The who, what, where of gum health
Periodontal (gum) issues are not only preventable but healthy gums can prevent other chronic illnesses. We are on a mission to get this information to as many people as possible.
Image by Kirti Virmani
Today in my clinic I saw three new patients. Three women at different stages in their lives and each of them presented with three different versions of gum disease. Unless you are born with some freakishly robust immune system and paired it with impeccable oral hygiene + lifestyle practices, throughout a lifetime you can expect to experience some form of periodontal (gum) issues. They occur during childhood when the teeth are transitioning from milk > adult, teenagers can experience them during orthodontic ( braces to fix alignment of teeth), any changes in a woman’s hormonal status may be a trigger ( puberty, menstruation, pregnancy, menopause, hormonal imbalances) and the list goes on a is exhaustive ( we will probably cover it inside out throughout the course of this newsletter in the coming issues).
So, to begin with it is important to differentiate types of gum diseases and common symptoms to look out for at home.
Presented here alongside some beautiful images from artists capturing women (in love) at different stages in their lives.
Healthy Gums
Do not bleed. It is not normal to have bleeding regularly. Healthy gums are pink (sometimes pigmented depending on how much melanin your body produces), they are firm and they usually form a covering all the way around teeth and between them.
Gingivitis
Gingivitis is the first and most common stage of gum disease. This is an early change in the gums and at this stage they are swollen. Signs to look out for range from regular bleeding (on brushing, flossing or spontaneously), bad breath and red or soft looking gums that feel tender.
This is a form of gum disease that most of us will experience. For a short term it may create an open channel of bacteria and inflammation but this is reversible through making lifestyle changes, cleaning your mouth more strategically and seeing the dentist, hygienist or therapist for professional bacteria removal ( a little thing we call PMPR in the dental world or the old school scale & polish).
For some people, this gingivitis may go unnoticed due to lack of access to dental care (a big problem in the UK right now and an issue faced by many living in poverty throughout the world), missing key areas when brushing, lifestyle or health factors influencing immunity. Unfortunately, gingivitis moves from the gums into deeper areas of the surrounding bone.
Image Parvathy
Periodontitis mild (stage I)
Once gingivitis moves further south ( along the root of the tooth that is), the signs are mostly the same as gingivitis (bleeding, bad breath, red or soft looking, tenderness). There may also be more noticeable calculus (the hard stony stuff that builds up around teeth).
Under the gum surface however, there may be some loss of bone that anchors the teeth. This is usually seen on routine x-rays done on dental visits ( every 2 -3 years here in the UK and similar in other countries but please speak to your dental professional for full details). It does mean more channels opening up bringing bacteria their toxins (chemicals that cause inflammation) into the body.
This stage is also easily managed and treated without much long term damage. Although it may leave people with some gum recession, increased spaced between the teeth and mild short term sensitivity ( easily managed with sensitivity toothpaste).
Periodontitis Moderate ( stage II/III)
Periodontitis proper if you will. This is where some long term damage to the tooth’s supporting bone may occur. It will show up as all of the signs above along with some movement of teeth. Like teeth may change position ( getting longer, drifting towards other teeth) or feel looser.
Beneath the surface bone is lost towards the middle to the root and the bacteria leaking to the rest of the body may impact other body systems ( for example impacting blood sugar level, increasing inflammation around joints, impacting symptoms around periods or pregnancy or depositing within the brain which may later present as Alzheimer's disease).
Moderate to severe periodontitis is treatable but depending on how far it has progressed around a tooth or area, it may need additional treatment like surgery to clean the bacteria deeper and regenerate some of the lost bits.
Teeth may have more recession of gums compared to the mild stages and some longer term tooth sensitivity may ensue ( usually manageable but may need additional surgery).
Image Tarun Chouhan
Periodontitis Severe ( stage III/IV)
Once the bacterial inflammation has gone past the middle of the tooth and more than 30% of the mouth becomes implicated, periodontitis is classified as severe. Here, the symptoms may present themselves in all sorts of manner but things that may occur in addition whats previously discussed; bigger gaps between teeth, teeth feeling visibly looser, the bite may change and infections around teeth with discharge around the gum margins.
This stage leads to a poor bone support and open pore channels that aren’t managed through simple treatments. Once periodontitis enters severe stages, some teeth may need to be removed as they become a source of constant bacteria reinfection causing damage in the mouth and throughout the body. Along with effective cleaning above the gums, surgery of multiple areas may be needed followed be further treatments to improve the harmony of the bite ( this varies person to person and case to case).
Luckily, this happens to a small number of people because despite all the environmental factors working against humans, our bodies have an adaptable immune system. The trouble occurs when the immune system becomes compromised ( severe stress, viral infections such as covid-19, long term poor nutrition, diabetes, cancer immune, chemo, or radio therapy treatment or genetics are some of the many examples of this). Also fortunately for most of us, all this may be preventable in adult life through preventive measures in our childhood, 20s, 30s and even 40s & beyond.
Pre-Edentulous ( damage beyond treatment)
A rare but devastating consequence of poorly managed or rampant progression. This requires removal of all remaining teeth as they cannot hold together (quite literally) and become a hindrance of bacterial source. This may be followed by a rehabilitation to replace missing teeth. However, as the saying goes, “ teeth don’t get periodontitis, people do”, there may be some lasting consequences.
Even with a fake smile ( using dental implants or removal prosthesis (image here for the curious few)), the mouth may revert back to its gum disease causing bacteria if these aren’t cared for properly and the leaky pore of bacteria exchange with the rest of the body may open back up.
Image Ali Khurshid
If you made it this far (a big thank you and we appreciate your valuable time and attention), we hope you are able to appreciate the different presentations of gum disease. We also hope that if you have found any yourself experiencing any signs or symptoms discussed here, you will get in touch with a dental professional (if accessible) or make a preventive appointment with a hygienist.
Lastly, if you found this post useful (you may have even found it fun!), please share it with friends & family. See you next week when we cover the reasons behind why gum diseases occur ;)