Periodontal Disease Is Not Just About Your Mouth
It has been known for a long time that diabetes can lead to complications with our cardiovascular systems, renal systems, nervous systems, and more recently periodontal system, which is why it is so important to control diabetes.
The link between diabetes and our oral health is mostly due to inflammation, which is a common denominator for both conditions. For those that have uncontrolled diabetes there is typically more inflammation within the body. This can lead to poor wound healing, an increase in susceptibility to infection, vascular complications, and ultimately more inflammation which directly affects our gums. With inflammation, there is a decrease in blood flow to the tissues. This is problematic because cells that are considered “first responders” to inflammation aren’t able to gain access to the site very well.
Toxins that are now able to enter the blood stream can worsen the control of sugar levels eventually making diabetes harder to control. In an environment higher in glucose, certain cells within the gums responsible for repair of tissue aren’t able to function properly.
Cardiovascular disease is a broad term for conditions of the heart and blood vessels and how they function. When bacteria and their toxins build up along and below our gums, ulcerations form allowing bacteria and their by-products to enter our blood stream, spreading the inflammation. These inflammatory mediators can damage blood vessels, causing hardening of the arteries (atherosclerosis). When this happens the blood can’t easily get to parts of the body (like the brain) leading to stroke. It can also put more strain on the heart making it work harder unnecessarily. When there is inflammation present there is a breakdown of tissue, both within our gums and blood vessels.
While it may not be a cause of dementia, it initiates an immune response: oral infection leads to systemic infection, and toxins in body may contribute to existing brain pathologies, breakdown of BBB, and vascular changes that has potential to impact brain function, lead to cerebral pathology, or neuron death.
Premature and Low Birth Weight Babies
When women are pregnant there are several changes happening within the body. Oral manifestations of pregnancy can include signs that resemble gum disease. Often times during pregnancy gums are more red and swollen, and may bleed more easily when brushing and flossing. This is usually short term, and subsides after childbirth. However, in cases where gum disease is more progressed, and affects the bone and supporting structures, bacteria and their toxins are more problematic. Toxins produced by bacteria elicit a host response to have inflammatory mediators be produced to help fight the infection. Certain cells involved in fighting this inflammation, in higher quantities can stimulate uterine contractions, dilate the cervix and induce premature labour.
Recare Interval – 3 vs 6 vs 12 Months
First we need to understand the differences in our oral health. A healthy mouth will show no signs of inflammation. The gums are a nice pink colour, there is no bleeding or swelling of the gum tissue. The bone and ligaments that hold our teeth in our mouths is of adequate height around the teeth providing good support.
If you have gingivitis, this indicates early gum disease. The gum tissue might be darker in colour, sometimes even red. The gums might bleed when you brush and floss and they might be sore. The bone and ligaments around the teeth are usually not affected at this point, and there is still much that can be done to eliminate the inflammation.
If you have been told you have periodontitis, this is a more severe form of gum disease and is more difficult to treat. Periodontitis not only affects the gums, but also the bone and ligaments around the teeth. With this disease, these supporting structures are lost over time, and can result in tooth loss.
Why does my hygienist tell me to come in every 3 months, but some people come in every 6 or even 12 months? The reason for this is based on a few factors:
- How well you clean your teeth and gums at home (how often, how long do you brush, floss, etc.)
- How often are you currently coming in for your hygiene appointments (has it been a while, how do your gums and bone levels look at your current appointment)
- Are you at higher risk of developing gum disease (do you smoke, family history, medications, age, gender, pre-existing medical condition)
Based on this, your hygienist may recommend the following:
Usually recommended for people that have history of, or currently are dealing with, periodontitis. Because the bone levels are affected at this point, we want to make every effort to prevent the bone from being destroyed further. This is often done by coming in more frequently for your cleanings. The more often we can remove the harmful bacteria from below the gum line that is causing the problem in the first place, the better chance the gums have to heal and hopefully stop the bone degeneration. Sometimes what we do in a general office is just not enough; we may try other forms of treatment such as referring patients to a gum specialist (periodontist), doing laser assisted periodontal therapy, or trying PerioProtect (a treatment that uses hydrogen peroxide and antibiotics to help get the bacteria under control).
Sometimes more frequent cleanings are recommended for people that just get a lot of calculus (tartar) on their teeth. In an effort to prevent gum disease from occurring or getting worse, we suggest coming in more frequently so that the aggravating factors like the bacteria found in calculus don’t start an inflammatory process within our mouths.
Sometimes too, people just like coming in more frequently to prevent gum disease from occurring in the first place.
This is probably the most frequent interval that people come in for their professional cleanings. The reason for this is that the majority of people have some degree of gingivitis (gum inflammation). Whether the gums sometimes bleed when flossing or brushing, or they’re a “little puffy” in appearance, these are not signs of a healthy mouth. Usually this interval is recommended for people that don’t have too much build up on their teeth, but are experiencing those early signs of gum disease. In an effort to prevent the disease from getting worse (periodontitis) it’s necessary for us to clean areas below and above the gums that are maybe being missed at home.
This interval for professional cleanings is usually reserved for those who are clinically healthy. They don’t exhibit signs of inflammation, their home care is excellent, and the amount of tarter on their teeth is minimal.