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Do your gums bleed when you floss? If your answer is YES, you are not alone. Well over half of US adults have gum disease, and though bleeding is one indicator, it’s likely a majority of people are unaware of their disease.1 The US surgeon general has called gum disease a “silent epidemic”, and this disease is often ignored despite being highly treatable.2,3 Because gum disease can affect your overall health and your finances in addition to your mouth, we want to take some time here at the start of 2020 to talk about it. In the next four weeks we will have a series of posts to help define what gum disease is, how it interacts with our bodies in terms of specific diseases, and how it impacts our wallets.

At Teuscher Dental, our Focus is to Help You Get Healthy and Stay That Way. This week let’s discuss what exactly gum disease is and how it may get worse if left untreated. Keep reading to learn more!

What exactly is “Gum Disease”?

Gum Disease

When we talk about “Gum Disease” we may be referring to two distinct conditions. One is gingivitis, which refers to gum (gingiva) inflammation, or swelling (-itis). When a person has gingivitis, their gums become inflamed, or swollen, with blood and immune system cells. We will discuss the most common reason for this inflammation below. Gingivitis is the first stage of the second even more serious gum disease condition of periodontitis, or periodontal disease.

As opposed to gingivitis, periodontitis refers to inflammation around teeth (perio=around, dont=tooth, itis=inflammation). When inflammation spreads from the tops of gums (gingivitis) to the area surrounding teeth (periodontitis), the classic sign is bone loss, which we measure via radiographs and probing depths. We will discuss the mechanism of bone loss below. 47% of US adults have periodontitis, or periodontal disease, but a large portion of the remaining 53% may have gingivitis, which, without treatment, leads to periodontitis.1 The scary truth is that gum disease is usually painless and has no symptoms at all during the early stages of gingivitis and mild periodontitis, so it can go unrecognized initially.  Unfortunately, the more advanced the gum disease, the greater the systemic health implications – meaning that gum disease can affect other parts of the body and other diseases as well, some of which we discuss below.

How does Gum Disease Progress?

We can almost think of gum disease in two ways: as an infection, and as an inflammatory process.

Gum Disease as An Infection

Gum disease typically will start as gingivitis. The gums become inflamed due to dental plaque- the sticky matrix of bacteria and food debris that gets stuck to our teeth when we don’t clean them well. Eventually, the soft, sticky plaque hardens into calculus, which also harbors bacteria but can only be removed by a dental hygienist. The bacteria and bacterial products induce an immune response from our gums that tries to eliminate what our body is sensing as an infection.

In fact, when our gums are inflamed and bacteria are present in sticky plaques or clinging to calculus, even the simple act of chewing can cause the release of bacteria or their toxins into our bloodstream creating a condition known as bacteremia, or bacteria in the blood. 4

Usually the increase of bacteria in the blood is transient, or short-lived. But sometimes metastatic infections can occur and become chronic infections, especially if a person has artificial joints or heart valves, atheromas, or is otherwise immunocompromised.5 In fact, the species of bacteria present in gum disease have been found to specifically predispose us to systemic diseases such as cardiovascular disease, oral and colorectal cancer, gastrointestinal diseases, respiratory tract infection and pneumonia, adverse pregnancy outcomes, diabetes and insulin resistance, and Alzheimer’s disease, as reported in Clinical Microbiology Review.6 Plaque is just the first stage of bacterial colonization.

The worse the gum disease condition, the higher incidence of bacteremia and risk of complications.7 And, considering there may be up to a trillion dangerous bacteria per diseased tooth, it’s best to nip gum disease in the bud before it develops!

Gum Disease as an Inflammatory Process

Usually we talk about plaque and bacteria causing gum inflammation. But so can pregnancy, certain drugs, and hormonal changes due to puberty or menopause. Inflammation from gingivitis, when untreated, will cause oxidative stress in our bodies, and cytokines to be released from the epithelial lining of our gum pockets. These cytokines are like a messenger system for our body, and they attract immune cells. This process eventually results in the breakdown of our connective tissue and jawbone loss surrounding our teeth. A dental team would be able to see this bone and tissue loss via radiographs and probing depths . Tissue loss around teeth leads to an increased likelihood of tooth mobility (loose teeth) and, eventually, loss of teeth.

But the inflammation doesn’t just stop around your teeth. Many studies have shown an increase in systemic inflammatory markers as a result of gum disease, meaning that inflammation affects far more than your mouth.8 We talk more below about the effects on these systemic diseases in upcoming posts.

The great news about this sinister inflammatory process is it’s been proven that dental treatment for gum disease will reduce systemic inflammation.8 If you or a loved one have bodily inflammation, consider making dental treatment a part of your wholistic plan to get healthier in 2020!

Stay tuned for next week’s post about how gum disease relates to Pregnancy and Cardiovascular Disease.

 

References

1) American Academy of Periodontology. “CDC: Half of American Adults Have Periodontal Disease.” CDC: Half of American Adults Have Periodontal Disease | Perio.org, 4 Sept. 2012, www.perio.org/consumer/cdc-study.htm

2) “Surgeon General’s Report on Oral Health in America.” National Institute of Dental and Craniofacial Research, U.S. Department of Health and Human Services, www.nidcr.nih.gov/research/data-statistics/surgeon-general.

3) Benjamin, Regina M. “Oral Health: the Silent Epidemic.” Public Health Reports (Washington, D.C. : 1974), Association of Schools of Public Health, 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2821841/.

4) Geerts, Sabine O, et al. “Systemic Release of Endotoxins Induced by Gentle Mastication: Association with Periodontitis Severity.” Journal of Periodontology, U.S. National Library of Medicine, Jan. 2002, www.ncbi.nlm.nih.gov/pubmed/11846202.

5) Parahitiyawa, N B, et al. “Microbiology of Odontogenic Bacteremia: beyond Endocarditis.” Clinical Microbiology Reviews, American Society for Microbiology (ASM), Jan. 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2620633/.

6) Forner, Lone, et al. “Incidence of Bacteremia after Chewing, Tooth Brushing and Scaling in Individuals with Periodontal Inflammation.” Journal of Clinical Periodontology, U.S. National Library of Medicine, June 2006, www.ncbi.nlm.nih.gov/pubmed/16677328.

7) Carrizales-Sepúlveda, Edgar Francisco, et al. “Periodontal Disease, Systemic Inflammation and the Risk of Cardiovascular Disease.” Heart, Lung and Circulation, Elsevier, 2 June 2018, www.sciencedirect.com/science/article/pii/S1443950618305973.

8) D’Aiuto, F, et al. “Periodontitis and Systemic Inflammation: Control of the Local Infection Is Associated with a Reduction in Serum Inflammatory Markers.” Journal of Dental Research, U.S. National Library of Medicine, Feb. 2004, www.ncbi.nlm.nih.gov/pubmed/14742655.