SCIENTIA potentia est, knowledge is power indeed!
Did you know that the main cause of gum disease is plaque bacteria?
Although the patient’s susceptibility is influenced by their immune system (host defences), as well as genetic factors.
Naturally, microorganisms exist in the mouth from birth until death.
Although these bacteria are harmless and normal, they have the potential to become pathogenic — that is, to cause illness — in conducive situations.
There are an estimated 400 different bacterial species that can invade the mouth.
Although all the bacteria found in plaque have not been identified and studied, just 30 of the 400 or so species are believed to be periodontopathic, meaning they can cause gum disease.
Despite being curable, gum disease has become a vicious cycle that affects many people. Why is the question?
The main cause, in my opinion, is ignorance or lack of understanding; people do not know when to seek help, how to recognise the symptoms of gum disease or the importance of therapy.
Dispelling some of the mysteries around this problem is crucial.
To begin with, is the gum really that important?
The response is affirmative.
The portion that covers the upper portion of your teeth is called the gum.
The bone that is beneath the gum line is crucial for supporting your teeth.
Without that bone, teeth cannot survive the force of biting, and without the gum, teeth cannot be firmly anchored to the bone.
Gum compromise jeopardises the entire support system, which means your bone may lose function, which affects your teeth.
Gum disease is a broad word that includes periodontitis and gingivitis, two separate conditions.
Gingivitis is the mild form of gum disease or its initial stage and it manifests as bleeding gums and a minor bad smell.
The more severe kind of periodontitis may begin to spread farther into your gums and the bone so you might notice spontaneous bleeding even in sleep, bleeding on toothbrushing or biting into an apple, tooth mobility, the hardened plaque (also referred to as high calculus or tartar levels) that cannot be removed by mere toothbrushing and severe bad breath.
It is best to avoid reaching this point, but if it did happen to you, it is alright; there is still hope and treatment is accessible.
For gum disease to occur (gingivitis or periodontitis), the micro-organisms should increase in number until they reach a level where they can damage the host.
According to this hypothesis, in gingivitis, when plaque accumulates, there is stress to the system, inflammation develops and this causes environmental changes, leading to an ecological shift in the microflora that is likely to provoke more inflammation.
The philosophy is that disease can be prevented by targeting the causative agents and the driving forces behind their selection.
Dental plaque can be subgingival (just below the gum that is formed on the root surfaces below the free margin of the gum) and supragingival (usually adherent to the tooth surface, it is usually associated with saliva).
Plaque formation always precedes calculus (hardened plaque) formation.
After brushing or eating, a healthy layer called pellicle forms on the tooth surface.
A few hours later, plaque forms, which allows bacteria to grow.
As this matures, calculus or tartar may form.
The deposits of calculus are typically pale yellow in colour, hard and clay-like and can be stained by tobacco or food pigments (colouring matter).
They are particularly prevalent on the back of your lower teeth and are typically not very noticeable because they obtain mineral salts from salivary secretions.
Calculus can blend in with your tooth’s colour if it isn’t discoloured.
As it grows over time, it will appear to be a natural part of your tooth.
This is the most hazardous kind of plaque, since it appears to be healthy on the outside and seems not to be a serious issue right away.
However, on the inside, it is gradually eroding your bone until the teeth become movable, which increases the need for surgery or the rapid extraction of all your teeth.
The transition between the stages from health to gingivitis to periodontitis is difficult to predict and some patients and sites within a patient’s mouth are more susceptible than others, reflecting the importance of the oral environment and the balance between the microbial challenge, host defences and various risk factors.
Risk factors can be an aspect of personal behaviour or lifestyle, an environmental exposure or an inborn or inherited characteristic that causes susceptibility to periodontal disease.
It can also be a local factor which increases the infection of a site.
There are two major classes of risk factors for periodontal disease:
Local factors such as overhanging restorations (fillings, crowns etc) and root caries that tend to allow for plaque accumulation and hence result in more periodontal disease.
Other local risk factors for periodontal disease include pocket depth (when the depth space between the gum and teeth is increased), intrabony pockets (when the space between the tooth and the gum increases to the level of the bone), especially involving root canal infections.
Systemic factors that affect the entire body, such as cigarette smoking, diabetes mellitus and genetic factors.
Risk factors frequently have a dosage response, meaning that the more exposure to the risk factor, the higher the likelihood of developing the disease.
This is true, for instance, for cigarette smokers.
A direct linear relationship exists between the anticipated amount of smoking exposure and the number of years spent smoking cigarettes and the degree of alveolar bone loss.
Additionally, the degree of periodontal disease severity and the degree of glucose management in diabetic patients are directly correlated.
It is thought that there is a threshold for many risk variables below which have very little clinical impact on the illness.
Are the risk factors modifiable?
There are numerous modifiable risk factors, including systemic aspects like smoking and local concerns such as overhanging restorations.
Participating in a smoking cessation programme can help to eradicate smoking just as removing an overhanging restoration can curtail this problem.
Some risk factors, like genetic traits, cannot be changed.
Smoking cessation and blood sugar control in diabetic individuals have been proven to improve the prognosis of periodontal disease treatment and are crucial steps in preventing the disease from recurring.
Controlling weight, taking calcium supplements, managing stress and improving coping mechanisms may also be crucial in the treatment of periodontal disease in high-risk individuals.
In addition to your regular dental hygiene regimen, you should visit a dentist twice a year to reduce the chance of developing periodontitis.
A toothbrush cannot get rid of calculus or the discoloured plaque.
Flossing once daily and brushing twice a day for two minutes each are important, but since none of these techniques can reach the area between your teeth and gums, only the dentist can assist you with that.
You will see the difference if you give it a try.
There is no harm in trying.
- Patience Matambo is a final year BSc Dental Surgery student at the People’s Friendship University of Russia. She can be reached at patiencedental2024@gmail.com