled with a jelly-like mass where the bone should be. Bacteria now live in these pockets forming and reforming colonies of more and more aggressive bugs. As the pocket becomes deeper and deeper, the tooth starts to loosen.

Once the infection begins, the plaque and calculus have to be mechanically removed by a process called scaling and root planing. If the dentist does not correct this, the pockets will never heal. When this happens, the pockets remain septic, odorous, easily bleed and sometimes develop pus in the form of an abscess.

In summary, gingivitis is reversible with consistent cleanings (at least two times per year) and adequate oral hygiene home care practices.

Periodontitis, on the other hand, requires the assistance of a periodontist or skilled dentist/hygienist. Proper treatment can control periodontitis and you can keep your teeth for a lifetime.

Smoking damages immune cells making you more susceptible to gum disease.

A greater understanding of your genetics and good oral care habits should be a priority. Persons with a genetic history of gum diseases are disadvantaged, however, not doomed. With timely and effective treatment these patients also enjoy a lifetime of good oral health.

A healthy mouth is the first step toward a healthy body.

Next issue: How a periodontist manages the different types of gum diseases.

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