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Jim Tait 02/01-02/28/17

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January 19, 2018

1/12/2018 7:26:00 AM
The impact of gum disease: More at stake than a lost tooth?
Kim Walker
Special to the Lakeland Times

A visit to the dentist is generally not on the top of our "to-do" lists. Some of us avoid it altogether which, according to emerging research, might be not only detrimental to your oral health but to your general health as well. The threat of tooth loss alone should be enough inspiration for diligent oral care but for those who need a better reason, research has it.

Causes of gum disease

In the mouth, bacteria, mucus and other particles form a sticky substance known as plaque. If not removed by brushing and flossing, it hardens and forms tartar. Plaque and tartar build-up can cause inflammation of the gums, known as gingivitis. Gums swell, become inflamed and may bleed easily. When gingivitis is not addressed, it may turn into periodontal disease, in which gums pull away from the teeth and form infected pockets.

The immune system kicks in and attacks the bacteria that has "set up shop" below the gums surface. This battle rages on, and the end result is not one of victory, but defeat, in the form of tooth and bone loss.

The real health concern

The impact of periodontal disease might not be limited to the mouth. Research has shown associations between gum disease and other systemic diseases such as heart disease and most recently, esophageal cancer.

Esophageal cancer: A study published in a journal by the American Association of Cancer Research, found that oral bacteria associated with periodontal disease were linked to a higher risk of esophageal cancer. Three types of bacteria were identified to increase the risk. Tannerella forsythia was linked to a 21 percent increased risk and Streptococcus and Neisseria were both linked to a 24 percent increase.

The research did not demonstrate the bacteria were a direct cause of esophageal cancer but instead played a role in increasing the risk.

Heart disease: Studies have indicated that severe periodontal disease is linked to anywhere from 25 to 90 percent increased risk of cardiovascular disease. It is thought that inflammation caused by the body's immune response to gum disease may be the reason for the link. In fact, it is standard procedure for those individuals who have risk for infective endocarditis (those with heart valve defects or valve repairs with prosthetic material) as well as those with artificial joints to be prescribed pre-dental work antibiotics. Bacteria can enter the blood stream from periodontally infected areas and travel to the heart valve or artificial joint, causing infection in those sites.

Prevention and treatment

"An ounce of prevention is worth a pound of cure," rings true in the case of gum disease. This is especially true if you have risk factors that make this disorder more likely. These include, smoking, hormonal changes in women, diabetes and disorders and/or medications that cause dry mouth.

I spoke with Greg Cyra D.D.S., Lakeland Dental Care, Minocqua about some of the key ways to prevent periodontal disease and treatments available if it occurs.

"Flossing is crucial in prevention of many oral health issues, however, many people floss but few do it effectively," Cyra explained. "There is a technique to it. You need to use the right pressure and angle to get around the tooth surface effectively."

Cyra said brushing must be effective as well, but not too overzealous, as that can do more harm than good, causing the gum line to recede.

"It is better to brush and floss accurately and effectively once a day, rather than haphazardly three to four times a day," Cyra said. He also sees a benefit from the use of a "WaterPik" like device especially if there are already pockets formed in the gum tissue.

As far as dental cleanings, individual needs are different. Cyra said some periodontal patients or those who quickly form tartar deposits need a cleaning every three-months despite thorough oral hygiene, whereas others can go much longer between visits.

Regarding treatment of periodontal disease, Cyra said there are many options, depending on its severity. First, an assessment takes place via x-rays and clinical exam to determine the extent of the problem. Then, one of the initial treatments employed is known as scaling and root planing. In this procedure, the hygienist performs an extensive deep cleaning, where tartar and plaque adherent to teeth in deeper pockets are cleaned from the teeth below the gum line. If the patient follows through with good oral care at home and appropriate lifestyle changes such as quitting smoking and regular professional cleanings, substantial improvement often results.

Sometimes periodontal surgical treatment is necessary to get access to deeper hidden areas to clean teeth and to recontour soft tissue and bone to facilitate better hygiene. When bone loss is too great and infected periodontal pockets are too far advanced and there is too much tooth mobility, the only option is extraction of the diseased teeth.

What's at stake

It is becoming apparent that oral health has a close relationship with systemic health. Research is showing links between oral disease and disorders system-wide.

"Although there are studies which show an association between gum disease and heart disease, diabetes, and some other systemic diseases, that does not mean one causes the other," Cyra cautions. "Nevertheless, prevention and treatment of periodontal disease is beneficial for optimal health. It is false economy to skip dental cleanings, exams, and dental treatment because if dental pathology is treated when the problem is small, the treatment is better, faster, less expensive than waiting until the pathology gets worse."

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