Last week we talked about taking ownership of your health! We will be discussing what that means over the next few weeks. It is way too much information to discuss all at once, so I will be breaking it down into easier-to-absorb tidbits.

Knowing the health of your mouth is where I recommend starting your journey; Why?

According to the Centers for Disease Control, one out of every two American adults aged 30 or older has periodontal disease. Take a moment to let that sink in.

One out of every two!

I see it every day when I work. There are days I do not see a patient with a healthy mouth. Not one! Especially now with wearing a mask. We see more patients than ever before that are mouth breathing and have gingivitis. These are the patients that go to the dentist. What about the people that do not go to the dentist

Are you one of the 75% of adults with gum disease?

Dental disease is silent, and most people don’t even know they have it until it’s too late. If you don’t know the health of your mouth or have not gone to the dentist in years eventually, you may have teeth fall out or, worse, need to be pulled out due to an infection and/or pain in your mouth. Also disturbing is that studies have found a link between periodontal disease and many systemic illnesses, including the # 1 cause of death in the U.S. heart disease.

Let us begin with what is periodontal disease and why should you care how you find out if you have it?

Your mouth is a window into your body. It gives us warning signs bleeding gums is one of the first warning signs there may be something wrong. Please don’t ignore it. Dental disease is preventable and reversible if you catch it early. 

Periodontal Disease

Periodontal disease is mainly the result of an infection and inflammation of the gums and bones that surround and support the teeth. In its early stage, we call gingivitis 100% reversible; the gums become swollen and red and may also bleed. The infection has not affected the bone surrounding the teeth in this stage. A fun fact If you are a smoker, your gums may not bleed.  Patients who smoke don’t usually experience bleeding gums because of the constriction of the gums’ blood vessels due to the heat.

Bleeding gums when brushing and flossing are a common symptom of gingivitis but, because nicotine restricts the blood flow to the gums, smokers may not experience this early warning sign of gum disease.

The more severe form of periodontal disease is periodontitis, This is where the gums pull away from the tooth, bone and the teeth can lose surrounding structure, and the teeth may loosen or even fall out. Periodontal disease is mainly seen in adults. I have seen patients as young as eight years old experience juvenile Periodontitis. It is an uncommon condition characterized by severe loss of attachment and destruction of alveolar bone around one or more permanent teeth in an otherwise healthy adolescent. For children, it can be an early warning sign of juvenile diabetes.

Periodontal disease and tooth decay are the two biggest threats to dental health.

Want to hear a surprising statistic: 80 % of American adults have some form of gum disease.

Here are a few interesting facts regarding Gum Disease related to the prevalence of periodontitis in the U.S, from the Centers for Disease Control and Prevention.

  • It seems to be  more common in men vs. women (56.4% vs. 38.4%), 
  • 65.4% of people living below the poverty level have gum disease
  • 66.9% of people with less than a high school level education have gum disease
  • 64.2% of smokers have gum disease

It is 100% preventable, so why do many U.S. adults live with it? The sad truth and the primary reason people have gum disease is a lack of motivation for home care. This is mainly because there is no pain in the early stages and a lack of knowledge on how to prevent it. This is not the case for everyone; other reasons include genetics (hereditary), health-related issues like diabetes, AIDS, or even hormonal changes such as pregnancy. Some reasons are self-inflicted. Smoking, stress, and poor oral hygiene are examples of these. While hereditary or health causes cannot be prevented, habits can. Change your habits, change your life! There are self-inflicted reasons that can and should be reversed. What you put in your mouth, how you take care of it, Diet and pH are things you control. Your genetics does not doom you. Believe it or not, your beliefs and habits dictate your health, including your mouth’s health.

Causes of Periodontal Disease

Bacteria in the mouth infect the tissues surrounding the tooth, causing inflammation around one or more teeth leading to infection. When bacteria stay on the teeth long enough, they form a film called plaque, which eventually hardens to tartar, also called calculus. The tartar build-up accumulates below the gum line, making the teeth harder to clean. Then, only a dental health professional can remove the hard deposits and stop the periodontal disease process. There is a lot you can do at home to avoid this.

Warning signs

The following are warning signs of periodontal disease:

  • Bad breath or bad taste that won’t go away
  • Red or irritated gums
  • Tender, swollen, or bleeding gums
  • Sensitive teeth
  • Loose teeth
  • Pain when Chewing
  • Gums that have pulled away from your teeth or flapping
  • Any change in the way your teeth fit together when you bite

Risk factors

Certain factors increase the risk for periodontal disease:

  • Smoking
  • Diabetes
  • Poor oral hygiene
  • Stress
  • Heredity
  • Crooked teeth
  • Underlying immuno-deficiencies—e.g., AIDS, 
  • Fillings that have worn down or become defective
  • Medications 
  • Dry mouth
  • Bridges or Partial dentures that no longer fit properly
  • Female hormonal changes, such as with pregnancy or the use of oral contraceptives

How do you know if You have Periodontal Disease? 

Recent epidemiologic surveys and studies have provided important information on the prevalence, extent, and severity of periodontal diseases in the United States.  The problem with this study is these are the people that seek dental care. Over 50% of the population with dental insurance does not see a dentist or use their benefits.  I believe these #’s are most likely even higher reported. 

An average of 80% of adults have gingivitis that affects 3 to 4 teeth in their mouth. That is one out of every two adults, and subgingival calculus means a hard deposit in 67% of the adult population. This includes children. 

The prevalence of early-onset periodontitis ranged from less than 1% in 14- to 17-year-olds to 3.6% in young adults aged 18 to 34. Children are more likely to develop gingivitis than periodontal disease. Gingivitis affects about 73 percent of children between six and eleven years old, I discuss this on my podcast.  

Gingival recession accounted for a significant amount of attachment loss. When you scrub your teeth too hard, or your bite is off, it can cause recession which also causes bone and attachment loss. I have another Podcast just on this subject.

Adult periodontitis is measured by the presence of bleeding,  bone loss, and periodontal pockets greater than  3mm, and there are four stages.

Early disease is  > or = 4 mm, was found in about 80% of the population on an average of 3 to 4 teeth. 

What is periodontal charting?

There are ten essential components of comprehensive periodontal charting are probing depths, bleeding on probing, evaluation of plaque, calculus and bone levels, gingival recession, tooth mobility, occlusal factors, degree of furcation involvement, and tooth-related factors, such as open contacts, crowns, bridges or malpositioned teeth. 

How do we measure periodontal pockets?

We measure the depth of the space between your gums and teeth by sliding a dental probe against your tooth beneath your gum line until it hits the bottom of the pocket, usually at six sites per tooth throughout your mouth. In a healthy mouth, the pocket depth is generally between 1 and 3 millimeters (mm). Pockets deeper than 4 mm may indicate gingivitis or periodontitis. Pockets 5 or greater may need further treatment; at the least, they need you to step up your home care.

What do the numbers mean?

During the measuring process, you’ll hear your dental professional say numbers ranging from 1 to 9, sometimes higher, but most software does not chart double digits. These numbers reflect how deep your gum pockets are in millimeters. These numbers, along with bleeding when probing and bone loss, and other factors, are how we determine if your gums are healthy or not. We use this to determine what stages of gum disease you are in and if you have an active disease requiring treatment or continuing on a maintenance regimen.  We also advise you on what tools you will need to disrupt the plaque and bacteria to prevent further damage. 

Know Your Periodontal Measurements and The Meanings of the Measurements

  1. 0-3mm without bleeding: Perfect! 
  2. 1-3mm with bleeding: Early signs of gingivitis.
  3. 3-5mm with no bleeding: This indicates a potential for gum disease. 
  4. 3-5mm with bleeding: This is an early stage of gum disease or the beginning of periodontitis.
  5. 5-7mm with bleeding: Active disease
  6. 7mm and above with bleeding: Severe disease 

 

 What stage are you in?

Periodontal disease is an illness broken up into four different stages:

  • Stage 1: Initial- Gingivitis
  • Stage 2: Moderate-slight periodontal disease
  • Stage 3: Severe bleeding and potential for tooth loss.
  • Stage 4: Advanced with mobility, infection, and potential for loss of all the teeth.

 

Gingivitis is the only stage of periodontal disease that is reversible as it has not yet had time to attack the bones. At any stage, you can stop the3 progression if you take action.

Disease status is determined by reviewing the medical history, clinical assessment, patient, and radiographic data and comparing it to previous visits. This is why the numbers are so important; we can compare each visit and determine if you are stable or have active disease.

For example, in my practice, the dental hygienists always have the patient’s original and most recent radiographs and intraoral camera pictures side by side for comparison. This allows for rapid assessment of bone levels’ stability, therapy outcomes, caries risk, rates of tooth loss, and possible future treatment indicated. It is also a compelling way to show our patients their individual stories and course of history. Successful long-term control of periodontal disease depends on active Periodontal Maintenance care and, if indicated, additional therapy or better home care.

Smoking and diabetes have been identified as risk factors, especially diabetics with poor metabolic control and poor oral hygiene. I recommend people with diabetes get their teeth cleaned four times a year. When their sugar is under control, I have had several diabetic patients; they have healthy gums. On the flip side, I have had several patients who thought their bleeding gums were from diabetes. We could not get the bleeding to stop no matter what we did to find out there was another underlying issue. Several of my diabetic patients had developed cancer we were able to find early.  My Uncle was one of them we did not discover until stage four. I was much younger and did not trust my instincts. He is one of the reasons I am such an advocate for educating about the mouth-body connection. 

Bleeding gums are not normal and are a sign! Your body is telling you there is something wrong. If we can not get bleeding under control between the dental professional and the patient, this is a sign you need to be your own advocate and find the root cause. Bleeding gums is how I was able to find my cancer early. I knew my gums were healthy. There had to be another reason I could not get them to stop bleeding. I had breast cancer and ignored all the other signs until my gums started bleeding. 

Prevention and treatment

Gingivitis can be controlled and treated with good oral hygiene. You may need regular professional cleanings. More severe forms of periodontal disease can also be treated successfully but may require more extensive treatment. Such treatment might include a deep cleaning of the tooth-root surfaces below the gums, medications prescribed to take by mouth or placed directly under the gums, and sometimes periodontal surgery to reduce the pockets so you can keep them clean. We do not have tools you can use at home to get to the base of a pocket greater than 5 MM.

To help prevent or control periodontal diseases, it is essential to:

  1. Brush and floss every day to remove the bacteria that cause gum disease. Electric toothbrushes are 10X more effective than a manual brush and a water flosser is another great tool to flush out the pockets.
  2. See a dentist at least once a year for checkups or more frequently if you have any warning signs or risk factors mentioned above.

There are soft tissue management programs in dentist’s offices, insurance referral guidelines, quality-assurance mechanisms, and protocols that are essential for diagnosing and treating persons with periodontitis. This is part of why it is so important you know the health of your mouth and listens to the warning signs.

Upon completion of periodontal therapy, patients should enter into a maintenance program. Periodontal maintenance (PM) is started after the completion of active periodontal therapy and continues for the life of the patient. 

The main objective of the maintenance phase of treatment is to monitor the risk for periodontal disease recurrence and progression. The components of a PM visit should include an update of medical/dental histories, extraoral exam, intraoral exam, mechanical tooth cleaning, clinical exam, periodontal exam, and radiographic exam, as indicated. For most patients with a history of periodontal disease, a 3-month interval effectively maintains gingival health.

Typically, PM patients are comprehensively charted on an annual basis. We chart every visit so we can compare and monitor your 

Concerning charting, there is no standard of care regarding the frequency of full periodontal charting. This is because each patient has a unique periodontal history and set of risk factors for disease recurrence. are based on the fact that not all patients are equally susceptible. Therefore, patients who are at high risk should be charted more frequently so that early signs of disease recurrence can be detected.

PERIO CHARTING SAVES TEETH AND LIVES 

The big question with perio charting is that do you know your numbers and the health of your mouth?

We know that patients with an active periodontal infection have an elevated risk not only of tooth loss but also cardiovascular events, stroke, and diabetes. If a patient is pregnant, periodontal disease can increase the risk of adverse pregnancy outcomes like low birth weight or preterm delivery.

By knowing your numbers and taking action and ownership of your health, you can eliminate major risk factors which can help lower the overall risk for cardiovascular disease, stroke, and other illnesses in the body.

Certainly, that’s worth our time.

Picture courtesy of Arestin- A medication put into a periodontal pocket to treat gum disease.

If you can’t afford dental care, you may be able to find help through the following sources:

 

References:

  1. Cohen RE, Research, Science and Therapy Committee, American Academy of Periodontology. Position paper: periodontal maintenance. J Periodontol. 2003;74:1395–1401.
  2. Comprehensive periodontal therapy: a statement by the American Academy of Periodontology. J Periodontol. 2011;82:943–949.

https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html

https://pubmed.ncbi.nlm.nih.gov/9526927/