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Periodontal Disease

A recent literature review article has showed the strong connection between gum infection (periodontal disease) to other systemic diseases. In this newsletter, I will help to explain some common links between patients’ bleeding gums to their overall health.

Periodontal disease is the infection of the gum, teeth, and bone that surround teeth. Current estimates show that 75% of North American population has some form of gum infection[1]. Normally these are a low-grade chronic infection, which does not show any signs and symptoms besides occasionally bleeding of the gums and teeth while brushing and flossing. Due to the lack of symptoms, gum infection is usually undiagnosed or untreated.

Periodontal Disease and the Body

Chronic inflammation response of the gum and bone surrounding the teeth cause the total body inflammation response to increase overall. This heighten inflammatory response contributes directly to worsening of systemic diseases which are caused by inflammation such as rheumatoid arthritis, osteoporosis, and pneumonia.

Inflammation factors from the gum also causes dislodging of fatty deposits in the blood vessel. These dislodged fatty deposits will travel through the blood system, which could block a blood vessel at the heart causing a heart attack or block a blood vessel in the brain causing a stroke.

Periodontal Disease and Alzheimer’s Disease

There is evidence that periodontal disease may be a risk factor for dementia through the bacterial and viral infections commonly found in periodontal disease. Oral infection can either directly or through systemic signals to the brain contribute to the development of Alzheimer’s disease[2].

Periodontal Disease and Cancer

Periodontal disease also have strong link to several type of cancer such as oral cancer, upper GI and gastric cancers, pancreatic cancer, lung cancer, and esophageal cancer[3].

Periodontal Disease and Diabetes

The association between diabetes and inflammatory periodontal diseases has been studied extensively for more than 50 years. Large evidence research shows that diabetes is associated with the increase in gum infection. Also periodontal disease can also adversely affect the metabolic control of diabetes. Patients with diabetes who have periodontal disease have two chronic conditions, each of which may affect the other, and both of which require frequent professional evaluations by health care providers[4].

Periodontal Disease and Premature Birth

The oral cavity works as a continuous source of infectious agents, and its condition often reflects progression of systemic pathologies. Periodontal infection happens to serve as a bacterial reservoir that may exacerbate systemic diseases. Research suggests that the bacteria that cause inflammation in the gums can actually get into the bloodstream and target the fetus, potentially leading to premature labor and low-birth-weight babies[5].

The common links of these systemic diseases to gum infection are bacteria in the blood and infl­ammation factors that produce by-chronic infection on the gum and teeth. The consequences of untreated gum infection often time would lead to serious health implications and the loss of multiple teeth. Scheduling a periodontal evaluation with your dentist is the first step to fight this silent deadly disease.

To Be Continued…

[1] Friedewald et al. Editors Consensus: Periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol? 104:59-68, 2009. Published simultaneously in the Journal of Periodontology. July, 2009.

[2] Watts, A.; Crimmin, E.M.; Gatz.M.: Inflammation as a potential mediator for the association between periodontal disease and Alzheimer’s disease. Neuropsychiatric Disease and Treatment. 4(5):

[3] Comlan Missih, DDS, MPH: The link between periodontal disease and cancer: A review. Perio- Implant Advisory website.

[4] Mealey BL. J Am Dent Assoc. 2006 Oct;137 Suppl:26S-31S. Review. Erratum in: J Am Dent Assoc. 2008 Mar;139(3):252.

[5] Saini R, Saini S, Saini SR. Periodontitis: A risk for delivery of premature labor and low-birth-weight infants. J Nat Sci Biol Med. 2010 Jul;1(1):40-2.865-876, 2008

In the previous newsletter, we cited many scientific studies to show the link between gum infection and systemic diseases.  In this newsletter we will be discussing the Treatment of Gum Infection, Perio Maintenance, and Prevention of Gum Infection. 

Treatment of Gum Infection

The primary goal of periodontal treatment is to clear infection from the gums and teeth.  Periodontal infection is a chronic and non-curable bacterial infection. The traditional deep cleaning technique tries to clean the pockets forming between the gums and teeth due to infection. This method had been working very well but also had its limitation.

One thing one must understand is that infected periodontal pockets have two walls: tooth side and bone-gum side (Figure 1)The deep cleaning treatment utilizes scalers to physically scale and clean the teeth side of the infected pocket.  However, bacteria has also penetrated and destroyed the gum and bone surrounding the infected teeth.  Adjunct treatments such as medication and laser help to reduce and remove infection in the gum and bone side.  The idea here is to create two clean sides (tooth side and bone-gum side) which ensure that no bacteria are trapped during the healing phase.

Perio Maintenance

What is the difference between perio maintenance and a regular cleaning?  Why do I need to have cleanings more often (every 3-4 months)? These are questions that are routinely asked by our patients. The perio maintenance program is designed to help patients with history of gum infection.  The general rule is, if you already have a history of gum infection, which causes the change of the bone level supporting your teeth, then you need to get cleanings more often.  

During routine home care with the proper cleaning technique, patients can clean up to 3 mm below the gum line.  If you had gum infection in the past, most likely you would have some areas of the gum that are deeper than 3 mm due to the history of bone loss.  These areas need to be cleaned out by the hygienist with special tools.  Cleanings every 3-4 months are required in these cases to prevent infection from starting again.  Just imagine you have some areas in your mouth with food stuck in there and rotting out for 3 months.  Since you cannot clean past 3mm depth of gum, the hygienist has to do that for you every 3-4 months.

For a regular cleaning, a patients gum depth is less than 3mm, there’s no bleeding, and can maintain an excellent hygiene routine at home.  Cleanings every 6 months are recommended at this stage of oral health.

Prevention of Gum Infection

Promptly removing foods in between your teeth is the goal of brushing and flossing to help in preventing gum infection.  How often one should brush and floss really depends on how often one eats in a day.  Routine dental care with your dentist and hygienist is a must.  Our body is a very sophisticate machine; however, just like our car, we need tune-ups regularly to keep our body functioning properly for many years to come.

– Vinh Le, D.D.S