The Battle Against Gum (Periodontal) Disease Needs to Be Fought by Both the Patient and The Dentist to Win
by Dr. Iyad Sood, MS – PDS®-supported Periodontist
Recent studies have estimated that one out of every two individuals in the United States over the age of 35 has gum (periodontal) disease. This finding has sparked much concern because not only is periodontal disease the leading cause of tooth loss, but it has also been linked to systemic diseases, such as diabetes, heart disease, cancers, diabetes, stroke, erectile dysfunction, lung disease, Alzheimer’s disease and more. There are a number of research studies, both published and currently in progress, that have been attempting to identify the mechanisms and physiology of the link between gum disease and these systemic diseases. From a clinicians’ standpoint, our main focus is to try to arrest the gum disease so that we can minimize the progression, and hopefully in turn reduce the risk of acquiring these systemic diseases.
Before discussing treatment options for gum disease, we as dental providers need to first discuss and thoroughly educate our patients about the causes and risk factors of gum disease itself. The primary etiology/cause of gum disease is plaque. However, it has been shown that certain contributing or risk factors have also been linked. These risk factors include smoking, bruxism (clenching and/or grinding) genetics, occlusion, stress, pregnancy, systemic factors (e.g., heart disease, diabetes, cancers, etc.), orthodontic treatment, obesity and more.
The first stage in the treatment of gum disease should include patient education. Since plaque is the root cause of gum disease, patients need to understand various plaque control measures, including proper brushing/flossing techniques, as well as introducing various adjunctive oral hygiene tools like irrigating devices, dental floss aids, etc. In addition to oral health measures, gum disease patients should also follow a regular schedule with their physicians to make sure their systemic conditions, if any, are under good control.
For patients who smoke, we as dentists can suggest many routes of smoking cessation that are available currently. They include medications, electronic cigarettes and many others. Pregnancy-induced gum disease has been linked to preterm low-birth weights, miscarriages and other gestational anomalies. Finally, dental anxiety has been linked to gum disease, and there are various measures to help patients overcome their fears.
Unfortunately gum disease is not a curable disease. A dentist’s main objective is to stabilize the disease and ultimately prevent the disease’s progression. Gum disease is an inflammatory disease that leads to the loss of supporting gingiva and bone tissue around a tooth. Once enough of those periodontal-supporting tissues are lost, the tooth becomes very mobile and infected and eventually will need to be extracted and replaced with dentures or other measures. Early warning signs of gum disease include: bleeding gums during brushing/flossing, severely inflamed gingiva, sensitive teeth/gingiva, etc.
The treatment of gum disease should be initiated once any of these symptoms are identified. The treatment should include a very thorough session of root planing (deep scaling) along with adjunctive antibiotic or laser therapy on all teeth. The next phase is a follow up re-evaluation by a primary care dentist to assess if the gum disease has been stabilized. If the disease has not stabilized, patients will be referred to the periodontist for possible periodontal surgery. Once the gum disease has stabilized, patients will resume a well-structured periodontal maintenance cleaning schedule with the dental hygienist.
So, although gum disease cannot be fully cured, it can be stabilized through various measures as described above. Gum disease, unlike a toothache, is sometimes asymptomatic; it can go undiagnosed for several years for those patients who are not seeing their dentists on a regular basis. That’s why is up to us as oral health providers to increase awareness to the very communities we practice within.