Did you know that according to a team at King’s College London and the Natural History Museum, “there were less people with Gum disease (5%) in the Roman, and certainly pre-brush era than modern day people (33%) suffering from the condition”?
Considering they did not use a toothbrush and skulls showing heavy deposits of tartar or calculus on them from that period, gum disease must be more complex than simply failing to brush your teeth. Severe Gum disease was found to be the 6th most prevalent global disease (Kassbaum et al 2014). It affects approximately 15% of the population in its most severe form and can affect around 80% of the population in a milder form by the age of 60.
So, what is Gum Disease or Periodontitis?
Is it an infection or inflammation or even an auto-immune disease?
If it were simply an infection then it would have been relatively simple to find some sort of antimicrobial to treat it by now. Inflammation is typically characterised by heat, redness, swelling, pain and loss of function while an auto-immune condition is when the body over reacts and attacks itself mistakenly sending out an army of cells to fight invaders such as bacteria and viruses.
Periodontitis is a non-resolving inflammatory process initiated by a bacterial biofilm (plaque) in the mouth but the inflammation is ineffective at eliminating this oral biofilm and the ongoing management of this disease is centred around restoring the balance between the biofilm and the body’s response. Further factors that affect the host response include genetics, smoking, stress, diabetes, nutrition, obesity and lifestyle.
Failure to maintain the balance between the biofilm and the response to it can result in damage to the teeth support structures, namely the gums, the ligaments that hold them and the bone surrounding them. This eventually leads to loss of the teeth after complete destruction of the supporting structures and bone.
The genetic link with the disease means that there is a trend running in families thereby making both siblings and children of a sufferer of the disease at more risk of also suffering from gum disease. It is good practice to screen such family members once a person is diagnosed with the disease.
How can I treat gum disease?
Just like the condition of Diabetes, gum disease can be treated successfully but it cannot be cured. It can however, be controlled to prevent further damage to the teeth surrounding structures thereby allowing teeth to be retained for a long time.
The patient’s role in the treatment of gum disease is crucial accounting for about 90% of what is needed. The role of the dental team is much smaller in influencing the overall result but is equally crucial in early identification of the disease and help in its management preventing progression is much simpler than trying to treat advanced disease. The dental team show the patient techniques aimed at cleaning the teeth to a very high standard thereby disturbing and removing the biofilm to reduce the body’s response to it. This biofilm naturally begins to reform within hours and failure to remove it after a period of 24hours means a harder deposit of tartar or calculus begins to form around teeth which further encourages biofilm build-up on its rough surface.
Smoking is the top modifier of gum disease not only affecting the disease process directly but also making it less responsive to treatment. Smokers are 3 to 4 times more likely to have gum disease and smoking cessation advice is routinely given not only at the dental surgery but at GP surgeries and chemists in the high street.
Diabetes in its most common form (Type 2) is a disease where there are higher levels of sugar in the bloodstream than normal. Dentists have known for years that diabetics are at an increased risk of suffering from gum disease and the disease can be worse and more difficult to treat in these patients. Well controlled diabetics with a stable sugar level are more likely to be successful in treatment of gum disease. Recent evidence has now emerged whereby there is a link between people with gum disease and a person’s sugar level whether they are diabetic or not. In patients with diabetes suffering from severe gum disease, there is an increased blood sugar level compared with those with healthy gums while those who do not have diabetes but are suffering from severe gum disease, the body’s control of blood sugars is not as good as it should be. The good news is that treatment of gum disease or keeping your gums healthy can help in controlling and reducing blood sugar levels in some patients with diabetes and has been likened to introducing a second medicine in the control of diabetes. Treatment of gum disease or keeping healthy gums is thought to help those at risk of developing diabetes alongside other measures such as losing weight and taking exercise.
While inflammation is essentially a way for your body to protect you, too much of it can be harmful and cause damage to the body. Some elements of your diet are known to encourage inflammation while others can reduce it so the balance of what you eat can influence your gums.
In general terms, anything containing sugar, sweeteners or flour promote inflammation and should be reduced. Refined carbohydrates such as sugars in all forms in processed/ packeted foods or white flours and high sugar fruits such as melons and pineapples or in dried fruits are particularly bad. Some vegetables like potatoes, parsnips and carrots and white rice along with saturated fats in dairy products, animal fats (red meat) and some palm/coconut oils and saturated fatty acids all promote inflammation.
The good news is that the advice of your 5-a-day is good to reduce inflammation while eating whole fruits (except those mentioned above), berries, whole vegetables especially green (except those mentioned above), fish and seafood, white meats, poultry and game, whole grains (whole grain rice, oats, barley, quinoa), nuts and seeds, eggs and some oils such as olive oil. Omega-3 fatty acids are important for metabolism and brain function as well as they help reduce inflammation and have now been noted for helping prevent or treat several conditions such as gum disease, asthma, cardiovascular disease, rheumatoid arthritis, Alzheimer’s and depression.
People who are healthy and maintain a good body weight and exercise regularly have been shown to suffer less gum disease than those who do not exercise regularly. However, moderate exercise is advised as extreme exercise can increase inflammation but it is a good idea to speak to your health professional to ensure the correct level of exercise to suit your lifestyle.
Early diagnosis and treatment of gum disease is essential and as part of our routine screening here at Merton Dental in Wimbledon we carry out these checks at every dental health check. If you think you would benefit from such screening for the 6th most prevalent disease in the world, give us a call at Merton Dental on 02085441122 or email on [email protected] or use the contact form on www.mertondental.co.uk