Gum Disease

Most of us know that regular brushing and flossing of our teeth will result in better oral hygiene and that regular visits to the dentist will keep our teeth in good shape. What is not as widely known is that the state of one’s dental health has a close relationship with the state of one’s general health.

Gum Disease

Periodontal disease is the term used to describe a group of inflammatory diseases that affect the supporting structures around the teeth. Gingivitis involves only the gums and “Periodontitis” affects the gums and supporting bone. Gum disease is seldom symptomatic or painful. Thus, the painless nature of gum disease renders early detection difficult from the patient’s stand point. In many cases, significant damage is caused before one seeks professional help.

A large proportion of the general population has some degree of periodontal disease. According to a survey commissioned by the Singapore Dental Health Foundation and the Singapore Human Resources Institute, “no pain” was the top reason that Singaporeans gave for not visiting the dentist regularly. Adults who have some form of gum disease may not be aware of the condition because there is often no pain during the early to moderate stages of the disease. In the advanced stages, teeth become loose and frequent swelling of the surrounding gums occurs.

Gum Disease and its Connection with Overall Health

Gum disease is closely related with other medical conditions, such as diabetes, heart disease and pre-term delivery for pregnant women. Periodontal problems also affect other organs, such as the liver, lungs, and kidneys.

Diabetes

Gum disease is far more common in diabetics compared with non diabetics. Diabetics who have untreated periodontal disease will often find it difficult to control their blood glucose level due to insulin resistance. Thus, this group of patients will take longer to heal from infections, including periodontal infections. Both periodontal disease and diabetes are chronic diseases that develop slowly. There are no obvious, outward signs in the early phases of both diseases. Since diabetes is known to occur in families, susceptible persons can take early steps to monitor the health of their gums as well as prevent or delay the onset and severity of diabetes.

Heart Disease

Gum inflammation has also been linked to heart disease. Inflammation of the inner lining of blood vessels increases the chance of formation of the atheromatous plaque that blocks these vessels and cuts off blood flow to the heart.

Long term studies have shown that periodontal disease occurs before cardiovascular disease and is strongly linked to strokes.

Pregnancy, Preterm Delivery and Low Birth Weight Babies

The products of inflammation affect other organs of the body. Prostaglandins, which are formed when the body tries to defend itself against bacteria, causes smooth muscle contraction. In pregnant women, this may cause a premature contraction of the muscles of the uterus and lead to preterm delivery. Premature babies have a lower birth weight and are known to have more developmental problems. In addition, a higher rate of miscarriage is possible in women with severe periodontitis.

Pregnant women are also known to complain about bleeding gums due to the increased levels of estrogen and progesterone hormones which make the gums more sensitive to inflammation.

Unchecked periodontitis that progresses during pregnancy increases the risk of pre-eclampsia, with the accompanying danger of high blood pressure and protein in the urine. If plaque or calculus have been removed prior to pregnancy and maintained at low levels during pregnancy, then little inflammation and bleeding would occur.

Other Medical Conditions

Other organs affected by periodontal inflammation include the liver, kidneys and lungs. The liver is the major organ that receives, processes and detoxifies products of infections from other parts of the body. In the process, the liver releases more products that have further adverse reactions on other organs. This negative effect can be reduced through treating periodontal disease by scaling and deep cleaning.

The same bacteria that cause gum disease have been implicated in infections of the lungs, leading to pneumonia. Poor oral health has also been linked to chronic obstructive pulmonary disease, a lung disease in which the lungs are damaged, making it hard to breathe.

Studies have shown that untreated gum disease is also associated with a higher chance of developing various types of cancer. Diseases of the blood such as leukaemia, anaemia and thrombocytopenia, can show up in the gums. Leukaemia patients have over production of white blood cells which can cause swelling and bleeding of the gums, and increases susceptibility to infections. This can progress to bone loss and cause teeth to loosen.

Prevention and Treatments

Knowing the close connection between gum health and systemic health (the health of the rest of the body), prevention is a practical, cost effective and relatively easy option.

• Ensure that good oral hygiene is maintained through regular and proper tooth brushing (at least twice a day) and regular flossing;
• Keep twice yearly appointments with the dentist to ensure that gums and teeth are healthy; and
• Address any outstanding dental problems promptly rather than waiting for the pain or discomfort to be unbearable before going to the dentist.
• An individual, who has a history of diabetes in the family can take early steps to monitor the health of their gums as well as prevent or delay the onset and severity of diabetes.

For patients who are undergoing major surgical procedures (e.g. transplantations) or embarking on a course of treatment such as chemotherapy or radiation, a dental assessment is crucial to identify and treat any pre-existing dental conditions (e.g. periodontal problems) that may interfere with post-surgical recovery or cause oral complications in the middle of treatment.

Our body is a living system. Infections in one part of the body can cause problems in another part of the body. Thus, one good way to maintain overall health is by starting at the mouth.