At the dentist

Danger spot periodontitis – As the gate to the outside world the oral cavity is also the home of many bacteria.

The tongue, the gums and the teeth are covered by a thick carpet of bacteria composed of an individually varying mixture of different bacteria. Although many of the bacteria are largely harmless, disease-causing bacteria can also become established. The number of bacteria depends largely on a person's oral hygiene. Poor oral hygiene leads not only to an increase in the number of bacteria but also to greater multiplication of the aggressive and harmful species. In young years the consequences are dental caries, in adults very often permanent inflammation of the periodontium (the tissues supporting the teeth) - chronic periodontitis.

Periodontitis a widespread disease

Periodontitis - like high blood pressure - is very often a chronic process extending over many years. It is one of the most widespread diseases in the adult population.

In the early stages of the disease the bacteria are found at the border between teeth and gums (Fig. 1). However, in the course of time the scarcely perceptible inflammatory process leads to the development of pockets between the teeth and the gums. These are the result of destruction of the periodontal tissues. When the erosion of the bone exceeds a critical limit the teeth become loose in their sockets and fall out.

If the bacteria get into the blood

In the pockets the harmful bacteria in particular can multiply unhindered. The human body responds to this situation with inflammation of the gums - in advanced cases the gums also bleed on toothbrushing. The chronic inflammation leads to an increase in the blood vessels in the gums and to an increased flow of blood. Now the bacteria have the opportunity to enter the bloodstream and thus to travel to all parts of the body. While healthy individuals have no bacteria in their blood, patients with chronic periodontitis are constantly at risk. The quantities of bacteria are rarely large enough for the body to respond with fever; however recent scientific findings show that the constant migration of bacteria into the bloodstream over many years is particularly dangerous.

The bacteria lead to changes in the lining of the blood vessels and thus to the increased occurrence of vascular diseases such as heart attacks. The life expectancy of a periodontitis patient decreases with increasing severity of the disease. Patients with susceptible vascular linings, e.g. heart valve patients, should be particularly aware of these risks.

How can periodontitis be treated or prevented?

The sooner periodontitis is treated, the greater are the chances of success. Only the early forms can be completely cured; as the disease progresses it is often only possible to slow down but not completely stop the destructive process.

Because of this difficult treatment situation it is important to begin preventive measures as early as possible. Children with still healthy gums should learn how they can lastingly reduce the number of harmful bacteria by good oral hygiene.

This includes not only regular toothbrushing but also especially the correct technique and individually varying additional aids (dental floss, dental sticks, interdental brushes, chewing gum etc.). The technique must be learned and perfected in special prophylaxis (prevention) sessions. The belief that frequent toothbrushing is equal to good oral hygiene is unfortunately not correct.

If the bacteria get into the blood

In the pockets the harmful bacteria in particular can multiply unhindered. The human body responds to this situation with inflammation of the gums - in advanced cases the gums also bleed on toothbrushing. The chronic inflammation leads to an increase in the blood vessels in the gums and to an increased flow of blood. Now the bacteria have the opportunity to enter the bloodstream and thus to travel to all parts of the body. While healthy individuals have no bacteria in their blood, patients with chronic periodontitis are constantly at risk. The quantities of bacteria are rarely large enough for the body to respond with fever; however recent scientific findings show that the constant migration of bacteria into the bloodstream over many years is particularly dangerous.

The bacteria lead to changes in the lining of the blood vessels and thus to the increased occurrence of vascular diseases such as heart attacks. The life expectancy of a periodontitis patient decreases with increasing severity of the disease. Patients with susceptible vascular linings, e.g. heart valve patients, should be particularly aware of these risks.

Professional tooth cleaning indispensable

Even with optimum care there are individually more or less extensive areas which cannot be properly cleaned, for example because of a slightly defective position of the teeth. The teeth should therefore be cleaned regularly (every 3 to 4 months) by the dentist or dental hygienist. The invisible bacteria can be located by means of special disclosing agents (Fig. 3 and 4). Even with good care there are always pockets of bacteria growing on dental plaque. The combination of optimal personal cleaning techniques with regular professional cleaning is today the recommended procedure for long-term reduction of pathogenic bacteria in the oral cavity. Of course, it is also important to replace your tooth brush regularly (every eight weeks).

Exposed dental necks are the consequence of longstanding inflammation

After successful treatment of periodontitis, once the inflammation and swelling have subsided the necks of the teeth often appear to be longer and are sometimes more sensitive, e.g. on toothbrushing. These changes are normal. During the inflammatory phase of the periodontitis the destructive processes were masked by the inflammatory swelling; when the inflammation subsides they then become visible.

The exposed dental necks are thus the consequence of the years of inflammation and not the result of sudden gum loss. While the hypersensitivity usually disappears of its own accord the aesthetic correction of exposed dental necks is more difficult and belongs in the hands of a specialist.

Periodontitis can reduce life expectancy

We know with certainty to-day that periodontitis reduces quality of life and life expectancy not only in heart valve patients. However, for historical reasons, this disease often does not receive the necessary attention from dentists. In addition, the readily treatable early stages of the disease are often not visible to the naked eye and must therefore be specifically looked for. As a complete periodontal status is too time consuming for routine use in many dental surgeries this has led to the development of screening tests which are faster to perform. One of these is the PSR recommended by the ADA (American Dental Association) which provides information on the presence or the course of periodontal disease in only a few minutes.

Early detection of periodontitis belongs in the hands of the dentist and should be performed routinely in every patient. This would make it possible not only to avoid high consequential costs resulting from tooth loss and dental caries but also to increase quality of life and life expectancy. It is even more important in heart valve patients because in these patients any infection can be life-threatening. The advances of dental medicine should be utilized and implemented on a broad basis.

Dr. med. Andreas C. Bortsch, Am Adels 4, 40883 Ratingen/Germany (2005) 

Notice to patients:
Please speak to your doctor before taking any medication other than that which has been prescribed by him. Please always tell the pharmacist that you are on oral anticoagulation therapy when purchasing any medication over the counter. This also applies to creams and gels as well as to tablets.

Speak to your doctor before applying any therapy subsequent to the aforementioned information.

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