Oral health
Almost half of all adults are affected by periodontitis, yet the effects of this gum disease are still often underestimated
Healthy gums are important and bleeding or other signs of problems should be checked with a dentist© Photo credit: Rolf Vennenbernd/dpa/dpa-tmn
Carolin Binder
Dentist and periodontist Lisa Hezel explains in this interview why bleeding gums are always a warning sign, the crucial aspects of oral hygiene and the consequences the disease can have for the entire body.
Dr Hezel, what causes teeth to lose their firm hold?
This does not happen suddenly, but is usually a process that develops over many years. It always starts with an inflammation of the gums, which we call gingivitis. Unfortunately, the symptoms, such as reddened gums, are often either not noticed or incorrectly identified by those affected.
The disease is caused by bacteria in dental plaque. The oral cavity can be colonised by over a hundred different types of bacteria. Most of these are harmless and are part of the natural oral flora. However, if oral hygiene is neglected, certain bacteria multiply and the balance of the oral flora is lost.
What exactly are the effects?
No individual bacteria causes the damage, but over time, the bacteria build up a plaque or biofilm on the teeth over several hundred or thousand layers – and that is when the bacteria’s destructive potential comes into play.
The body reacts to this with inflammation. Initially, this process only affects the gums. The first signs of gingivitis are swelling, redness and bleeding gums, for example when brushing your teeth or eating. In contrast to periodontitis, gingivitis remains restricted to the gums and does not cause any permanent damage to the periodontium.
The gums can heal again after the plaque has been thoroughly removed. This is why early intervention is so important.
How can gum problems be prevented?
Simply by taking bleeding gums seriously. Healthy gums don’t bleed! Many people brush rather cautiously instead of thoroughly, but that’s exactly the wrong approach to take. You should take consistent countermeasures at the first symptoms of gingivitis – which typically include bad breath or a bad taste in the mouth – and improve your own oral hygiene.
I also recommend having your teeth cleaned regularly by a professional. This involves smoothing the tooth surfaces and removing all deposits and roughness, especially in niches that are difficult to access with oral hygiene at home. Patients also receive tips and instructions for care at home.
What is particularly important when it comes to oral hygiene?
The aim is to twice a day physically remove the biofilm on the teeth, which is caused by bacteria – irrespective of which toothbrush or toothpaste you use. There is no need for mouthwash.
Care of the interdental spaces is extremely important – the interdental spaces make up 40% of the tooth surface! If you overlook these, it’s almost as if you are cleaning the upper jaw and saying to the lower jaw: “Oh, don’t worry, it’ll be fine.” Appropriately sized interdental brushes are the tool of choice for this. Flossing is only an alternative if the spaces are so narrow that not even the smallest brush can fit through.
And what happens if you neglect your oral hygiene and the plaque film is not removed?
If gingivitis, or superficial gum inflammation, persists for a long time, the inflammation will eventually attack the entire periodontium, the tooth-supporting tissue, with the tooth-bearing bone – depending on the individual risk factors and susceptibility to the disease.
The worst case scenario is that the teeth lose their hold due to the bone loss and that the lost bone hardly recovers at all. In addition, the chronic inflammation is not limited to the periodontium; it affects the entire body.
What are the connections here?
Bacteria and inflammatory messengers from the gum pockets enter the bloodstream and travel to other parts and organs in the body, where they can cause damage. There is evidence of an increased risk of heart disease and diabetes mellitus. Diabetes and periodontitis even have a reciprocal effect on each other: poorly controlled diabetes worsens periodontitis, but untreated periodontitis also makes blood sugar control more difficult, thus exacerbating diabetes.
Now, thanks to a European initiative between general practitioners and periodontists, we also have scientific evidence that periodontitis and other diseases are associated independently of each other, in other words, they have common risk factors. These include cardiovascular diseases, diabetes, COPD [chronic obstructive pulmonary disease] and Covid complications.
If the microbial balance in the oral cavity is disturbed, there is also an increased susceptibility to infection. There are many positive outcomes when gum inflammation is detected early, treated and seen in a larger context. Some of my patients can physically feel the inflammation leaving the body after treatment. It’s not just about saving your teeth, but also about improving your quality of life.
Dr Lisa Hezel has her own practice and is a dentist and specialist in periodontology and a research associate at the Department of Periodontology and Dental Preservation at the University of Mainz. She is also a member of the Public Relations Committee of the European Federation of Peridontology. © Photo credit: Private
What is particularly important when it comes to oral hygiene?
The aim is to twice a day physically remove the biofilm on the teeth, which is caused by bacteria – irrespective of which toothbrush or toothpaste you use. There is no need for mouthwash.
Care of the interdental spaces is extremely important – the interdental spaces make up 40% of the tooth surface! If you overlook these, it’s almost as if you are cleaning the upper jaw and saying to the lower jaw: “Oh, don’t worry, it’ll be fine.” Appropriately sized interdental brushes are the tool of choice for this. Flossing is only an alternative if the spaces are so narrow that not even the smallest brush can fit through.
And what happens if you neglect your oral hygiene and the plaque film is not removed?
If gingivitis, or superficial gum inflammation, persists for a long time, the inflammation will eventually attack the entire periodontium, the tooth-supporting tissue, with the tooth-bearing bone – depending on the individual risk factors and susceptibility to the disease.
The worst case scenario is that the teeth lose their hold due to the bone loss and that the lost bone hardly recovers at all. In addition, the chronic inflammation is not limited to the periodontium; it affects the entire body.
What are the connections here?
Bacteria and inflammatory messengers from the gum pockets enter the bloodstream and travel to other parts and organs in the body, where they can cause damage. There is evidence of an increased risk of heart disease and diabetes mellitus. Diabetes and periodontitis even have a reciprocal effect on each other: poorly controlled diabetes worsens periodontitis, but untreated periodontitis also makes blood sugar control more difficult, thus exacerbating diabetes.
Now, thanks to a European initiative between general practitioners and periodontists, we also have scientific evidence that periodontitis and other diseases are associated independently of each other, in other words, they have common risk factors. These include cardiovascular diseases, diabetes, COPD [chronic obstructive pulmonary disease] and Covid complications.
If the microbial balance in the oral cavity is disturbed, there is also an increased susceptibility to infection. There are many positive outcomes when gum inflammation is detected early, treated and seen in a larger context. Some of my patients can physically feel the inflammation leaving the body after treatment. It’s not just about saving your teeth, but also about improving your quality of life.
Is periodontitis a disease that only affects the elderly?
Periodontitis is a multifactorial disease. The main factor is bacterial influence, but age is definitely another risk factor. That is why, especially from middle age onwards, strict oral hygiene is even more crucial than ever.
How is the disease diagnosed?
Dentists and periodontists will measure what is known as the periodontal screening index (PSI) every one to two years, depending on the individual risk, to detect periodontitis early on. This involves using a fine, blunt instrument to gently examine each tooth between the tooth and gum, checking how deep the gum pockets are in the immediate vicinity of the tooth and whether or how much the gums bleed. This allows us to assess whether treatment is needed.
What treatment options are there?
If the gum pockets are found to be at least four millimetres deep at the PSI, the periodontitis is considered to require treatment. The treatment involves several interlinked steps, including improving oral hygiene, removing plaque and tartar from the teeth and removing deposits below the gum line. In very rare cases, antibiotics may be recommended.
There is also a surgical approach that uses special biomaterials to rebuild the periodontium in certain bone defects. However, in many cases the bone cannot be restored – so the most important thing is to prevent it from getting that bad. Gingivitis and periodontitis are not inevitable, they are completely preventable!
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