Between 8 and 9 out of 10 people over the age of 35 have gum disease: gingivitis or periodontitis. The latter is the main cause of tooth loss in adults and, according to the WHO, it ranks as the sixth chronic pathology in the world, behind caries.
And yet, approximately half of the European adult population (including Germany, Spain, France, Italy and the United Kingdom) does not know what it is, as indicated by a study presented last June. For example, in Spain, the percentage of ignorance reaches 51%. In the same work, it is observed that this ignorance drops to around 35% at high educational and socioeconomic levels.
40% of adults suffer from periodontitis
It is justified to start, then, by explaining how the two ailments mentioned differ. While gingivitis is inflammation of the gums, caused in most cases by bacteria, periodontitis also causes bone loss around the teeth. 40% of the adult population suffers from this immunoinflammatory infection –also caused by bacteria–, and 10% suffer from it in an advanced or severe form.
That half the population ignores what periodontitis is is surprising. First of all, it not only affects the masticatory function, due to the initial loss of posterior teeth, but also worsens the aesthetic appearance. Its symptoms –recession or loss of gums around the teeth and the displacement of these– compromise the smile and reduce self-esteem.
But it is also that it has consequences on health at a general level, since chronic inflammation is not limited to the gums, but transcends the rest of our body.
Scientific evidence, especially since the 1990s, confirms that patients with advanced periodontitis have a higher risk of suffering from other very important systemic diseases, such as acute myocardial infarction, diabetes – which makes its control difficult – or aspiration pneumonia. It also increases the chances that pregnant women will have a premature birth. And recently, the list has increased: associations with hypertension, Alzheimer’s and even some types of cancer have been shown.
An exacerbated inflammation
What is the reason for this trail of sequels? When a patient suffers from advanced periodontitis, their immune system has responded powerfully to bacterial aggression through inflammation. Specifically, the presence of anaerobic gram-negative (G-) bacteria in the gingival sulcus, the space between the gum and the tooth.
The aforementioned microorganisms, present in the biofilm or oral bacterial biofilm, have the capacity to colonize the tissues that make up the gum; it is in them where the exacerbated inflammatory response occurs. This natural reaction to the aggression of microbes has consequences, both in the mouth and in the rest of our body.
Locally, the invasion of bacteria and their toxins produces an attraction of defense cells and proteins. As a consequence, a cascade of powerful inflammatory mediators is generated that destroy the collagen present in the gum and bone. This is what deteriorates the insertion and support of the teeth.
Secondly, several mechanisms can affect other organs of the body, but mainly two: the presence of the G- bacteria themselves and their toxins in the blood vessels, which damages their internal structures; and the circulation of inflammatory mediators through the blood, which stimulate the development of said inflammation in the placenta, pancreas, etc.
From diabetes to gastrointestinal cancer
When it comes to diabetes, advanced periodontitis increases insulin resistance, leading to poorer management of the disease. It also generates an increase in C-reactive protein levels – a marker of inflammation – and blood pressure: both indicate the risk of suffering cardiovascular accidents.
Regarding the moderate association with Alzheimer’s, it is more important when the existence of Porphyromonas gingivalis (the main bacteria of periodontitis) in the brain. Likewise, it has been observed that the high and continuous presence of another fundamental microorganism in the development and progression of this ailment, Fusobacterium nucleatummay increase the risk of gastrointestinal cancer.
Elementary hygiene measures
Now for the good news: periodontitis prevention is easy. This should include good oral hygiene to remove oral plaque bacteria twice a day by brushing for two minutes – the electric toothbrush can be very helpful – and the use of dental tape and interdental brushes.
Of course, we also need to regularly remove bacteria in a dental clinic with sonic, ultrasonic or manual devices. And it is essential that a periodontist or dentist diagnose the state of health of your gums to avoid greater evils.