Dental Hygiene 101: Let’s Talk About Gum and Bone Health

In my last Dental Hygiene 101 article I focused on tooth decay and how to prevent it. Now let’s focus on the support system that holds our teeth in place, the periodontium. While tooth decay starts in toddlers and is a concern throughout life, the destruction of the periodontium takes longer and is sometimes not noticed until middle age.

Have you been to the dental hygienist and had “probing” done? Has the hygienist reported how many 3s, 4s, and 5s you have? If so, then your hygienist is measuring the space under your gums to evaluate the health of the periodontium.

Anatomy and Function of the Periodontium

Gingiva (Gums)

When flossing (insert hopeful, smiling face here), have you noticed that under the gums there is a stopping point where the gum feels attached to the tooth? This stopping point is a type of biological barrier that prevents bacteria from affecting the bone and entering the bloodstream.

Alveolar Bone

The bone of the maxilla and mandible contains sockets that your teeth sit in. The deeper the roots of the teeth are in the boney socket, the more stable the tooth is. Think of a post in the ground, the deeper it is, the more stable the post is.

Periodontal Fibers

Have you noticed that your teeth move slightly when you clench them or eat something hard? While the teeth sit in bone sockets, they are connected to that bone by small fibers. These fibers serve as little shock absorbers and allow slight movement of the teeth within the socket.

The Periodontal Diseases: Gingivitis and Periodontitis

Keeping these support structures healthy is important to your oral and systemic health! Periodontal disease is an inflammatory disease caused by bacteria; the bacteria is in the sticky white plaque that develops when you haven’t brushed your teeth… and makes them feel like they are wearing little sweaters!

Periodontal disease starts as a reversible infection of the gums, known as Gingivitis. Left untreated, it may progress to an irreversible infection of the bone, known as Periodontitis. As bacteria infect the gums, the gum pulls away from the tooth and a deeper space is created where more bacteria collect. As a response, the gums become inflamed, sensitive, and bleed.

Eventually, the bacteria effect the bone supporting the tooth and the bone is destroyed. Without the boney support, the tooth loosens and is eventually lost. This inflammatory process affects your entire body!

Contributing Factors

Blood glucose levels have an effect on Periodontal disease. Diabetes and Periodontal disease have a bi-directional relationship. Uncontrolled glucose levels promote bacteria and inflammation; the infection from Periodontal disease can increase glucose levels.

Smoking contributes to the destruction of the periodontium by constricting blood vessels, reducing blood flow to the periodontium. This limits the oxygen and nutrients available, which reduces the body’s natural healing process.

Prevention

Prevention starts with the daily practice of bacterial plaque removal both at the gumline and under the gum, in the space between the gum and the tooth.

For plaque removal at the gumline, an electric (also called power) toothbrush provides better plaque removal than a manual toothbrush. Toothbrushes, manual or electric, remove plaque mostly from above the gum.

For plaque removal under the gum, flossing when done correctly is an effective choice, but it is not the only choice (YAY!). Other options include:

• For teeth with a lot of space between them, using thicker “interdental” cleaners helps. Examples are Proxabrushes, Superfloss, Dr’s Picks, and Stimudents.
• For teeth that are too tight for floss, options include Waterpiks and Water Shower Flossers. Both use pulsing water to help flush plaque from larger spaces between teeth and under the gums.

Professional Care

The diagnosis of Periodontal disease is made by assessing periodontal probing scores and bone levels as seen on dental x-rays. As with all things health-related, early diagnosis is critical. Professional cleanings by a licensed dental hygienist are essential to prevention and early diagnosis. As plaque hardens into tarter, the tarter serves as a reservoir for more bacteria. Having light amounts of calculus removed during a routine cleaning is painless and more affordable.

It’s interesting to note that there is no science backing the recommendation for twice a year cleanings; some people can go a year or more without a cleaning while some require 3- or 4-month cleanings. The twice-a-year protocol was based on a 1920s Pepsodent campaign encouraging people to brush their teeth regularly and visit the dentist “twice a year.”

Access to Professional Care

As we age, access to care can become a challenge. Fixed finances and limited mobility can make access to professional care difficult. One solution is to utilize teaching institutions. If you don’t have a dental school near you, check the local community colleges; many have Dental Hygiene programs where you can have preventative care and often a screening by a dentist.

While this takes more time, students are closely supervised by licensed dental hygienist faculty and treatment is thorough. If your ability to visit an office is a barrier to care, some states have mobile dental hygiene services where dental hygienists and dentists bring mobile equipment to homes and care facilities. Google “mobile dental hygiene care” to find possibilities.

Let’s Have a Conversation:

Do you go to routine dental checkups? Have you had to deal with gingivitis or periodontal disease?