Reasons for Worsening Gum Disease
Why does one person suffer from gum disease while another does not? Usually the answer is home care. One person might brush, floss, and rinse more often or more thoroughly than another person does. Sometimes, however, the reasons are less obvious, such as immune differences (some people are naturally more resistant to gum disease). This blog will discuss some of the other factors that worsen a case of gum disease.
Unhealthy gums usually begin with bacteria collecting on the roots of teeth. For most individuals, an improved home care routine in the morning and at night will reduce gum bleeding and swelling.
Click the links to learn how to improve your gum health
Following is a list of the most
common reasons for worsening gum
disease:
Poor home-care:
Failure to brush:
Brushing removes plaque (a mix of bacteria and protein that cover the teeth) that begins the process of gum
inflammation.
Failure to floss or use a Waterpik (to ‘irrigate’ or ‘wash’ between teeth):
Flossing and irrigation devices, such as a Waterpik, removes plaque and food particles from between the teeth, and lessens the chance of getting gum disease. Toothbrushing alone does not clean between the teeth.
Physical factors:
Crowded and crooked teeth:
Bactria collects between crowded, crooked teeth. Getting braces, will improve both your smile and gum health. For older patients who do not, or cannot, straighten their teeth, a good home-care routine may be sufficient.
Thin bone:
The bone under the gums can be very delicate around the bigger teeth such as upper canines (the pointy teeth in the front). These teeth cannot tolerate gum inflammation. A type of bone thinning typical of aging is osteoporosis which leaves patients at greater risk for destructive gum disease. This may be a two way street because gum disease may increase the risk of osteoporosis.
A tooth that is sticking up (or down from the top):
Any tooth that ‘sticks up’ and gets particularly banged on when you bite, will have more gum and bone problems. Your dentist will advise you on correcting your bite, sometimes through extraction (taking out teeth), or sometimes by cutting a tooth down that sticks up.
Tongue-tie:
This is a thin, soft string-like piece of gum connecting the tongue and the back of the lower front teeth (see picture). It is a cause of gum problem in the front teeth. This little bit of gum can easily be removed by your dentist.
Aging
Aging results in difficulty in using a toothbrush due to hand tremors, arthritis and impaired dexterity. Aging also frequently means greater difficulty in chewing, The result is poor nutrition, tooth decay, and gum disease. For easier brushing, try wrapping aluminum foil or a bunch of rubber bands around the brush handle to make gripping the brush easier. Reduced saliva flow with age also contributes to gum disease (see Home Care Help Section about artificial saliva products - click on link below).
Chemical factors:
Hormonal changes:
Gum inflammation is commonly seen during the second and third trimesters of pregnancy and is known as ‘pregnancy gingivitis’. Frequent professional cleanings make a difference! Other hormonal imbalances can lead to swelling of the gums including menstrual cycle and early menopause. Also, for children entering puberty gum inflammation may occur.
Medications:
Many medications cause dry-mouth resulting in increased gum swelling and cavities. Some of these medications include: Dilantin (phenytoin) for epilepsy, blood pressure medications such as nifedipine, immunosuppressants such as cyclosporin, opioids, benzodiazepines and antidepressants.
Tongue tie see above
Nutritional deficiencies:
For healthy gums, focus on foods high in vitamin A ,C, D and E. All of these are ‘antioxidant micronutrients’ that may help to prevent gum inflammation.
Here are the important actions of vitamins for your gums:
Vitamin A keeps the gum surfaces healthy.
Vitamin B helps in gum repair.
Vitamin C keeps the gum’s interior (the collagen) healthy.
Vitamin D brings calcium into our bodies, which is important for bone health.
Vitamin K plays an important role in blood coagulation.
Also, besides vitamins, omega-3 fatty acids (from certain fish, nuts and vegetable oils) may play a role in gum healing, particularly after a gum treatment. One final note, in adult, calcium supplements are important for gum and bone health but will NOT benefit the teeth.
Smoking is not cool. You can suffer severe loss of bone without even noticing it! This is because smoking hides gum damage. Your gums may look healthy…but they are not. Smoking and gum disease go hand in hand.
Many systemic diseases contribute to gum disease. These include:
Down syndrome:
If you care for a Down syndrome child, do not avoid the dentist! These children make lovely patients and a joy to treat. Severe gum disease is common, possibly caused by poor blood circulation (low blood pressure is common). These patients also show immune problems, poorly formed gums, and poor home-care that requires supervision.
Glycogen storage disease (GSD):
This is a group of conditions which affects glycogen, an essential form of sugar. Certain types of GSD come with potentially serious oral problems. Type 1b GSD is especially associated with bleeding gums and ulcers.
Ehler’s-Danlos syndrome:
Skin and tissue focused genetic disease with severe gum breakdown.
Papillon-Lefevre:
Genetic skin disease with early onset gum disease.
Leukemia and neutropenia:
Leukemia based gum disease and neutropenia based gum disease are both related to a compromised immune system.
Diabetes:
Gum condition worsens due to: excess sugar in the saliva, reduced saliva flow allowing bacteria to grow, and poor blood circulation which decreases the immune response to infection and inhibits gum health.
Crohn disease:
An inflammatory disease that is suspected to have a relationship to gum disease.
Factors for invisible gum disease - you don’t see the disease, but it’s there:
Smoking:
It is easy to be fooled by smoking. The gums may look healthy but there is a great deal of destruction going on underneath. Smoking decreases blood circulation in the gums and reduces the ability of the immune system to fight infection.
Malnutrition:
Micronutrients, including vitamins and minerals, are essential for healthy gums. For patients who have suffered malnutrition, casual observation in my dental office has shown significant bone loss. This may be due to a suppressed immune system in these individuals.
It is proven that many conditions in the body worsen gum disease. But, is it also true that gum disease can worsen conditions in the body? The answer is yes. Bacteria and inflammation in the gums may contribute to:
diabetes,
heart disease,
low-weight delivery in pregnancy
osteoporosis (thinning bone).
Many of these relationships are uncertain and are still being studied. Note, for instance, that it remains uncertain if gum treatment will reduce already established heart disease.
Summing up, final thoughts on gum disease:
It is important to understand the importance of morning and evening brushing, flossing and irrigating with a Waterpik to reduce the bleeding typical of gum disease.
If gum bleeding continues despite good brushing, this may signal the presence of a more severe case of gum disease or the presence of a systemic condition (such as a blood cancer, autoimmune disease, other genetic problem, or one of the above mentioned conditions).
Some medical treatments also worsen gum disease. For example, head and neck radiation to treat cancer leaves patients prone to severe jaw bone loss.
Some medicines also can worsen gum disease by promoting dry mouth. These medications reduce saliva flow causing gum soreness, bleeding, and inflammation in the palate, check and tongue.
Down syndrome poses enormous dental challenges:
Small upper palate and tooth crowding.
Delayed eruption - teeth coming in late.
Difficulties in home-care and in keeping braces clean.
Challenges in speech articulation.
Gum disease more common.