Captain Cook had to impose strict dietary regimes to prevent scurvy on his ships of the 1700’s. When a healthy diet, regular brushing and general oral hygiene is not enough, ‘Periodontics’, the branch of dentistry involved in the study, diagnosis and treatment of gum disease, will help make your mouth shipshape.
Gingivitis and Periodontitis
A group of Norwegian Researches in 1963 used a group of compliant dental students to study the effects of stopping all oral hygiene methods. After just 3 days, their gums became red, swollen and bled when touched. Left untreated, this inflammation can spread to the bone below the gums and “melt” the bone away. The students resumed effective oral hygiene, and quickly recovered.
Over longer periods, slow progression of ‘Adult Periodontitis’ can lead to uniform bone loss around the roots. Alternatively, Juvenile Periodontitis results with faster, more aggressive bone loss in younger patients. In more extreme cases, ‘Rapid Progressive Periodontitis’ can result in quick, irregular bone loss.
Diagnosis of Periodontitis
The diagnosis and distinction between these susceptible patients is critical to identify as early as possible to reduce tooth loss. The disease can often go undetected by patients until the volume of bone loss becomes so extensive that teeth can move and become loose. The Specialist Periodontist will assess the extent of bone loss around the entire circumference of each tooth and put into action a treatment strategy according to the diagnosis.
Periodontal disease accounts for 60% loss of teeth after the age of 40 years. Late diagnosis with advanced and rapidly progressive bone loss accounts for a much greater percentage of tooth loss.
The Treatment of Periodontitis
The relatively slow Adult Periodontitis involves introducing the patient to effective plaque control measures with particular emphasis upon removing the bacteria in between the teeth effectively every 24 hours before the volume of bacterial colonisation produces the toxins to attack the bone. Deep scaling or root planing is carried out to remove the bacteria that have colonised below the gums. The more rapidly progressive forms of the disease may require topical, local or systemic antibiotics in addition to surgery. Recent surgical developments have introduced regenerative procedures to attempt to regrow the bone.
Considerable bone loss or an unfavourable response to periodontal treatment may sometime require teeth to be removed to conserve remaining bone, allowing implants to be used in place of lost teeth.
Risk factors for Periodontitis
It is well established in the clinical literature that a genetic predisposition to periodontal disease is often confirmed in the family history of the patient. This predisposition can be exacerbated with poor oral hygiene and poor diet. Smoking can also contribute to greater bone loss, as nicotine directly reduces blood supply to gums. This means fewer white blood sells present to heal the gums and with the reduced production of saliva, the mouths’ natural anti-bacterial defence mechanism is compromised.
Needless to say, those patients not susceptible to periodontitis can get away with neglecting their teeth although an absence of oral hygiene may lead to an element of social isolation due to halitosis.