Recognizing Gum Disease

The Dental Educator

Recognizing Gum Disease

In previous writings on this topic I focused on the connections between gum disease and other systemic ailments such as heart disease, diabetes and obesity, to name but a few.  My point was that oral health, and in particular gum health, cannot be relegated to being isolated health issues, but rather, everything is intimately related.  In a way, while we may be dentists, i.e. physicians who specialize in treating the oral cavity, in effect we treat systemic health as well, albeit in an indirect way.

That said, what exactly is gum (periodontal) disease?  Why is it harmful?  How does it manifest itself, both to the patient as well as the doctor?  How is it treated?  I don’t promise you that I’ll answer all these questions today, because of space constraints.  Instead, I can only advise you to stay tuned.

I remember seeing a cartoon many years ago picturing a dentist seating his patient up following his examination of her.  The caption underneath read as follows:  “Well, Mrs. Jones, I have some good news and bad news.  The bad news is that your gums are so bad that all your teeth will have to be taken out.  The good news is that you have no cavities.”  In my nearly 30 years in private practice I’ve seen the truth of this caption borne out time and time again.  Most denture wearers today have lost their teeth because of gum disease, not cavities.  And, in fact, patients in my early years considered tooth loss to be as inevitable as hair loss, part of the aging process.  Because of the dental profession’s increased concern regarding periodontal disease, and the importance of saving teeth, as well as the public’s acceptance of these concerns, dentures are becoming a thing of the past. 

So, what exactly is periodontal disease?  Periodontal disease is ultimately the loss of the supporting tissues of the teeth, the supporting tissues being the jaw bone into which the roots of the teeth are embedded, the pink tissues overlying the bone which we call the gums, and the (periodontal) ligament that attaches the teeth to the bone.  In the early stages, when tartar, which contains bacteria, settles on the teeth near the gumline, it releases toxins that eat away at the tissues that attach the teeth to the dental ridge (bone).  As time goes on, less and less of the tooth is attached to the ridge.  Even worse, the bacteria begin to eat away at the supporting bone around the tooth so that there is less bone available to hold the tooth in place.  Eventually, there is so much loss of attachment tissue and bone that the tooth loosens up and falls out.  Often, these teeth are virgin, having no decay or previous fillings. 

One of the problems with gum disease is that it often goes unrecognized, there being little pain, especially in the early stages, and even later on.  The patient may notice some bleeding when he brushes his teeth or flosses, and in a more advanced state some loosening of his teeth.  Only in a more extreme state, such as a gum abscess (infection), will he realize that something is terribly wrong and consequently have it looked at by a dentist.  By that time, it’s often too late to save the tooth through conservative means, or even save the tooth at all.

What can be done to address, or even prevent periodontal disease?  We’ll address that question next time.