What is
Periodontal Disease?
If your hands bled when you washed them, you would be concerned. Yet,
many people think it's normal if their gums bleed when they brush or
floss. In a 1999 study, researchers at the U.S. National Institutes
of Health (NIH) found that half of Americans over 30 had bleeding gums.
Swollen and bleeding gums are early signs that your gums are infected
with bacteria. If nothing is done, the infection can spread and destroy
the structures that support your teeth in your jawbone. Eventually, your
teeth can become so loose that they have to be extracted.
"Perio" means around,
and "dontal" refers to teeth. Periodontal diseases
are infections of the structures around the teeth, which include
the gums, periodontal ligament and alveolar bone. In the earliest stage
of periodontal disease — gingivitis — the infection affects
the gums. In more severe forms of the disease, all of the tissues are
involved.
For many years scientists have been trying to figure out what causes
periodontal disease. It is now well accepted that various types of bacteria
in dental plaque are the major villains. Researchers also are learning
more about how an infection in your gums can affect your overall health.
In recent years, gum disease has been linked to a number of other health
problems. This is a new and exciting area of research, but it remains
controversial. Studies have produced varying answers about the extent
of the connection between gum disease and other medical problems, and
more research is needed.
Researchers are studying possible connections between gum disease and:
- Atherosclerosis and heart disease — Gum disease
may increase the risk of clogged arteries and heart disease, although
the extent of this connection is unclear. Gum disease also is believed
to worsen existing heart disease.
- Stroke — Gum disease may increase the risk
of the type of stroke that is caused by blocked arteries.
- Premature births — A woman who has gum diseases
during pregnancy may be more likely to deliver her baby too early and
the infant may be more likely to be of low birth weight. One study
showed that up to 18% of premature, low-birth-weight babies might be
linked to maternal gum disease.
- Diabetes — People with diabetes and periodontal
disease may be more likely to have trouble controlling their blood
sugar than diabetics with healthy gums.
- Respiratory disease — Gum
disease may cause lung infections and worsen existing lung conditions
when bacteria from the mouth reach the lungs.
What Causes Periodontal Disease?
Periodontal disease is caused by bacteria in dental plaque, the sticky substance
that forms on your teeth a couple of hours after you have brushed. Interestingly,
it is your body's response to the bacterial infection that causes most of the
problems. In an effort to eliminate the bacteria, the cells of your immune
system release substances that cause inflammation and destruction of the gums,
periodontal ligament or alveolar bone. This leads to swollen, bleeding gums,
signs of gingivitis (the
earliest stage of periodontal disease), and loosening of the teeth, a sign
of severe periodontitis (the
advanced stage of disease).
Practicing good oral hygiene and visiting your dentist regularly (about
once every six months, or more often if you have gum disease) can prevent
periodontal disease. Daily brushing and flossing, when done correctly, help remove most of the plaque
from your teeth. Professional cleanings by your dentist or dental hygienist
will keep plaque under control in places that are harder for a toothbrush
or floss to reach.
If oral hygiene slips or dental visits become irregular, plaque builds
up on the teeth and eventually spreads below the gum line. There, the
bacteria are protected because your toothbrush can't reach them. Good
flossing may help dislodge the plaque; but if it is not removed, the
bacteria will continue to multiply, causing a more serious infection.
The buildup of plaque below the gumline leads to inflammation of the
gums. As the gum tissues become more swollen, they detach from the tooth
forming a space, or "pocket," between the tooth and gums. In
a snowball effect, the pockets encourage further plaque accumulation
since it becomes more difficult to remove plaque. If left untreated,
the inflammatory response to the plaque bacteria may spread to the periodontal
ligament and alveolar bone, causing these structures to be destroyed.
Another problem is that if plaque is allowed to build up on teeth, over
time it becomes calcified, or hardened, and turns into calculus (commonly
called tartar). Since calculus is rougher than tooth enamel or cementum
(a layer that covers the tooth root), even more plaque attaches to it,
continuing this downward spiral. Using a tartar-control toothpaste may
help slow accumulation of calculus around your teeth, but it can't affect
the tartar that has already formed below the gum line.
Risks and Prevention
Although bacterial plaque buildup is the main cause of periodontal
disease, several other factors, including other diseases, medications
and oral habits, also can contribute. These are factors that can increase
your risk of gum disease or make it worse once the infection has set
in.
- Genetics — Researchers believe up to 30%
of the population may have a genetic susceptibility to periodontal
disease. Having a genetic susceptibility, however, doesn't mean gum
disease is inevitable. Even people who are highly prone to periodontal
disease because of their genetic make-up can prevent or control the
disease with good oral care.
- Smoking and tobacco use — Smoking
increases the risk of periodontal disease and the longer, and more
one smokes, the higher the risk. If periodontal disease is present,
smoking makes it more severe. Smoking is
the main cause of periodontal disease that is resistant to treatment.
Smokers tend to collect more tartar on their teeth, develop deeper
periodontal pockets once they have gum disease and are likely to lose
more bone as the disease progresses. Unlike many other factors that
affect the health of your gums, you have control over this one. Quitting
smoking can play a major role in bringing periodontal disease under
control.
- Misaligned or crowded teeth, braces or bridgework — Anything
that makes it more difficult to brush or floss your teeth is likely
to enhance plaque and tartar formation above and below the gum line,
which increases your chance of developing gum disease. Dentists and
periodontists can show you the best ways to clean your teeth, especially
in hard-to-clean circumstances. For example, there are special tools
and ways of threading floss to clean around bridgework or slide under
braces. And if overcrowded or crooked teeth are a problem, your dentist
might recommend orthodontics to straighten out your smile and give
you a better chance of preventing disease.
- Grinding,
gritting or clenching of teeth — These habits won't
cause periodontal disease, but they can lead to more severe disease
if inflammation is already present. The excessive force exerted on
the teeth by these habits appears to speed up the breakdown of the
periodontal ligament and bone. In many cases, patients can learn
to stop this habit simply by recognizing when it is happening and
then relaxing. If these efforts don't work, your dentist or periodontist
can create a custom guard appliance (sometimes called an occlusal
guard, night guard, mouth guard or bite guard) that helps reduce
the pressure of clenching or grinding on the teeth.
- Stress — Stress can worsen
periodontal disease and make it harder to treat. Stress weakens your
body's immune system, which makes it harder for your body to fight
off infection, including periodontal disease.
- Fluctuating hormones — Whenever hormones
fluctuate in the body, changes can occur in the mouth. Puberty and
pregnancy can temporarily increase the risk and severity of gum disease,
as can menopause.
- Medications — Several types of medications
can cause dry mouth, or xerostomia,
including antidepressants, diuretics and high blood-pressure medications.
Without the protection of adequate amounts of saliva, plaque is more
likely to form. Other medications may cause the gums to enlarge, which
in turn makes them more likely to trap plaque. These medications include
phenytoin (Dilantin and other brand names), used to control seizures;
cyclosporine (Neoral, Sandimmune), used to suppress the immune system;
and nifedipine (Adalat, Cardizem and others) and other calcium channel
blockers, used to treat angina or heart arrhythmias.
- Diseases — Although
the exact mechanisms aren't totally understood, certain diseases increase
susceptibility to periodontal diseases. For example, people with diabetes
are more likely to get periodontitis, than people without diabetes
and it's likely to be more severe. Other diseases, such as leukemia,
inflammatory bowel disease and HIV infection, also can increase the
risk. Having one of these diseases will make control of periodontal
disease more difficult, but a good periodontist or dentist who is aware
of the additional risks and difficulties should be able to offer the
kind of guidance needed to maintain your periodontal health.
- Poor nutrition — Nutrition is important for
overall good health, including a working immune system and healthy
gums and mouth.
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