Periodontal Disease - LPNI

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Periodontal Disease

LPNI Health Topic - June 2023

Periodontal disease is the result of inflammation and infection of the gums and bone that surround and support the teeth. In its early stages, called gingivitis, the gums can become swollen and red, and they may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out.

The World Health Organization’s data of periodontal disease are based on the Community Periodontal Index of Treatment Needs (1=bleeding on probing; 2=calculus; 3=periodontal pocket of four to five millimeters; 4=periodontal pocket of at least six millimeters). Within the limitations of data, one study found the distribution of periodontal disease increases with age. According to the Global Burden of Disease Study (2016), severe periodontal disease was the 11^th most prevalent condition in the world. The WHO Global Oral Health Status Report (2022) estimated that oral diseases affect close to 3.5 billion people worldwide. Prevalence continues to increase globally with inadequate exposure to fluoride (in the water and oral hygiene products such as toothpaste), the availability and affordability of food with high sugar content, use of tobacco products, and poor access to oral health care services in the community. In 2021, the 74^th World Health Assembly approved a resolution on oral health towards prevention and timely care.

When bacteria normally found in the mouth interact with starches and sugars in food long enough, a film called plaque forms. Plaque can cause gingivitis, the mildest form of gum disease. Without brushing, plaque eventually hardens to tartar, also called calculus. Tartar build-up can spread below the gum line, which makes the teeth harder to clean. Ongoing gum inflammation can cause periodontitis. Deep infection can cause a loss of tissue and bone. Ongoing chronic infection can put a strain on the immune system. Periodontitis has been linked to respiratory disease, coronary heart disease, and controlling blood sugar in diabetes due to the bacteria entering the bloodstream.

The warning signs of periodontal disease include bad breath or bad taste that won’t go away, red or swollen gums, tender or bleeding gums, gums that bleed easily when brushing teeth, painful chewing, loose or sensitive teeth, gums that have pulled away from the teeth, any change on how the teeth fit together when biting, and any change in the fit of partial dentures.

Factors that increase the risk for periodontal disease include smoking or chewing tobacco, recreational drug use such as marijuana or vaping, obesity, inadequate nutrition including vitamin C deficiency, poor oral hygiene, crooked teeth, defective fillings, medications that cause dry mouth, and certain diseases such as diabetes, rheumatoid arthritis, and Crohn’s disease.

Diagnosis is done by examination of the gums and noting any signs of inflammation. A tiny ruler called a probe can be used to check for and measure any pockets around the teeth. In a healthy mouth, the depth of these pockets is usually between one and three millimeters. An X-ray may be done to see whether there is any bone loss.

Keep gums and teeth healthy by brushing your teeth twice a day with fluoride toothpaste. Floss regularly to remove plaque from between the teeth. Stop using all forms of tobacco. Visit the dentist routinely for a check-up and professional cleaning.

Darlene Rueter, RN, St. Paul Lutheran Church Parish Nurse, Carroll, Iowa 51401, USA

LCMS Parish Nurse Representative for Iowa District West, USA

drrueter@gmail.com