Dentist and periodontist Lisa Hezel explains in this interview why hemorrhagic gums are always a warning sign, critical aspects of oral hygiene and the consequences the disease can have for the whole body.
Dr. Hezel, what causes teeth to lose their business?
This is not the case suddenly, but it is usually a process that has been developing for many years. It always begins with an inflammation of the gums, which we call gingivitis. Unfortunately, symptoms, such as red gums, are often not observed or incorrectly identical to those affected.
The disease is caused by bacteria in the dental plate. The oral cavity can be colonized from over a hundred different types of bacteria. Most of them are harmless and are part of natural oral flora. However, if oral hygiene is neglected, some bacteria multiply and the balance of the oral flora is lost.
What exactly are the results?
No individual bacteria causes the damage, but over time, the bacteria create a plate or biofilm on the teeth over several hundred or thousands of layers – and this is the case when the devastating potential of the bacteria is put into operation.
The body reacts to it with inflammation. Initially, this process only affects the gums. The first signs of gingivitis are edema, redness and bleeding, for example when brushing your teeth or food. Unlike periodontitis, gingivitis remains limited to gums and does not cause permanent damage to the periodontal.
The gums can be healed again after the plate has been removed thoroughly. That is why early intervention is so important.
How can gum problems be avoided?
Simply taking severe bleeding gums. Healthy gums do not bleed! Many people brush rather carefully instead of thoroughly, but this is precisely the wrong approach to follow. You should take consistent countermeasures to the first symptoms of gingivitis – which usually include bad breath or bad taste in the mouth – and improve your own oral hygiene.
I also recommend cleaning your teeth regularly from a professional. This involves normalizing teeth surfaces and removing all deposits and roughness, especially in niches that are difficult to access with oral hygiene at home. Patients also receive tips and instructions for home care.
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What is especially important when it comes to oral hygiene?
The goal is to naturally remove biofilm in the teeth, which is caused by bacteria – regardless of which toothbrush or toothpaste you use. There is no need for mouth.
Space care is extremely important – space spaces make up 40% of the surface of the teeth! If you overlook these, it’s almost like cleaning the upper jaw and saying in the lower jaw: “Oh, don’t worry, it will be fine.” Intermediate brushes with appropriate size are the choice tool for it. The thread is only an alternative if the spaces are so narrow that not even the smaller brush can fit.
And what happens if you neglect your oral hygiene and the plaque tape has not been removed?
If gingivitis or superficial inflammation of the gums remains for a long time, inflammation will eventually attack the whole periodontal, the tissue that supports the teeth, with the bone carrying the teeth-dependent with individual risk factors and sensitivity.
The worst scenario is that the teeth lose their hand due to the loss of bone and that the lost bone does not recover at all. In addition, chronic inflammation is not limited to periodontal. It affects the whole body.
What are the links here?
Bacteria and inflammatory messengers from gum pockets enter the bloodstream and travel to other parts and organs in the body, where they can cause damage. There are indications of increased risk of heart disease and diabetes mellitus. Diabetes and periodontitis even have a mutual effect between them: the poorly controlled diabetes exacerbates periodontitis, but unprocessed periodontitis also makes control of blood sugar more difficult, thereby aggravating diabetes.
Now, thanks to a European initiative between general doctors and periodists, we also have scientific evidence that periodontitis and other diseases are linked independently, in other words, have common risk factors. These include cardiovascular disease, diabetes, COPD [chronic obstructive pulmonary disease] and complications of Covid.
If the microbial balance in the oral cavity is disturbed, there is also increased sensitivity to infection. There are many positive results when gum inflammation is detected early, treated and observed in a wider context. Some of my patients may naturally feel the inflammation that the body leaves after treatment. It is not only about saving your teeth, but also to improve your quality of life.
Dr. Lisa Hezel has her own practice and is a dentist and specialist in Periodontics and Research Associate in the Department of Periodontics and Dentistry at the University of Mainz. He is also a member of the European Federation Public Relations Committee. © Credit Photo: Private
Is the disease of periodontitis A that only affects the elderly?
Periodontitis is a multifactorial disease. The main factor is the bacterial effect, but age is definitely another risk factor. That is why, especially from middle age, strict oral hygiene is even more critical than ever.
How is the disease diagnosed?
Dentists and periodontists will measure what is known as the periodontal sorting indicator (PSI) every to two years, depending on the individual risk, to detect periodontitis early. This implies the use of a minute, blunt tool to gently examine any tooth between the tooth and the gum, checking how deep the gum pockets are in immediate proximity to the tooth and whether the gums bleed. This allows us to evaluate if treatment is required.
What treatment options are there?
If the gum pockets are found to be at least four millimeters deep in the PSI, periodontitis is considered to require treatment. The treatment includes various interconnected steps, including improved oral hygiene, plaque removal and tartar from teeth and removing deposits below the gum line. In very rare cases, antibiotics can be recommended.
There is also a surgical approach that uses special biomaterials to rebuild the periodontal in certain bone defects. However, in many cases the bone cannot be restored – so the most important thing is to prevent it from getting so bad. Gingivitis and periodontitis are not inevitable, they are completely preventive!
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