Many people think it’s normal if their gums bleed on brushing.
Over half of adults have bleeding when brushing.
Swelling and bleeding gums are early signs that the gums are infected with bacteria.
Periodontal disease is the infection of the structures around the teeth, including the gums, the periodontal ligament and the alveolar bone. In the early stage of periodontal disease – gingivitis – the infection only affects the gums. In more severe forms of the disease, all tissues are involved. It is now well accepted that different types of bacteria in the dental plaque are the cause of this disease.
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In recent years, gum disease has been linked to a number of other health problems.
There are now established links between gum disease and:
- Atherosclerosis and heart disease – periodontal disease can increase the risk of swollen arteries and heart disease, although the extent of this connection is unclear. It is also known to aggravate existing cardiac disease.
- Stroke – Periodontal disease may increase the risk of stroke caused by blocked arteries.
- Diabetes – People with diabetes and periodontal disease may be more likely to control their blood sugar than diabetes with healthy gums.
- Respiratory disease – Periodontal disease can cause lung infections and aggravate existing lung conditions when bacteria in the mouth reach the lungs.
What Causes Periodontal Disease?
Periodontal disease is caused by bacteria in the dental plaque, the sticky substance that forms on your teeth a few hours after you wash. Interestingly, the body’s response to bacterial infection causes most problems. In an effort to eliminate the bacteria, the immune system cells release substances that cause inflammation and destruction of the gums, periodontal ligament or alveolar bone.
This leads to swollen, bleeding gums, signs of gingivitis (the earliest stage of periodontal disease) and tooth decay, a sign of severe periodontitis (the advanced stage of the disease). The practice of good oral hygiene and the regular dentist’s visit (about once every six months or more if you have gum disease) can prevent periodontal disease.
Daily brushing and use of dental floss, when done properly, helps remove most of the tooth plaque. Professional cleaning by your dentist or dental hygienist will keep the plaque under control in places that are harder for a toothbrush or thread to reach. If oral hygiene or dental visits become irregular, the plaque accumulates on the teeth and possibly extends below the gum line. There, bacteria are protected because the toothbrush can not touch them. Good dosing can help dislodge the plate; but if not removed, the bacteria will continue to multiply, causing a more serious infection.
Accumulation of the plaque under the gum leads to inflammation of the gums. As the gum tissues become more swollen, they detach themselves from the tooth that forms a space or “pocket” between the teeth and the gums. In a snowball effect, pockets encourage the accumulation of additional bacteria, as it becomes more difficult to remove the plaque. If left untreated, the inflammatory response to plaque bacteria can spread to the periodontal ligament and to the alveolar bone, causing the destruction of these structures. Another problem is that if the plaque is allowed to accumulate on the teeth, it becomes calcified or hardened and turns into calculus (commonly referred to as tartar). Because the tartar is harder than the tooth enamel or cement (a layer covering the dental root), add more plaque, continuing this descending spiral. Using a toothpaste to control tartar can help slow down computational accumulation around the teeth, but it can not affect the tartar that has already formed under the gum line.
Risks and prevention
Although the accumulation of bacterial plaques is the main cause of periodontal disease, some other factors, including other diseases, medications and oral habits, may contribute. These are factors that may increase the risk of gum disease or may make it worse once the infection has entered.
Genetics – up to 30% of the population may have a genetic susceptibility to periodontal disease. Having a genetic susceptibility, however, does not mean that gum disease is inevitable. Even people who are extremely prone to periodontal disease can prevent or control illness with good oral care.
Smoking and tobacco consumption
Smoking increases the risk of periodontal disease and as more and more one smokes, the greater the risk. If periodontal disease is present, smoking makes it more severe. Smoking is the main cause of periodontal disease that is resistant to treatment. Smokers tend to collect more tartar on their teeth, develop deeper periodontal pockets once they have gum disease and are likely to lose more bone while the disease progresses. Unlike many other factors that affect gum health, you have control over it. Quitting smoking can play a major role in bringing periodontal disease under control.
Anything that can make it harder to brush or attach your teeth is likely to increase the formation of plaques and tartar above and below the gum, which increases the chance of developing gum disease. Dentists can show you the best ways to clean your teeth, especially in difficult-to-clean situations. And if overcrowded or strained teeth are a problem, the dentist may recommend orthodontic treatment to align your smile and give you a better chance of preventing disease.
Tooth clenching, Bruxism
These habits will not cause periodontal disease, but may lead to more severe illness if there is already an inflammation. Excessive force exerted on teeth through these habits seems to accelerate the destruction of the periodontal ligament and bone. In many cases, patients can learn to stop this habit. If these efforts do not work, the dentist can create a personalized protective device (sometimes called an occlusal guard) that helps reduce tooth pressure.
Stress can aggravate periodontal disease and make treatment more difficult. Stress weakens the body’s immune system, making it harder for your body to fight infection, including periodontal disease. Fluctuating hormones – Whenever hormones fluctuate in the body, changes can occur in the mouth. Puberty and pregnancy may temporarily increase the risk and severity of gingival disease as it may change.
Several types of drugs can cause dry mouth or xerostomia, including antidepressants, diuretics and hypertension medications. Without the protection of adequate amounts of saliva, the plaque is more likely to form. Other medicines may cause gums to grow, which in turn makes them more likely to cry. These medicines include phenytoin, used to control seizures; ciclosporin, used to suppress the immune system; and nifedipine and other calcium channel blockers used for the treatment of angina pectoris or cardiac arrhythmias.
Although the exact mechanisms are not fully understood, certain diseases increase the sensitivity to periodontal disease. For example, people with diabetes are more likely to suffer from periodontitis than people without diabetes and are likely to be more serious. Other conditions, such as leukemia, intestinal inflammatory disease and HIV infection, can also increase the risk. Having one of these diseases will make it more difficult to control periodontal disease, but a good periodontist or dentist who is aware of the additional risks and difficulties should be able to provide the type of guidance needed to maintain periodontal health.
Nutrition is important for good overall health, including an immune system and healthy gums and mouths.