Why We Take Gum Disease So Seriously

If you’re a patient in our office, you know we take gum disease seriously. If you’re not a patient, you might wonder why any dental practice would make such a big deal about it. It’s only gum disease, right?

It seldom hurts much, especially in the early stages. Even one of its most obvious signs — bleeding gums — is easy to misread. You might just think you’re brushing or flossing too hard and should maybe ease up a little bit.

More often, that bleeding is a sign of inflammation and a reason to clean between your teeth more often, not less — whether you use floss or interdental brushes or a water flosser. It’s a prompt to reconsider your diet, sleep, and exercise habits, and other lifestyle factors that can affect your risk of periodontal problems.

Without taking action, the inflammation can progress. As it does, the gums start to pull away from the teeth, creating deeper pockets where harmful bacteria can thrive. Eventually, they lose attachment from below, as well, destroying the soft tissues and bone that hold your teeth firmly in their sockets.

With less and less support around them, your teeth can start to shift and loosen. Some may ultimately be lost altogether.

And tooth loss is just the start of it. Research continues to show that poor gum health may affect other parts of the body, too.

Take the kidneys, for instance. In a study of more than 6,000 adults, researchers found that severe periodontitis was associated with reduced kidney function and higher levels of albumin in the urine, an important marker of kidney damage. The relationship was especially notable among people in the earlier stages of chronic kidney disease.

That doesn’t mean that gum disease causes kidney disease. It does add another piece to a much larger body of research linking periodontal health with systemic health. And nowhere has that connection been getting more attention than in cardiovascular research.

Earlier this summer, researchers presented some intriguing findings at the American Heart Association’s Basic Cardiovascular Sciences Scientific Sessions. Their focus was calcific aortic valve stenosis, a condition in which calcium builds up on the heart’s aortic valve, making it harder for blood to flow through.

When the research team analyzed diseased human valve tissue, they found notably higher levels of Porphyromonas gingivalis, a bacterial species strongly linked with gum disease, in calcified aortic valves than in valves without the condition. They then investigated the connection in lab mice.

They found that repeated exposure to P. gingivalis led to bacteria accumulating in the aortic valves, as well as more calcification and signs of aortic stenosis. The researchers also identified a specific inflammatory pathway that appeared to be involved.

This could be another piece to the puzzle of why gum disease and cardiovascular disease (CVD) so often seem to travel together — and it’s hardly the only recent work in the area.

For instance, one systematic review and meta-analysis looked at studies that followed people who hadn’t been diagnosed with CVD. Overall, poor periodontal health was associated with a higher risk of later cardiovascular events. Stronger associations were found as periodontal disease became more severe.

Others have approached the question from the opposite direction: What happens to cardiovascular risk markers when periodontal disease is treated? A review from earlier this year found a link between nonsurgical periodontal treatment and reductions in markers of inflammation such as C-reactive protein and IL-6, along with modest improvements in blood pressure and some measures of cholesterol and blood fats.

It’s research like this that’s a big part of why we take gum disease so seriously.

It’s also why our approach to periodontal care goes beyond just cleaning your teeth and measuring your pockets. Your medical, dental, and lifestyle history can help us understand what may be making you more vulnerable to disease. Salivary testing and phase contrast microscopy can tell us more about the bacteria and other microorganisms involved. And with perioscopy, we can actually see beneath the gums at high magnification, identifying exactly where deposits remain on the root surfaces and guiding the cleaning as it’s being done. Instead of relying on touch alone to tell us when a root surface is clean, we can see the results in real time, helping us provide a much more thorough cleaning.

Put together, that information helps us get a much clearer picture of what’s going on and what it will take to get the infection and inflammation under control. It also helps us tailor both treatment and home care to you.

Because periodontal care isn’t only about saving teeth, important as that is. It’s about taking care of your health. There is no total health without dental health.