Or – Gingivitis can Kill You!
This site has four chapters that present various aspects of the design, breakdown and therapies related to the periodontal (gum) tissues.
But the current chapter deserves a special place, because I will show that in some instances problems with the gum tissues can become problems with the whole body!
Recall that the periodontal attachment is what surrounds the teeth and makes the seal that keeps bacteria from invading our bodies. If you realize that a booth through the gum tissue is like a compound fracture, where the bone sticks out through the skin – it clearly does require a specialized mechanism to protect us.
In Chapter IV.4 we discussed periodontal charting – what the dentist or hygienist measures in your mouth to assess the seriousness of your gum condition.
From all of these other sections we can learn that most people have an ongoing infection in their mouth, around the teeth and gums, and this causes inflammation and redness and soreness. But it is not simply an inconvenience!
Inflammation in General
Inflammation is an immune response of the body – just part of the body’s overall potential for fighting infections. For gingivitis and periodontitis this is a LOCAL RESPONSE.
But it has been shown that when you have this inflammatory immune response in your mouth, you are more likely to have more severe SYSTEMATIC health issues, like cardiovascular disease, diabetes, arthritis and even dementia (Bredesen, DE. The End of Alzheimer’s. The fist program to Prevent and Reverse Cognitive Decline. New York, NY: Penguin Random House LLC; 2017)!
Landmark research at the University of Toronto School of Dentistry has now demonstrated the nature of the connection between local oral inflammatory responses and systemic immune responses to remote infections!
They discovered that spefcific WHITE blood cells that mediate inflammation can be primed by oral inflammatory processes to over-react to other infections.
Most importantly – this means that in people with active gingivitis or periodontal disease there could be an exaggerated response to infection by Coronavirus, causing a “cytokine storm” more damaging to our tissues than would be otherwise found. This was suggested in a followup article by the University of Toronto Faculty of Dentistry. In fact, it seems that people with oral inflammatory responses are more likely to suffer acute symptoms of Covid-19.
So: it behooves us all to keep the inflammation in our mouths down as much as possible!
Oral Home Care becomes Oral Self Care
The reason I use a new term here is because the former suggests only that we need to take care of our oral health at home, whereas the latter term says if we do, it will benefit our entire SELF!
We’ve looked at Home Care in other chapters. But because of the new awarenesses we are getting as to the link beetween oral care and systemic health, I’ve decided to emphasize this topic further in this Chapter, with reference to prior discussions.
There are something like 600 microorganisms in your mouth at any one time – the vast majority of which are harmless or even helpful. But, if the oral environment is conducive for the flourishing of a harmful one – we get in trouble. When the sulcus or pocket around each tooth, between it and the gingiva becomes deep, then bacteria can grow there and they’re harder to remove. When they are bacteria that don’t like air, they can find air-free areas in deeper pockets. It is these bacteria that can release chemicals that harm the gums and bone, and the body must FIGHT them from inside by sending white blood cells that mediate inflammation.
How do we Remove the Bacteria?
The bacterial plaque, that is the sticky substance made by bacteria to keep them from being washed away from the area by tongue and fluid movement, may be removed deliberately by you!
The ease with which you can remove plaque depends on the anatomical configuration of your teeth and gums. This anatomy CHANGES AS YOU AGE!
Whenever in your life you let the bacteria get the upper hand, the level of the gumline on the sides of the tooth will drop – called recession. It is NOT reversible! It is the rare individual that does not accumulate a fair amount of recession during a few decades of life.
Recession uncovers parts of the teeth that are meant to be covered. For example, as the gumline drops BETWEEN the teeth an empty space if formed, where even more plaque can accumulate.
Recession can even uncover the area where roots on the same tooth come together – and naturally plaque can accumulate there too.
So – for US to remove plaque we must clean all surfaces of the teeth and that gets more challenging as we age – due to changing tooth contours above the gumline where plaque can accumulate AND due to possible decreases in manual dexterity.
But – if we are to keep the oral inflammatory level down, we MUST find a way to remove plaque on all tooth contours near the gumline.
Methods for Plaque Removal Depend on Age
For the normal progression of recession with age, we can suggest what must be done for plaque removal.
In youth there is NO recession and plaque accumulates on the enamel surface at the gumline and the contours allow efficient removal by brushing.
In adulthood the recession has allowed plaque to accumulate more in the areas where adjacent teeth touch. The spaces between the teeth below the contact areas are filled by the gingiva in youth, but now there is a space. This space allows plaque to build up unless removed. Removal will often not be adequate with simple brushing. Oscillating electric brushes may help, but flossing is the go-to technique for interproximal plaque removal for this age group.
If you are middle aged, it is likely you have enough gingival recession in the interproximal area so the open space is significant. For front teeth this might even show up as unsightly “black triangles”. The “good ” news is that now there is enough space for you to use an INTERPROXIMAL BRUSH to clean these areas.
Interproximal brushes come in a variety of sizes. Personally I use such brushes every day for my own treeth and the ones I use are made by the TePe company.
The picture below shows some of the sizes of angled brushes:
You can readily use them while reading a book or watching TV after dinner and they have proven to be quite effective. I use each one until the brush breaks off the handle (longer than suggested!), which is fine as long as you have a way to get the brush out from between your teeth – tweezer or hemostat is recommended.
For more advanced age groups, the space between roots of one tooth may be exposed and these brushes work very well to clean between these roots.
When plaque stays in these areas too long decay is often produced in a place that is impossible to restore, so the tooth may be lost.
We have methods to remove plaque bacteria from the gumline at any age and amount of gum recession. If we DO remove it daily, no inflammatioin will be present. The gums will LOOK healthier and FEEL healthier, and the body’s immune system will NOT already be primed to over react to another infeciton at a remote location, like a respiratory virus being detected in the lungs or nasopharyngeal passages.
If we do NOT remove the plaque bacteria regularly, the body’s immune response will already to triggered and other infections may well be handled poorly.
If the coronavirus infection is handled poorly, it could cause the need for a lengthy stay in the ICU and hopefully you will WALK out at the end of it!
Bear in mind: if you have calculus deposits on your teeth you CANNOT remove all bacteria. So, FIRST you must have this removed by your dentist.
Since I went through dental school we’ve learned far more about the relationship between oral disease and inflammation and systemic disease states. While there can be seen to be a large benefit to OVERALL health by taking good care of your mouth, it’s not always clear what is the MECHANISM of this connection.
One might observe, for example, that people with dementia have more gingival inflammation. This does NOT PROVE that gingival inflammation causes dementia or even makes it worse. It COULD be that those with dementia forget to clean their teeth and hence have gingivitis. A correlation or association does not demonstrate causality.
But – we are now learning more about HOW gingival inflammation CAN have a whole health impact, and there are specific disease states where cause-and-effect have been clearly identified.
The immune system is one of the more complex of the human systems, but it is in many cases what keeps us alive. It can also MISFUNCTION and cause us great pain and discomfort.
It is now clear that the oral condition influences the operation of the immune system, and to the extent that we ALLOW this, we are literally be taking our life in our hands, or in this case our mouth.
Find a convenient if not pleasant way to keep your mouth healthy and your quality of life and the LENGTH of your life may well reap huge benefits! Companies like TePe are dedicated to providing you with the means to achieve this global reward.
Looking at it from an immunological perspective, an interproximal brush could save your life! This is especially obvious when one considers that in the age-range most susceptible for serious Covid-19 symptoms, we also find the most challenges keeping the teeth clean.
Is this just a coincidence?
There are, certainly other factors, but the oral health link is quite suggestive! But why take a chance?
If you’re in the 45+ age group and you can fit an interproximal brush between your teeth, put on a good movie and get to it!