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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.
- Diabetes — people with diabetes and periodontal disease may be more likely to have trouble controlling their blood sugar than diabetics with healthy gums
- 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 Causese 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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