Gum treatment

On this page we explain everything about gum treatment, the procedures themselves and what we can do for you.

The periodontium

Our teeth and molars are stuck in our mouths. But what about that exactly? The periodontium is the “suspension device” that holds teeth in our mouth. The periodontium These tissues consist of the gingiva, the alveolar mucosa, the root cement, the periodontal ligament and the jawbone. Gingiva is another word for gums and in particular the edge of the gums that is located directly next to the teeth.

The gingiva merges into the alveolar mucosa, which is the flexible gums just like in the cheeks and inside of the lips. On the roots of the teeth and molars is a thin layer of cement, the root cement. Very small fibers attach to that root cement that attach the teeth and molars to the jawbone, the periodontal ligament. A very complicated connection with which the teeth are stuck in your mouth. Something we have to be very careful about.

Dental plaque and tartar

Everyone has dental plaque (also called dental plaque). Dental plaque is a layer of food, saliva and bacteria on your teeth. Plaque removal is extremely important to prevent tartar and prevent oral problems.

Dental plaque is a soft, sticky and barely visible layer on your teeth. Plaque is caused by food particles that remain in your mouth. So you have to deal with dental plaque every day.
Plaque is made up of food particles, saliva and bacteria that live in your mouth. The bacteria in dental plaque also convert the sugars from your food and drink into acids that affect your tooth enamel. This can cause cavities and tooth erosion.

Dental plaque is all over your teeth. Both on the front and back of your teeth and in between. Because plaque is the same color as your teeth, it is barely visible to the naked eye. Plaque is therefore sometimes difficult to remove. When plaque stays in place for too long, it hardens, calcifies and turns into tartar. Tartar is most common between the teeth and in other hard-to-reach areas during brushing.

General health and gum disease

The relationship between general health and periodontitis, but also peri-implantitis is twofold. Both gum infections pose risks to general health, but vice versa, general health or medications can pose risks to gums.

The risk to general health in periodontitis and peri-implantitis is caused by large amounts of bacteria and inflammatory substances entering the bloodstream. In both conditions, deep pockets (pockets) have formed under the gums, where much more bacteria can accumulate. The bacteria-induced gum disease caused by the deep pockets (pockets) in periodontitis and peri-implantitis has a larger surface area of inflammation, so that many more inflammatory substances enter the bloodstream.

Hormones

The risk of gum disease is greater during pregnancy because of the altered hormone balance, at least if bacteria have accumulated under the gums. However, pregnant women who have more inflamed gums do not necessarily show more loss of jaw bone or root membrane and therefore do not necessarily have more periodontitis. In other words, the hormonal changes increase the risk of gum disease but do not necessarily increase the risk of periodontitis or peri-implantitis. Due to similar hormonal changes, gum infections are also more common during puberty.

Another thing that can occur during pregnancy is that in the final period teeth can sometimes become looser, because the root membrane around the teeth becomes weaker, but this has nothing to do with the gum disease. After the pregnancy, this decreases again, just like the increased gum disease, but the inflammation that was already present before is still there. Because implants lack the root membrane, these will not become looser during the last period of pregnancy due to the hormonal changes.

Medication

Some medicines affect the metabolism of the subcutaneous connective tissue of the gums, which can cause it to grow several months after using the medicines. The gums become, as it were, thicker (called hyperplasia) and can sometimes even grow over the entire tooth in extreme situations. This thickened gums often causes a problem with cleaning the teeth, which in turn leads to more bacteria to build up and the gums to become more inflamed.

If this gum disease persists for a longer period of time, the risk of developing periodontitis or, in the case of an implant, peri-implantitis is greater. This means that the jawbone around an implant can be affected and, in the case of your own tooth, also the root membrane, which is unique to your own teeth and does not exist with an implant. However, it is not the case that such medicines have a direct influence on the retention of the teeth or implants.

Examples of drugs that cause gum growth are certain blood pressure lowering drugs and anti-defensive drugs given after organ transplants.

Heart and vascular disease

Periodontitis and also peri-implantitis, which are characterized by gum disease deeper under the gums, have a negative impact on general health. The health risk is posed by the deep pockets (pockets), in which large amounts of bacteria have accumulated and a larger area of inflammation has formed. Both have an effect on the condition of the blood vessel walls, because bacteria but also inflammatory products from the gums enter the bloodstream and thus irritate the blood vessel walls. Together with fats or sugars in the blood, the inflammation products and also the bacteria from the gums can lead to the formation or worsening of hardening of the arteries (atherosclerosis).

Scientific research has shown that with periodontitis the number of inflammatory proteins in the blood has indeed increased, but that these substances also decrease if periodontitis has been successfully treated. Thanks to the reduced amount of bacteria and inflammatory substances in the bloodstream, the condition of the blood vessels improves and therefore gum treatment contributes to better general health. Conversely, it means that an unhealthy mouth, as in the case of periodontitis and peri-implantitis, poses a risk to general health. That is why timely treatment of periodontitis but also peri-implantitis is important, not only for a healthy mouth but also for a healthy body.

Schematic cross section of a blood vessel wall with arteriosclerosis (atherosclerosis).

Arteriosclerosis is actually a swelling in the blood vessel wall as a result of accumulation of cholesterol and dead white blood cells.

inner lining of blood vessel (endothelium);
accumulation of cholesterol, fat, dead white blood cells;
calcified core;
connective tissue layer;
muscle layer.

Diabetes

In addition to the positive health effect on the condition of the blood vessels, the treatment of periodontitis also has a positive effect on diabetes. Thanks to the reduction of gingivitis due to the treatment of periodontitis and the reduced amount of bacteria and inflammatory substances in the bloodstream as a result, the control of the diabetes is improved. Scientific research has shown that a diabetic needs less medication if the periodontal disease has been successfully controlled.

The extent to which periodontitis or peri-implantitis also influences the development of diabetes is as yet unclear. On the other hand, diabetes, which is insufficiently controlled or still untreated, has a negative influence on the course of a gum disease.

Chronic diseases, Alzheimer's and cancer

More and more diseases can be related to periodontitis and the size of the inflammatory surface appears to be an important criterion in this regard. That is, the more deep pockets (the spaces between the gums and teeth) are present in a person's teeth, the stronger the relationship with that disease or the substances in the blood that are characteristic of that disease. If deep pockets are present, much more bacteria can accumulate in them, which also causes a much larger wound surface with inflammation and pus.

Although periodontitis is associated with more and more diseases, it is still unclear whether it is a cause and effect relationship. Namely, do the inflammatory products and bacteria that enter the bloodstream in periodontitis cause the disease or influence the course of the disease, or is it a matter that both conditions share common risk factors? In the latter case, there is no direct cause and effect relationship, but the risks of developing serious forms of periodontitis increase if someone suffers from a chronic disease, such as rheumatism, which can also be related to periodontitis.

To further elucidate the complex relationships between periodontitis and other diseases, additional and well-conducted research is needed.

Pneumonia and COVID-19 Complications

On the other hand, research has been able to show conclusively that the risk of pneumonia in frail elderly and people with dementia is higher if there is a lot of bacteria and therefore poor oral hygiene or periodontitis. Because this group of elderly people often also have swallowing problems, the risk of so-called aspiration pneumonia is much greater. This means that if the elderly choke, saliva enters the lungs, which can lead to pneumonia. If their mouth is not clean or their gums are very inflamed, much more bacteria will end up in the lungs, greatly increasing the risk of pneumonia.
The good news is that if the mouths of these elderly people are cleaned and there are much less bacteria in their mouths, this risk is greatly reduced. Dutch research conducted in nursing homes successfully demonstrated this a number of years ago.

The higher risk of pneumonia in gingivitis may also be the reason why COVID-19 patients with periodontitis develop more serious complications, such as ventilation, ICU treatment or even death. The higher risk of pneumonia in COVID-19 patients certainly seems real if they end up in the ICU, are kept in a coma and have to be given a ventilator. This is because a tube is placed in the trachea, so that the risk of introducing bacteria from the oral cavity is much greater if these patients have severe periodontitis.

The above emphasizes the importance of good oral hygiene and a healthy mouth in relation to general health. This also means that the teeth and certainly the gums are not separated from the rest of the body.

Source: periodontologiefokkema.nl