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What is the Major Cause of Tooth Loss In Adults?

Periodontal Disease

 Not only Periodontal Disease is the number one reason for tooth loss, research suggests that there may be a link between periodontal disease and other diseases such as, stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy.  Researchers are determining if inflammation and bacteria associated with periodontal disease affects these systemic diseases and conditions.  Smoking also increases the risk of periodontal disease.

Four out of five people have periodontal disease and don’t know it! 

Since periodontal disease is usually painless, very few patients know about it and very few dentists speak about it.

Actually, most people think that cavities are the main cause of tooth loss.

The same way most cancers are not detected until patients start feeling pain, periodontal disease remains mostly undetected until pain or tooth mobility or receding gums appear.

In very few countries in the world, dentists are sanctioned for not informing their patients about the importance of periodontal disease. Unfortunately, in most of the European countries, the vast majority of patients having the painless periodontal disease totally ignore the fact that they are gradually losing their teeth even though they go to their dentists for a checkup or cleaning once or several times a year. This Supervised Neglect by some general dentists leads to a huge number of tooth loss every year.

Periodontal disease can refer to any condition that affects the supporting bone, gums and other structures supporting your teeth. However, bacteria cause the most common forms of periodontal disease. These bacteria grow in a film called BACTERIAL Plaque that sticks on the tooth surfaces next to the gums. The bacteria can cause inflammation and infection.

Indeed, periodontal disease begins when the toxins found in the bacterial plaque start to attack the soft or gingival tissue surrounding the teeth. This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection. As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums. The response of the body is to destroy the infected tissue, which is why the gums appear to recede. The resulting pockets between the teeth deepen and, if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.

The word periodontal means “around the tooth”. 

Periodontium, showing the periodontal ligament attaching the cementum of the tooth root to the alveolar bone of the socket; the collagen fibers of the ligament are grouped into bundles.

Periodontal disease is diagnosed by your dentist during a periodontal examination.  This type of exam should always be part of your regular dental check-up.

Since periodontal disease attacks the bone that supports your teeth, special low-dose digital radiographs using the long-cone parallel-technique are used. Up to 14 precise low-dose radiographs are used by your periodontist (bone and gum specialist) to detect bone loss on all your teeth. Using digital radiographs reduce by more than 90 percent the dose of radiation, thus not only protecting the dentists but also the patients.

A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums.  The depth of a healthy sulcus measures three millimeters or less and does not bleed.  The periodontal probe helps indicate if pockets are deeper than three millimeters.  As periodontal disease progresses, the pockets usually get deeper.

Your periodontist will use special low-dose digital long-cone parallel-technique precision radiographs, pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

Gingivitis

Gingivitis is the first stage of periodontal disease.  Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.

Bacterial Plaque is a sticky film of bacteria that includes food debris and saliva.  It is not easy for patients to see the bacterial plaque that accumulates on the crown of your teeth. Therefore, practically nobody could know for how many days the bacterial plaque has been accumulating on the teeth.

Bacterial plaque should be removed by patients on a daily basis using very precise flossing and brushing techniques that your periodontist will teach you.

When the dead bacteria and food debris become calcified and hardened, they turn into calculus (tartar). 

When plaque and calculus are not removed, they begin to destroy the tooth-supporting bone and gums.  Gingivitis could lead to red, swollen, and bleeding gums.

Periodontitis

As calculus and plaque continue to build up, the gums begin to recede from the teeth.  Deeper pockets form between the gums and teeth and become filled with bacteria and pus.  The gums become very irritated, inflamed, and bleed easily.  Slight to moderate bone loss may be present.

Advanced Periodontitis

The teeth lose more support as bone, periodontal ligament and gums continue to be destroyed.  Unless treated, the affected teeth will become very loose and may be lost.  Generalized moderate to severe bone loss may be present.

 How to Treat Periodontal Disease?

A simple cleaning by a general dentist once or twice a year is NOT the appropriate definitive treatment to prevent periodontal disease and tooth loss!

Periodontal treatment methods depend upon the type and severity of the disease.  Your periodontist will evaluate for periodontal disease and recommend the appropriate treatment.

Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues.  When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!

If the disease is caught in the early stages of gingivitis, and no damage has been done, scaling should be sufficient only if you have been thought the proper technique to mechanically remove the bacterial plaque on daily basis.  

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended. 

Scaling and root planning (SRP) are done either one quadrant of the mouth at a time while the area is numb or as a full-mouth disinfection in one or two consecutive days.

In this procedure, toxins, tartar and plaque are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing).  This procedure helps gum tissue to heal and pockets to shrink.  Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.

If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to add bone grafts to regenerate the lost bone but also to reduce pocket depths, making teeth easier to clean.  

Maintenance

It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)!  Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.

Once your periodontal treatment has been completed, your periodontist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year.  At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. 

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

Mouth-Body Connection

Research studies have shown that there is a strong association between periodontal disease and other chronic conditions such as heart disease, pregnancy complications, respiratory disease and diabetes.

Common cofactors associated with periodontal disease:

Heart Disease

There are several theories which explain the link between heart disease and periodontitis.  One such theory is that the oral bacteria strains which exacerbate periodontal disease attach themselves to the coronary arteries when they enter the bloodstream.  This in turn contributes to both blood clot formation and the narrowing of the coronary arteries, possibly leading to a heart attack.

A second possibility is that the inflammation caused by periodontal disease causes a significant plaque build-up.  This can swell the arteries and worsen pre-existing heart conditions.  An article published by the American Academy of Periodontology suggests that patients whose bodies react to periodontal bacteria have an increased risk of developing heart disease.

Pregnancy Complications

Women in general are at increased risk of developing periodontal disease because of hormone fluctuations that occur during puberty, pregnancy and menopause.  Research suggests that pregnant women suffering from periodontal disease are more at risk of preeclampsia and delivering underweight, premature babies.

Periodontitis increases levels of prostaglandin, which is one of the labor-inducing chemicals.  Elevated levels prostaglandin may trigger premature labor, and increase the chances of delivering an underweight baby.  Periodontal disease also elevates C-reactive proteins (which have previously been linked to heart disease).  Heightened levels of these proteins can amplify the inflammatory response of the body and increase the chances of preeclampsia and low birth weight babies.

Respiratory Disease

Oral bacterium linked with gum disease has been shown to possibly cause or worsen conditions such as emphysema, pneumonia and Chronic Obstructive Pulmonary Disease (COPD).  Oral bacteria can be drawn into the lower respiratory tract during the course of normal inhalation and colonize; causing bacterial infections.  Studies have shown that the repeated infections which characterize COPD may be linked with periodontitis.

In addition to the bacterial risk, inflammation in gum tissue can lead to severe inflammation in the lining of the lungs, which aggravates pneumonia.  Individuals who suffer from chronic or persistent respiratory issues generally have low immunity.  This means that bacteria can readily colonize beneath the gum line unchallenged by body’s immune system.

Diabetes

Diabetes is characterized by too much glucose (or sugar) in the blood.  Type II diabetics are unable to regulate insulin levels which means excess glucose stays in the blood.  Type I diabetics do not produce any insulin at all.  Diabetes is a serious condition which can lead to heart disease and stroke.

A research study has shown that individuals with pre-existing diabetic conditions are more likely to either have, or be more susceptible to periodontal disease.  Periodontal disease can increase blood sugar levels which makes controlling the amount of glucose in the blood difficult.  This factor alone can increase the risk of serious diabetic complications.  Conversely, diabetes thickens blood vessels and therefore makes it harder for the mouth to rid itself of excess sugar.  Excess sugar in the mouth creates a breeding ground for the types of oral bacteria that cause gum disease.

It is well documented that people who suffer from diabetes are more susceptible to developing infections than non-diabetes sufferers.  It is not widely known that periodontal disease is often considered the sixth complication of diabetes; particularly when the diabetes is not under proper control.