GUM DISEASE INFORMATION
Periodontal ( GUM ) disease is a leading cause of tooth loss and may be associated with other chronic diseases, including diabetes and heart disease.
TYPES OF GUM DISEASE
Untreated gingivitis can advance to periodontitis and can eventually lead to tooth loss and other health problems.
Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.
Factors that may contribute to gingivitis include, diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medication use.
Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.
There are many forms of periodontitis. The most common ones include the following.
- Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
- Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
- Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
- Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.
GUM DISEASE SYMPTOMS
However, warning signs of gum disease include the following:
- Red, swollen or tender gums or other pain in your mouth
- Bleeding while brushing, flossing, or eating hard food
- Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
- Loose or separating teeth
- Pus between your gums and teeth
- Sores in your mouth
- Persistent bad breath
- A change in the way your teeth fit together when you bite
- A change in the fit of partial dentures
Millions of people don’t know they have this serious infection that can lead to tooth loss if not treated.
GUM DISEASE AND WOMEN
A woman’s periodontal health may be impacted by a variety of factors.
During puberty, an increased level of sex hormones, such as progesterone and possibly estrogen, causes increased blood circulation to the gums. This may cause an increase in the gum’s sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender.
Occasionally, some women experience menstruation gingivitis. Women with this condition may experience bleeding gums, bright red and swollen gums and sores on the inside of the cheek. Menstruation gingivitis typically occurs right before a woman’s period and clears up once her period has started.
Some studies have suggested the possibility of an additional risk factor – periodontal disease. Pregnant women who have periodontal disease may be more likely to have a baby that is born too early and too small. However, more research is needed to confirm how periodontal disease may affect pregnancy outcomes.
All infections are cause for concern among pregnant women because they pose a risk to the health of the baby. The Academy recommends that women considering pregnancy have a periodontal evaluation.
MENOPAUSE AND POST-MENOPAUSE
Women who are menopausal or post-menopausal may experience changes in their mouths. They may notice discomfort in the mouth, including dry mouth, pain and burning sensations in the gum tissue and altered taste, especially salty, peppery or sour.
In addition, menopausal gingivostomatitis affects a small percentage of women. Gums that look dry or shiny, bleed easily and range from abnormally pale to deep red mark this condition. Most women find that estrogen supplements help to relieve these symptoms.
GUM DISEASE IN CHILDREN
TYPES OF PERIODONTAL DISEASES IN CHILDREN
Chronic gingivitis is common in children. It usually causes gum tissue to swell, turn red and bleed easily.
Aggressive periodontitis can affect young people who are otherwise healthy. Localized aggressive periodontitis is found in teenagers and young adults and mainly affects the first molars and incisors. It is characterized by the severe loss of alveolar bone, and ironically, patients generally form very little dental plaque or calculus.
Generalized aggressive periodontitis may begin around puberty and involve the entire mouth. It is marked by inflammation of the gums and heavy accumulations of plaque and calculus. Eventually it can cause the teeth to become loose.
SIGNS OF PERIODONTAL DISEASE
Constant bad breath that does not clear up with brushing and flossing
IMPORTANCE OF GOOD DENTAL HYGIENE IN ADOLESCENCE
Hormonal changes related to puberty can put teens at greater risk for getting periodontal disease. During puberty, an increased level of hormones, such as progesterone and possibly estrogen, cause increased blood circulation to the gums. This may cause an increase in the gum’s sensitivity and lead to a greater reaction to any irritation, including food particles and plaque. During this time, the gums may become swollen, turn red and feel tender.
As a teen progresses through puberty, the tendency for the gums to swell in response to irritants will lessen. However, during puberty, it is very important to follow a good at-home dental hygiene regimen, including regular brushing and flossing, and regular dental care. In some cases, a dental professional may recommend periodontal therapy to help prevent damage to the tissues and bone surrounding the teeth.
ADVICE FOR PARENTS
Early diagnosis is important for successful treatment of periodontal diseases. Therefore, it is important that children receive a comprehensive periodontal examination as part of their routine dental visits. Be aware that if your child has an advanced form of periodontal disease, this may be an early sign of systemic disease. A general medical evaluation should be considered for children who exhibit severe periodontitis, especially if it appears resistant to therapy.
The most important preventive step against periodontal disease is to establish good oral health habits with your child. There are basic preventive steps to help your child maintain good oral health:
- Establish good dental hygiene habits early. When your child is 12 months old, you can begin using toothpaste when brushing his or her teeth. When the gaps between your child’s teeth close, it’s important to start flossing.
- Serve as a good role model by practicing good dental hygiene habits yourself.
- Schedule regular dental visits for family checkups, periodontal evaluations and cleanings.
- Check your child’s mouth for the signs of periodontal disease, including bleeding gums, swollen and bright red gums, gums that are receding away from the teeth and bad breath.
THE AAP RECENTLY PARTNERED WITH THE AD COUNCIL TO PROMOTE HEALTHY ORAL HABITS IN CHILDREN. CHECK OUT THE 2MIN2X.ORGFOR MORE INFORMATION.
References: perio.org (American Academy or Periodontology)
GUM DISEASE RISK FACTORS
Studies indicate that older people have the highest rates of periodontal disease. Data from the Centers for Disease Control and Prevention indicates that over 70% of Americans 65 and older have periodontitis.
Tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.
Research has indicated that some people may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early intervention treatment may help them keep their teeth for a lifetime.
Stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. Stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.
Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.
CLENCHING OR GRINDING YOUR TEETH
Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.
OTHER SYSTEMIC DISEASES
Other systemic diseases that interfere with the body’s inflammatory system may worsen the condition of the gums. These include cardiovascular disease, diabetes, and rheumatoid arthritis.
POOR NUTRITION AND OBESITY
A diet low in important nutrients can compromise the body’s immune system and make it harder for the body to fight off infection. Because periodontal disease begins as an infection, poor nutrition can worsen the condition of your gums. In addition, research has shown that obesity may increase the risk of periodontal disease.
PERIODONTAL DISEASE AND SYSTEMIC HEALTH
Research has shown that periodontal disease is associated with several other diseases. For a long time it was thought that bacteria was the factor that linked periodontal disease to other disease in the body; however, more recent research demonstrates that inflammation may be responsible for the association. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions.
GUM DISEASE AND MEN
Research has found that periodontal disease is higher in men (56.4 percent) than in women (38.4 percent). This may be because men are less likely to go to the dentist or because men have worse indicators of periodontal health than women, including higher incidence of dental plaque, tartar, and bleeding on probing. However, periodontal health for men is extremely important as it may impact a variety of other health factors.
Prostate-specific antigen (PSA) is an enzyme created in the prostate that is normally secreted in very small amounts. However, when the prostate becomes inflamed, infected, or affected by cancer, PSA levels rise. Research has shown that men with indicators of periodontal disease such as red, swollen or tender gums as well as prostatitis (inflammation of the prostate) have higher levels of PSA than men with only one of the conditions. This means that prostate health may be associated with periodontal health, and vice versa.
Research indicates that periodontal disease and cardiovascular disease are associated; having periodontal disease may actually increase your risk of cardiovascular disease. Both diseases are chronic inflammatory conditions, and researchers believe that inflammation is the connection between gum disease and heart disease. Since men are already more likely to develop heart disease than women, maintaining periodontal health is another way to reduce this risk.
Men with periodontal disease, especially those younger than 30 or older than 70, are at increased risk of developing impotence, according to research. Researchers believe that inflammation may be the link between the two conditions; prolonged chronic inflammation (the same type of inflammation that is associated with periodontal disease) can damage blood vessels leading to impotence.
Research has found that men with a history of gum disease are 14 percent more likely to develop cancer than men with healthy gums. Specifically, men with periodontal disease may be 49 percent more likely than women to develop kidney cancer, 54 percent more likely to develop pancreatic cancer, and 30 percent more likely to develop blood cancers.
COMPREHENSIVE PERIODONTAL EVALUATION (CPE)
WHAT IS A COMPREHENSIVE PERIODONTAL EVALUATION?
In 2011, the American Academy of Periodontology published the Comprehensive Periodontal Therapy Statement, which recommends that all adults receive an annual comprehensive evaluation of their periodontal health.
A Comprehensive Periodontal Evaluation, or CPE, is a way to assess your periodontal health by examining:
- Your teeth
- Your plaque
- Your gums
- Your bite
- Your bone structure
- Your risk factors
When your dental professional, such as a periodontist, general dentist, or dental hygienist, performs this evaluation, they will look at these six areas to determine the state of your periodontal health.
WHY DO I NEED A COMPREHENSIVE PERIODONTAL EVALUATION?
Recent research has indicated that the prevalence of periodontal disease in the U.S. may be significantly higher than originally estimated. This means that all adults should thoroughly assess the state of their periodontal health to receive accurate information about the health of their mouths.
By assessing your oral health on an annual basis, you and your dental professional will know how healthy your mouth is, and will be better able to notice any conditions, such as periodontal disease, that may need additional treatment.
Research has also shown, and experts agree, that there is an association between periodontal disease and other chronic inflammatory conditions, such as diabetes, cardiovascular disease, and respiratory diseases. Therefore, it is very important to treat the inflammation that causes periodontal disease as soon as possible to ensure that your entire body stays healthy.
YOUR COMPREHENSIVE PERIODONTAL EVALUATION CHECKLIST
To help you learn more about the state of your oral health, the Academy has developed a Comprehensive Periodontal Evaluation checklist. Download the checklist, print it out, and bring it to your next dental appointment. The steps of the evaluation are listed, and there is space for you to write questions or additional information you would like to share with your dental professional. Check off each step of the evaluation as your dental professional completes your exam, and be sure to ask your dental professional if you have any questions about the evaluation or about your oral health.
Disclaimer: The AAP recognizes that decisions with respect to the treatment of patients must be made by the individual practitioner in light of the condition and needs of each specific patient. Such decisions should be made in the best judgment of the practitioner.