Questions :

14. Periodontal Disease - Facts and Fallacies

Contributed by:

Dr. Dasan Swaminathan

Lecturer / Periodontist Faculty of Dentistry, University of Malaya Kuala Lumpur

"My gums are red, puffy and bleed when I brush my teeth and I thought that this was normal". This is a common complain from patients visiting the dentist. Gums should never bleed even when you brush vigorously or use dental floss. If your gums bleed even sometimes, something is wrong. No matter what a person's complexion, gums should never be red or swollen.

Periodontal disease or more commonly called gum disease affects a very large adult population worldwide WHO studies indicate that a very large adult population suffer from some form of periodontal disease and it has overtaken dental caries as the main cause of tooth loss. Dental caries was the main concern among the dental profession some years ago but periodontal disease has now taken the centre stage. Malaysians are also afflicted and more that 80% of our adult population tend to suffer from some form of periodontal disease. It is also the main cause of tooth lost amongst our adult population. Dentists in Malaysia are spending more time treating this disease than ever before.

There is evidence to indicate that this disease has been around since the dawn of history. Skull remnants of prehistoric man indicate some form of bone loss around the dentition and also tooth loss which could have been due to this disease. Mankind has not been spared the ravages of this disease ever since and despite lots of research and money spent to study this disease, mankind remain afflicted and tooth loss due to the disease continues. The modern era is characterised by longevity and better health but unfortunately many adults continue to suffer from periodontal disease leading to early loss of teeth.

Periodontal disease is almost always painless in the early stages. Therefore, you may not notice the gradual onset of puffiness of your gums or pay attention to occasional bleeding when brushing. You may think the longer look of your teeth is normal for your age. Four out of five teenagers and adults have periodontal disease and most do not know it. That is why people lose more teeth from periodontal disease than from all other reasons combined. But the good news is that most periodontal disease can be prevented or if already started, it can be treated. This is particularly true if it is recognised in its early stages.

Every day a sticky, almost invisible film forms on the teeth. This film is called plaque. It is a growing colony of living bacteria and is derived from saliva. In very large amounts, plaque can be seen particularly at the gum line and can be felt with the tongue as a furry, unclean coating on the teeth. The bacteria of plaque produces toxins (poisons) that make gums red, swollen and bleed easily. This inflammation is the start of periodontal disease! If you do not completely remove this plaque, it gets contaminated by bacteria which is found in abundance in the mouth. It is said that there are more than 350 species of bacteria present in our mouths and some of these bacteria can lead to periodontal disease if it multiplies outside the normal range. So the toxins produced by the bacteria of plaque not only inflame the gums but also cause destruction of the bone just beneath, which holds the root of our teeth. When sufficient bone has been lost, the tooth loosens. Finally when deprived of most of its supporting bone, the tooth becomes so loose it either falls off or must be extracted.

Gum disease in the early stages only involving the superficial layers is called gingivitis and when it proceeds to the roots of teeth and affects the supporting structures of teeth like the bone beneath, it is called periodontitis. Gingivitis is reversible if early treatment is sought but periodontitis is irreversible and can only be prevented from causing further damage on treatment. It is unfortunate that what is lost due to the disease especially bone is hard to gain back even with sophisticated dental treatment that is now available. The food we eat does not play a major factor in the disease process but we can assume that food which is sweet and sticky and also food impaction between teeth can act as a nidus for the bacterial plaque.

A few people are very resistant to periodontal disease. Some are highly susceptible. However most people have a varying resistance to the disease at different times in their lives. For example, a person's resistance may be normal for years and then for no apparent reason, resistance temporarily diminishes - periodontal disease then appears or disease that was under control flares up. No one knows why resistance to the disease varies from person to person or why it varies in the same person at different times. Dental research teams around the world are searching for answers.

Periodontal disease is very unpredictable. Different areas of the same mouth may have different severity of the disease and the plaque bacteria can vary in each of these areas. We used to think that the disease increases with age but we now know that the disease has different phases and progression is not with age. Sometimes the disease ceases to destroy without any reason and at other times its activity is veracious. We think that the disease is caused by a group of bacteria present in our mouth and not by any one bacteria. Thus it is difficult to develop a vaccine for this disease at the moment.

It can be concluded that periodontal disease has been around for a long time and it will continue to be active for years to come. lt is literally in our hands to prevent the disease from harming us and together with the dental profession we can prevent or at least arrest the disease. It is our responsibility to look after our oral hygiene well by regularly brushing and flossing and following instructions given by our dentist on the correct techniques.


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