‘This Rule states that the total time spent cleaning the mouth during every 24 hours must be equal to the amount of natural teeth in minutes’
I HEAR at least every week from a patient who has just been diagnosed with some degree of gum disease, “I brush and floss every day. I couldn’t possibly have gum disease.” But you know, I can genuinely empathize with potentially serious health risks, and can easily understand their frustration upon discovering that their conscientious home-care efforts simply weren’t capable of keeping them healthy. However, unless one obeys the Rule of Thoroughness (which I will tell you about later), your brushing may very well be virtually useless.

Having discussed previously what goes on under the gums (the trillions of bacteria that make there a haven), in the sulcus (the area between the tooth and the gum), we know how important it is to cleanse this space frequently enough to make sure the gum tissue remains a healthy barrier. This isn’t easy, especially if you are depending on brushing and flossing to accomplish this important task; you have to consider the sheer volume of food debris, living and dead microorganisms, odors, sloughed-off skin cells and toxins that can build up around the normal complement of twenty-eight to thirty-two teeth in that space under the gums. In the majority of cases, this stew in the sulcus is the spark that sets off periodontal disease.

While not pleasant to think about, all this is toxic waste that contains the rotted remains of literally trillions of dead microorganisms, all producing inflammation and odor that is for the most part, trapped in the sulcus. This stew can also contain various amounts of dead white blood cells (the cells that fight infection when they are living), with sulcular pus and periodontal abscesses containing very high amounts. Since these dead white blood cells also rot as the infection progresses and the numbers of dead cells accumulate dramatically, their rotting contributes to the breakdown of soft tissue and the perpetuation of the disease process.

This moist mixture produces inflammatory components, such as leukotrienes proinflammatory cytokines, and prostaglandins (each associated with inflammation anywhere in the body), as well as the volatile sulfur compounds (VSCs), namely, hydrogen sulphide and methyl mercaptan. These two VSCs are known to activate collagenase, which breaks down collagen (unfortunately, in the sulcus, this collagen happens to be the sulcular wall in the gum tissue). As previously mentioned, hydrogen sulfide and methyl mercaptan are easy to recognise by their smell — rotten eggs and sewer gas, respectively.

The harmful effects of the toxic stew under the gums, which leads to the breakdown of the gum-tissue wall due to collagenase produced by VSC and other toxic substances , in turn allows up to 400 types of germs to spread throughout the body via the circulatory system.

These microorganisms create a myriad of problems, including inflammation, and have been found in blood clots evaluated at autopsy. Perhaps the most serious effect of all is the inflammation-induced elevation of C-reactive protein (CRP). This substance is produced by the liver in response to a wide range of chemical and microbiological causes. CRP circulates at low levels in healthy individuals, but rises considerably in response to infection, inflammation, and injury, and gum disease is associated with all three of these stimuli.

A 2008 article in Diabetes Care described a study of 16,573 people. It says “about 90 per cent of apparently healthy individuals have C-reactive protein levels (less than 3ml/L) and 99 per cent have less than 10 mg/L.” So, we can assume that the lower the reading, the better. Gum disease can elevate CRP levels to more than 1000 times the normal healthy upper limit, and I have no doubt its severe consequences is becoming better known. CRP levels are directly related to circulating levels of inflammation-inducing blood elements. CRP has been responsible for causing clotting anywhere in the body, including the brain, heart, legs, and lungs.

Collectively, odors, circulating microorganisms, and elevated CRP can exact a terrible toll on a person’s health. In the Physicians Health Study that followed a broad range of lower-risk males, it was found that those with the highest CRP levels had triple the risk of a heart attack, as well as double the chances of having a stroke. So, to be on the safe side, it is well to reduce all factors that can elevate CRP.

To make oral care as valuable as it should be, the Rule of Thoroughness should be applied. This Rule states that the total time spent cleaning the mouth during every 24 hours must be equal to the amount of natural teeth in minutes. For example, if a person has 20 teeth, they should spend at least 20 minutes every day brushing, flossing, etc.

My experience as a dentist in the Public Service for 20 years tells me that an estimated one in every three Guyanese adults have moderate to severe periodontal disease, not counting gingivitis or early-stage periodontal disease, so it doesn’t take too much guess work to figure out what might be elevating CRP in much of the Guyanese population.

In addition, about 70 per cent of the population is either receiving “unconventional treatment,” or more likely, no treatment at all.