Today, March 20th, is World Oral Health Day. World Health Organization advocates for the "8020" concept, aiming for 80-year-olds to retain at least 20 healthy, functional teeth. This ensures proper chewing, leading to better nutrient absorption and overall well-being.
However, many young adults already have 3-4 missing teeth, and many others are loose (possibly requiring extraction). We have between 28-32 permanent teeth (excluding wisdom teeth), so if we don't take better care of our oral health, achieving the 8020 goal will be challenging. Periodontal disease is the primary culprit behind tooth loss.
Epidemiological data shows that over 30% of adults between 35-44 years old suffer from periodontal disease, and nearly 80% of adults aged 55-64 have the condition.
This disease often goes unnoticed in younger people, and they only start paying attention once they've lost teeth—but by then, it's too late. Today, we'll delve into periodontal disease.
What is Periodontium and Periodontal Disease?
"Periodontium" refers to the structures surrounding the teeth. Teeth reside in the jawbone sockets, but they're also attached by a network of "ropes" called the periodontal ligament (or membrane), connecting them to the bone.
The periodontium consists of the gums, periodontal ligament, alveolar bone, and cementum (tooth surface). Healthy periodontium is essential for firmly anchoring our teeth.
Periodontal disease occurs when these structures become infected and inflamed.
How Periodontal Disease Develops
Unlike dental caries and pulpitis, which cause toothaches, periodontal disease often starts insidiously. It's like boiling a frog—the progression is gradual, with no noticeable acute symptoms. This is why many young people don't take it seriously in its early stages.
The initial signs may include: slight redness of the gums, bleeding during brushing, or a bloody imprint on an apple.
With time, not only did the teeth become loose, they might shift and move from their original position—the gaps between the teeth became larger and larger. The previously loose teeth started to shake, and some even caused toothaches!
At this point, seeing a dentist was not enough and taking pain medication was useless. The tooth roots became exposed, and the tooth would become increasingly loose. One day, this shaky tooth would finally meet its end and be formally dismissed from the mouth, sacrificing its presence with honor.
What Causes Periodontal Disease?
Gum disease, known as gingivitis, usually starts from bacterial plaque and affects only the gum tissue. It can be treated and reversed. Some cases of gingivitis, if left untreated, can turn into periodontal disease. Thus, active treatment of gingivitis can help prevent periodontitis-induced attachment loss and alveolar bone resorption.
Dental plaque is an organized, dense, non-mineralized deposit that forms along the gingival margin, both supragingivally and subgingivally. Plaque starts to accumulate within 24 hours if not removed by toothbrushing and flossing.
Dental calculus, or tartar as it's commonly known, is a mineralized plaque that's a major cause of periodontal disease. After "settling down" on a tooth, it attracts a large amount of bacteria, which keep adding to the calculus deposits over time. This continuous stimulation of the periodontal tissues leads to periodontitis and gum recession.
Poorly made dental restorations, such as fillings, crowns, bridges, or veneers, with overhangs or poor adaptation, can also facilitate plaque accumulation. This can promote inflammation, and potentially lead to periodontal attachment and bone loss.
How Is Periodontal Disease Treated?
Periodontal therapy can be broadly divided into the following five types:
Scaling, also known as supragingival scaling and debridement, is the primary step in dental cleaning. It involves using "ultrasonic" cleaning devices to remove tartar—the primary cause of periodontitis—and the surrounding bacteria from around the teeth.
Tartar constantly forms, and no amount of brushing or other cleaning methods can stop it. Fortunately, it doesn't accumulate rapidly enough to cause irreversible damage. By regularly removing these tartar deposits, scaling helps prevent periodontal disease. The frequency of scaling should be based on the rate of tartar formation, which is usually about once a year.
Root planing is a procedure that also targets tartar. However, in this case, the tartar is located deeper in the gum pockets and cannot be thoroughly removed by scaling alone. This procedure requires more specialized instruments and can be more painful, so it's usually performed under local anesthesia. Despite the potential discomfort, with proper anesthesia and once the psychological fear is overcome, most patients tolerate the procedure well.
Scaling and root planing aims to remove calculus beneath the gums. Source: CARRANZA'S CLINICAL PERIODONTOLOGY, 12TH EDITION
When local irritants lie deeper and cannot be fully addressed by basic treatments like scaling and root planing, surgery may be the next step.
There are various types of periodontal surgeries, including resective, regenerative, reconstructive, and esthetic procedures. In general, they involve lifting the gum tissue covering the teeth, directly accessing and removing calculus, and then suturing the gums back in place.
However, the goal is not just to suture them back. It's also to ensure the area is easier to clean in the future to minimize calculus accumulation and maintain a pleasing aesthetic appearance.
Medication is not typically the primary treatment option for periodontitis. Antimicrobial agents like metronidazole and ornidazole may provide some support in managing acute inflammation but merely alleviate its symptoms.
However, those with poor oral hygiene practices often rely heavily on medications. Furthermore, medications for periodontitis are often not administered orally—rinsing with medicated mouthwash or placing medication directly into periodontal pockets is common.
Periodontitis often leads to tooth mobility and shifting, which can disrupt the bite's alignment and exacerbate periodontal problems.
Therefore, dentists may adjust the alignment of shifted teeth. For loose teeth due to periodontitis, periodontal splinting may be considered. However, in cases where teeth are beyond saving (i.e., excessively loose), extraction may be necessary. Extractions are also a viable "treatment" option.
Missing teeth can be replaced with dentures (either removable or fixed) or dental implants. Maintaining the surrounding teeth becomes more challenging with a compromised tooth, making extraction a better long-term solution.
Last but not least, adhering to proper oral hygiene and regular dental checkups post-treatment is paramount.
Preventing periodontal diseases is just as important as protecting your teeth!
The age-old advice still holds: Brushing and flossing consistently surpasses any "treatment" a dentist can provide! To prevent periodontitis and save your teeth, maintaining proper oral hygiene is essential, which boils down to two actions: brushing your teeth and flossing (or using interdental brushes).
Brush your teeth effectively twice daily (using the Bass technique for at least 2 minutes each time) and floss at least once a day to clean between every tooth. These two seemingly simple actions can be time-consuming, making it challenging to execute them perfectly. That's why many people still suffer from periodontal conditions.
If you have periodontitis or have wider gaps between your teeth due to the condition, flossing alone may not be as efficient. Using interdental brushes (also known as dental picks) can significantly improve cleaning effectiveness.
If you haven't had a professional dental cleaning in the past year, I highly recommend scheduling an appointment at your nearest dental clinic for a thorough examination.
