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Gum health is an essential aspect of overall oral hygiene, yet it often doesn’t receive the attention it deserves. This years focus for dental health week is on gums. Gum disease is a pretty silent on that can sneak up on you, so don’t wait till it’s too late. So let’s talk about gums and gum health.
Dental plaque is the soft white sticky patches of material that you can see sometimes in the morning before you brush your teeth. It is most commonly seen along the junction where your teeth and gums meet. Plaque is made up of bacteria and food debris. Bacterial plaque deposits are a complex system with a protective layer around them called a biofilm. This biofilm acts a little like a house with channels and connections that allow fluid and nutrients to pass through. The biofilm also sticks to the tooth through various proteins. If not removed, plaque can cause inflammation of the gums, and if long-standing can contribute to infection and advancement of gum disease.
Dental calculus, commonly known as tartar, is formed when long-standing plaque that has not been removed from teeth hardens. The hardening is caused by minerals like Calcium and Phosphate that are present in saliva which help remineralise and protect teeth from decay. Unfortunately, the rough surface that is created by calculus build up promotes further bacterial plaque accumulating and progressively more calculus formation. Calculus can develop above the gums, where is it called supragingival or subgingival where it develops under the gums. Calculus can only be fully removed by a dental professional using special tools during a cleaning appointment. All types of calculus can promote gum disease, but subgingival calculus is more problematic as it is more difficult to remove and can harbour more insidious bacteria.
Diabetes, especially when uncontrolled, is a serious risk when related to gum disease. People who suffer from diabetes, have higher amounts of the sugar glucose in the bloodstream. Diabetes affects the body’s ability to fight infection, making it harder to control gum disease. Additionally, some people can also experience reduced saliva production which can increase gum disease risk as there is reduced saliva to wash away bacteria. Good management of diabetes and good oral hygiene are critical in the prevention of gum disease.
Vaping can lead to an increase in gum inflammation and periodontal disease. Studies have shown that e-cigarette users have a unique oral microbiome that is less healthy than that of non-smokers. The chemicals in e-cigarette vapor can cause dry mouth, which reduces saliva production and increases the risk of gum disease2. Additionally, nicotine restricts blood flow to the gums, impairing the body’s ability to fight off infections. Shisha smoking involves inhaling tobacco smoke that has passed through water. This process does not filter out harmful chemicals; instead, it can introduce additional toxins from the charcoal used to heat the tobacco. These toxins can irritate the gums and increase the risk of gum disease and oral cancers Smoking affects the body’s immune response, making it harder to fight off infections, including those in the gums. It impairs blood flow to the gums, which can slow down the healing process and make the gums more prone to infection. Studies have shown that smokers have deeper periodontal pockets, increased alveolar bone loss, increased tooth mobility, and more tooth loss compared to non-smokers.
Gum disease starts with gingivitis. Gingivitis is the inflammation of gums caused by dental plaque build-up. There is a spectrum of gingivitis with some being quite mild and benign to acute and problematic. If chronic, extensive dental plaque build-up is left unmanaged, gingivitis can progress to periodontitis, where the gum can pull away from the teeth and form deep pockets that can harbour bad bacteria that can cause infections. The bacteria can also trigger bone loss around the tooth that can lead to tooth mobility and even loss of a tooth. For a large part of the gum disease progression, there are often few symptoms, like mild gum bleeding. There is hardly any pain or discomfort, and when pain and discomfort start to show up, the disease has already progressed quite far.
Trombelli, L., Franceschetti, G., & Farina, R. (2015). Effect of professional mechanical plaque removal performed on a long-term, routine basis in the secondary prevention of periodontitis: A systematic review. Journal of Clinical Periodontology, 42(Suppl. 16), S221-S236.
Könönen, E., Gursoy, M., & Gursoy, U. K. (2019). Periodontitis: A multifaceted disease of tooth-supporting tissues. Journal of Clinical Medicine, 8(8), 1135.
Mealey, B. L., & Oates, T. W. (2006). Diabetes mellitus and periodontal diseases.Journal of Periodontology, 77(8), 1289-1303.
Bergström, J., Persson, L., & Preber, H. (1988). Influence of cigarette smoking on vascular reaction during experimental gingivitis.Scandinavian Journal of Dental Research, 96(1), 34-39.
Danielsen, B., Manji, F., Nagelkerke, N., & Baelum, V. (1990). Effect of cigarette smoking on the transition dynamics in experimental gingivitis.Journal of Clinical Periodontology, 17(3), 159-164.
Feldman, R., Bravacos, J., & Rose, C. (1983). Association between smoking different tobacco products and periodontal disease indexes.Journal of Periodontology, 54(8), 481-487.
Between causing bouts of discomfort on unwary mouths and hiding in dark corners, the wisdom tooth shares snippets of wisdom from the field of dentistry.
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