The Bacteria Knife

January 2008

By: Dr. Scott R. Harden

With the beginning of the new year comes the opportunity of new beginnings, new hopes and new promises. We adopt new diets, new workout plans, better habits, more time at church, etc. However, the bacteria in our mouths don’t adopt any new year resolutions and in fact just keep on doing what they’ve done all along – creating cavities in our teeth, and infections in our gums and supporting bone. Without proper oral care, bacteria can cause inflammation of the gums (gingivitis), penetrate the gum line and finally spread into the underlying bone (periodontitis).

Bacteria are essentially parasitic organisms that reside in our mouths using us as a host for a food source. The food we eat is metabolized by the bacteria and in turn processed into an acid byproduct. This acid essentially creates what I would term the “bacteria knife”, which causes gum recession, and separates our gums away from our teeth, by unzipping the natural ligament attachment that holds the tooth in the bone. This open wound is a breeding ground for bacteria to multiply, and with the root now exposed, clumps of bacteria colonize on the root surfaces creating a sand paper like surface. This rough surface prevents our body from healing (without professional intervention) and will not allow the gum tissue to reattach to our bone. Over time gum disease causes infection and pus and gets so bad the jawbone supporting our teeth erodes away and leaves us with loose teeth and abscesses. The result is tooth loss. Sadly, this problem is still seen every day in dental offices with people from all socioeconomic backgrounds. Gum disease progresses very slowly and typically without pain or obvious symptoms. The best assessment is by your dentist, using an instrument called a “periodontal probe” to measure “pockets” around every tooth to diagnose health or infection from the effects of the bacteria knife.

Quiz Time: What percentage of adults has gum disease? Statistics show over 80% of the adult population has some level of gum disease. That is an amazing statistic. To realize eight out of ten adults is walking around right this minute with gum disease – harmful bacteria in their mouths that are causing infection and damage to their teeth and supporting bone. Gum disease is the most common disease of humans. This is truly an epidemic problem in the United States and the entire world population. What’s even more amazing is that this is the same percentage quoted to me back in the 1980’s while I was in dental school at Emory University. It has been known for two decades that brushing and flossing can prevent the development and progression of periodontal disease by removing bacterial plaque deposits. Yet, the problem continues at the same rate and frequency as in the past, despite the fact that Colgate-Palmolive sold over $6 billion in annual gross sales for toothpastes and toothbrushes in one year. More access to dental care products, more media information, more dentists with better skills and technology, more awareness overall about brushing and flossing requirements – yet gum disease still ranks right where it always has. Gum disease is responsible for the majority of tooth loss in the world. Gum disease may be a risk factor for a number of serious health conditions such as heart disease and stroke, pneumonia and other respiratory diseases, diabetes and premature or low birth weight babies. Given all the facts and potential for tooth loss and dentures to follow, the majority of people are still not adopting good oral hygiene habits.

There are several factors that lead to periodontal disease. The two major predisposing factors are poor oral hygiene and increasing age. Other factors include hormonal effects, with a worsening of the disease activity during puberty, menstruation, and pregnancy. Diabetes mellitus causes an increased incidence, particularly in juvenile diabetic patients. Finally, various genetic disorders are associated with an increased incidence of periodontal disease.

What you can do? Simply brush two minutes twice a day, floss your teeth properly twice a day with a recommended toothpaste and gum disease will stay away. Stop this daily routine and you will likely develop gum disease. If you have gum disease (and there is an 8 out of 10 chance that you do) and/or are at risk for heart disease, stroke or respiratory diseases, it is particularly important to pay attention to your oral health. With regular, proper oral care, gum disease can be controlled and sometimes even stopped or reversed. Professional treatment of gum disease with ultrasonic instruments, site specific antibiotic placement and meticulous care from a hygienist will help you to eliminate infection if it occurs in your mouth. Visit your dentist at least two times a year for a regular check up for gum disease and use your dentist and hygienist as a means of staying motivated to floss and brush properly every day. The dentist may advise additional dental products or techniques specific for your needs to help you stay healthy and free of gum disease.