Brushing, flossing and education
Nearly 50 percent of American adults have some level of periodontal disease, according to a recent study by the Centers for Disease Control and Prevention. This is double the number of adults with the disease in a previous study.
Periodontal disease, or its more common name, gum disease, is one of the most common diseases of man. It is, says Donna Grant-Mills, D.D.S., department of diagnostic services chair at Howard University College of Dentistry, “a number of infections that impact the supporting tissues of the teeth—the bone, the ligaments that hold the teeth to the bone, as well as the gums. Though it can begin as early as adolescence, people older than 35—if they have tooth loss—a lot of it is due to periodontal infections that have not been managed or treated.”
The study results have meaning for overall health, too. Many studies show that periodontal disease is a complication of diabetes. Further research is ongoing to find a connection between gum disease and other health conditions, such as heart disease.
Here’s what else Dr. Grant-Mills tells us about periodontal disease:
BHM: What causes gum disease? What are the symptoms?
DGM: The primary cause of it is specific bacteria contained in plaque that adheres to tooth surfaces, to restorations, dental appliances as well as dentures and partials. We now refer to plaque as biofilm.
Gingivitis is specifically inflammation of the gum, changes in the contour and color of the gum. Someone with gingivitis usually has plaque presence around the gum line of the teeth.
Diseases of the oral cavity can be hard tissue infection, such as tooth decay, or gum disease, such as gingivitis. Left untreated, gingivitis becomes periodontitis, a more severe form of gum disease.
Early symptoms are inflamed, sore gums that will bleed easily. Gums that bleed while brushing or flossing or bleed spontaneously are some of the signs. One may not initially feel any discomfort but notice bleeding while brushing.
Nutritional deficiencies can play a role. They don’t cause disease, but you need proper nutrition to fight disease in the body and to assist the body in healing.
BHM: A recent study found nearly half of all adults in this country have gum disease. I was blown away! Why are the numbers this high?
DGM: Several factors contribute to the high numbers: education about the diseases, access to care issues, being able to manage what we know. Infections start early. So a parent’s knowledge about caring for the mouth, caring for the body, has a lot to do with gum disease. Those early years of training a child to care for the mouth and proper nutrition sets the stage, sets the foundation across the lifespan. As early as adolescence we see gum infection. Infections can begin early and progress to a more chronic form.
In a more severe form of gum disease, teeth become loose. A person has difficulty cleaning the mouth on a daily basis. Each time we eat, food is trapped between the teeth and underneath the gums. On a daily basis if the mouth is not cleaned thoroughly to remove plaque and food, bacteria in the mouth can feed on the sugar in that food, turn it to acid.
I tell my patients, “Whatever you’re committed to doing on a daily basis has 80 percent to do with reaching optimal health. Dental health professionals are only 20 percent.”
BHM: Where can we address the high numbers?
DGM: Education and access to care, dentists, social workers, hygienists working collaboratively to address health disparities.
BHM: Where do African Americans stand on the spectrum? Do we have higher numbers of gum disease the way we do nearly every other disease?
DGM: Let’s start with our children. A decade ago, African-American children represented about 80 percent of oral disease, known as dental caries of children. A significant percentage of oral disease lies within the African-American population. Having that information has helped health-care practitioners, policymakers, educators and community leaders over the past in an effort to bridge the gap.
At Howard, we’ve developed community outreach programs aimed at increasing access to care and reducing disparities. What we have done has started to reduce the percentage. Through educating parents, restructuring dental school curriculum. Part of the key to reducing disparities is to work at the academic level where the training of the workforce is taking place to make it more culturally competent to get them ready to meet the needs of the public.
Within the Washington, D.C., metro area, we have expanded the safety net where we have community clinics as well as new dental centers established where we have the greatest need.
BHM: What role does gum disease play in other chronic illnesses?
DGM: We have emerging evidence that gives us a new understanding of periodontal infections. In 2005 the National Center for Health Statistics indicated that the leading causes of death were heart disease, cancer, cerebrovascular disease, accidental death and diabetes. At least four of these chronic diseases are related to periodontal disease. So management of periodontal disease can have a significant impact on the overall health of all of us.
As we learn more about infection of the mouth as it relates to systemic diseases—particularly heart disease and diabetes—it sheds new light on how we can manage and improve the quality of life for individuals. Health of our teeth has a tremendous impact on the health of the rest of the body. It’s all connected.