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The Suburbanite
  • Dr. Jeff Hersh: Brush and floss, or prepare for loss

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  • Q: My dentist said my gum infection has spread to my jaw bone, and it could mean I might lose my teeth if it does not get better. He referred me to a periodontist to get treated. Doesn’t everyone lose their teeth as they get older?
    A: Contrary to what many people think, tooth loss is not an inevitable consequence of aging. Although more than a quarter of Americans older than age 60 no longer have any of their teeth, this is actually a significant improvement from 50 years ago, due to the introduction of fluoride into drinking water, improved dental hygiene (including fluoride toothpaste) and improved dental care.
    Unfortunately, the percentage of adults with tooth loss is still much higher than this in certain developing nations. For people younger than age 35, the most common reason to lose a tooth is as a complication of cavities, but as people get older it is periodontal disease (a disease of the gums and underlying structures anchoring the teeth to the bones) that is the main cause of tooth loss.
    Healthy gums are pink and firm and do not bleed from tooth brushing or flossing. They wrap around the base of the teeth (although not quite as tightly as you may imagine) protecting the deeper tissues, including the periodontal ligaments, that help anchor the roots of the teeth to the bone.
    Gingivitis is the name of the condition where the gums become inflamed and/or infected, and it is extremely common, affecting most adults in some part of their mouth. It is usually caused by plaque (a thin film of bacteria) build-up, although it is not just the vast and variable types of bacteria alone that cause complications, but also certain substances (such as matrix metalloproteinase or MMP) made by the bacteria that contribute to the condition.
    Gingivitis is typically temporary and transient, although over months to years the inflammation and/or infection can spread to the deeper tissue and even the bone itself, a condition called chronic periodontitis. Other types of periodontitis also exist, but chronic periodontitis as a consequence of gingival disease is the most common.
    Diabetes, some hereditary factors, side effects of certain medications, malnutrition and certain other diseases increase the risk of someone developing periodontal disease. In addition to tooth loss, periodontal disease is a risk factor for developing certain systemic diseases, including types of cardiovascular, lung and kidney conditions. Periodontal disease has also been implicated as a contributing factor to preterm birth of underweight children.
    Periodontitis may be suspected based on the symptoms of gingivitis (such as painful, swollen gums and/or bleeding with tooth brushing) and/or loosening of some of the teeth, and can be confirmed by your dental professional on oral exam (including measuring how deep the “pockets” are where the gums wrap around the teeth) or by seeing abnormalities on oral x-rays.
    Page 2 of 2 - Treatment of gingivitis includes scaling and root planing (the scraping off of the plaque as is done as part of a dental cleaning) and does not usually require antibiotics. However, if the deeper structures are affected (periodontitis) more aggressive treatments may be needed, possibly including oral surgery (for example flap surgery, soft tissue grafts, bone grafting or other techniques), and even long-duration, low-dose, doxycycline antibiotic therapy (which is not intended to kill the bacteria, but instead is given to prevent the bacteria from making MMP and/or other deleterious substances).
    Good oral hygiene, including tooth brushing at least twice a day, daily flossing, routine dental checkups and regular cleanings, can help prevent periodontal disease and minimize the risk of subsequent tooth loss. In addition, a good balanced diet, minimizing sugar-rich foods and beverages, is also beneficial.
    Your teeth are meant to last a lifetime, so take good care of them and they will keep you smiling and healthy.
    Jeff Hersh, PhD, MD, FAAP, FACP, FAAEP, M.D., can be reached at DrHersh@juno.com.