MY DEEP concern lies in the fact that people with gum disease are, in fact, potentially seriously ill and do not even realise they have a problem, or if they do, think it’s of no more consequence than a cold. The challenge for me is that this country is not up in arms over gum disease, because it is a disease so insidious, so painless, so seemingly benign — yet so dangerous — that it is allowed to affect perhaps 90 per cent of the adult population, while we continue to pour oral health products containing antifreeze and alcohol on diseased gums.

Heart disease alone accounts for about fifteen of every hundred deaths. I say we’ve got to do a lot better than we do at present to address this dismal situation. And we can. If gum disease were as painful as a continuous bee sting or a burn, perhaps the three hundred thousand or so Guyanese who have moderate to advanced gum disease would be ringing their physicians’ and dentists’ phones off the hook.

This type of pain would serve to alert people to the fact that they did, in fact, have some sort of problem, as well as motivate them to do something about it. Nothing of this sort will happen, of course, because gum disease is, as I said, unusually painless, and bleeding gums aren’t given much thought. One patient told me recently: “Doc, my gums always bleed; so what’s all the fuss you’re making now!’

Periodontal disease literally means disease that is “located around a tooth,” and is generally meant to refer either to infections around the teeth, such as gingivitis, an early stage of periodontal disease, or to more deep-seated infections around the teeth, resulting in pockets and the loss of tooth-supporting bone, known variously as early, moderate, or advanced periodontitis. Exact gradations of the disease range from simple, easily cured conditions requiring little professional therapy, to exceedingly complex ones requiring therapy from a periodontist (a gum specialist).

End-stage periodontal disease results in extraction, the only therapy possible, and thus the loss of the tooth. While the traditional perspective is a tooth-by-tooth, oral-centric focus, my perspective is that we should be thinking about early, moderate, and advanced systemic disease that shows up first in the mouth.

There can be many causes of periodontal disease, and someone can have several factors working against them at any given time. One of the biggest factors in determining whether or not you have gum disease is how well you can control your plaque, by exercising whatever oral hygiene efforts you customarily perform.

Plaque, the sticky stuff that coats the teeth above and below the gums, is a major factor in the development and perpetuation of gum disease. Since up to 400 types of microorganisms are living, dying, rotting, stinking, and producing a whole host of destructive enzymes under the gums, and therefore next to the teeth, plaque is very high on the list of periodontal disease causes. No other part of your body is dirtier than you mouth, because one gram of biofilm from any source, whether above or below the gum margins, or even from the top of the tongue, can contain as many as 100 – 200 trillion organisms. Therefore, safe, effective methods of controlling these organisms on a daily basis are critical to maintaining oral health.

Although poor oral hygiene and plaque control is frequently the primary cause of gum problems, there are also other factors that contribute to periodontal disease (even an immaculately clean mouth can be diseased). They include:

* Nutritional deficiencies;

* a diet high in sugar, white flour, and other refined carbohydrates (these foods depress the immune system);

* diabetes (decreased resistance to infection, poor circulation);

* alcohol (dehydration, poor diet, topical effect of alcohol on gums, vitamin depletion);

* stress (compromised immune system);

* bruxism (grinding) and malocclusion (bad bite);

* volatile sulphur compounds ( derived from decomposing food debris — VSC breaks down protein, decomposing microorganisms, desquamated cellular debris under the gums);

* smoking, chewing, dipping, or using tobacco in any form (tobacco has many ill effects on oral soft tissues, including oral cancer and periodontal disease);

* drug reactions, especially to the birth control pill and steroids (mouth drying effects, reduced immune-system competency);

* hereditary factors (not commonly seen, but in some, its influence shows up early and can quickly result in major bone loss and loss of teeth);

* poorly fitting dental appliances (too much stress on remaining teeth), bad margins, or over — or under contoured restorations or crowns;

* food impaction between teeth (causing bone loss, chronic inflammation, localised pressure);

* habits, such as chronic nail biting, improper use of toothpicks, and overzealous brushing or flossing;

* foreign-body reaction (bone loss can occur rapidly when foreign material is lodged under the gums — popcorn hulls, tomato seeds, or tooth-pick remnants can all cause mischief in just two days or weeks);

* chronic immune diseases or HIV/AIDS infection;

* inflammation, the chief culprit in most periodontal disease-systemic disease conditions.