Gum Disease, Gingivitis and periodontitis...the silent infection. And can it be cured?

As a periodontist in Singapore, I am still amazed at the reluctance of people to seek treatment for bleeding gums which is one of the first few signs of gum disease. I have seen gum disease in people of all ages and status in life from a teenager to an 80-year old. It is not a disease that only inflicts the old but also the very young. And that is the most disturbing.

Gum Disease at Fox News

It is paramount to seek treatment early as gum treatment is extremely successful when the disease is in its infancy. Unfortunately, gum disease when it first occurs presents hardly any symptoms or pain. It is a largely silent disease. The patient may just has on and off bleeding from the gums and sometimes nothing at all.

If not detected early especially in the young, the patient can easily lose many teeth in as fast as 1-3 years. Sometimes too, gum disease in the young may be a manifest of other diseases that attack the immune system in the body that has not been detected eg leukaemia.

Smoking is a well -documented factor that increases a person's risk to gum disease. Also, smokers are more resistant to gum treatment as their healing potential after gum treatment is impaired.

Smokers are also at a disadvantage as they have an impaired healing potential and longevity with the use of dental implants. Hence, if they lose a tooth due to gum disease or other causes, their success rate to replace their tooth with an implant is much reduced compared with a non-smoker.

Diabetes and periodontal disease have one thing in common. Both are chronic (long-term) diseases that can never be truly cured but can definitely be well controlled.

People with diabetes are more likely to have periodontal disease than people without diabetes. In fact, periodontal disease is often considered the sixth complication of diabetes. Those people who don't have their diabetes under control are especially at risk. They also heal slower with periodontal (gum) treatment.

Diabetics, who are under optimal control, have HbA1c readings which are consistently less than 7 %. Well-controlled diabetics respond better to periodontal treatment and are less likely to lose teeth compared to poorly-controlled diabetics.

There is also some research to suggest that the relationship between periodontal disease and diabetes goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar

There has been some research to show an association between gum disease and heart attacks. Apparently, people with advanced gum disease run a higher risk of getting a heart attack. This is, however, an association and a direct link and means have yet to be proven. A particular medication for high blood pressure, nifedipine, has also a side effect of producing gum hypertrophy (enlargement) usually in patients who already have gum disease. There are many other medications that have an impact on the gums as well.

Hypertrophic (overgrowth) gums.

Nifedipine is not the only medication that can produce enlargement of the gums. Cyclosporin, which is used in transplant cases eg kidney transplant patients and Dilantin, an epilepsy medication, can cause a similar condition.This is turn makes it difficult for the patient to keep his gums and teeth clean and increases his risk of periodontal (gum ) disease.

This condition can be treated successfully by the Periodontist to give a normal looking appearance again. Good follow ups and maintenance on a regular basis can keep this condition under control.

Bisphosphonates eg Fosamax and Zometa

Fosamax is a commonly used medication to treat osteoporosis especially in the post-menopausal woman. Other bisphosphonates are used to treat certain cancers and bone conditions eg Zometa. For those patients on bisphosphonates such as Fosamax, there is a small risk of contracting osteonecrosis (destruction of the jaw bone) whenever an extraction or oral surgery has to be done. However, this risk increases after 3 years of continuous usage. Those on intravenous bisphosphonates such as Zometa have a 1-10% risk of contracting osteonecrosis. This means that if a patient on these medications need to getan extraction due to gum disease or decay, the socket that remains may never heal and destruction of the jaw bone may follow.

These patients are often sent by their doctors before the commencement of the medications for a dental clearance. Imagine if the patient had untreated gum disease, the dentist or Periodontist would have had no time to get it treated before the commencement of the medication especially if the medication is for cancer treatment. This is because gum treatment usually takes a minimum of 2 months to treat. Hence, the patients end up with many extractions instead just so that they have an infection-free mouth to start on the bisphosphonates as soon as possible. This can be avoided if everyone ensures that their gums are in a healthy state at any time in their lives.

These patients on bisphosphonates should also be under close supervision by their dentists as they should try never to undergo an extraction in their lives thereafter to reduce risk of osteonecrosis.

Radiotherapy in the head and neck region
Those patients who have gone through radiotherapy for cancers in the head and neck region, the most common being nasopharyngeal cancer, suffer from lack of saliva flow after the therapy. This leads to a dry mouth, ulcers, burning gums and an increased risk to decay and gum disease. They also run a similar risk to osteonecrosis.
Various prescription and over the counter creams, mouthwashes and ointments can help alleviate all these conditions. Such patients should seek dental clearance and treatment before and after radiotherapy to avoid long term dental problems which become major and decrease the risk of osteonecrosis

Gum boils are most of the time sacs of pus in the gums. Contrary to popular belief, it is probably not due to a person being "heaty" as it is an acute infection resulting in the formation of pus.

Most of the time, the person already has an existing gum disease that he or she is not aware of and the gum boil is just a progression or sign of the disease as it gets worse.

However, sometimes these gum boils become more frequent in a person whose immune system is a little down or compromised e.g. when he/she has not enough sleep, is stressed, has a flu or other ssytemic (body) diseases that he is not aware of e.g. diabetes.

It is always best to get a bum boil checked out if it recurs more than once and in a relatively short span of time.

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