When I ask that question maybe you thought of painful gum tissue surrounding a tooth. You could have been correct but in this case I really mean killing you, as in dying. Also, your bleeding gums may actually make the road to the grave a lot more painful than it needs to be. If you are interested in avoiding this cause of early death, keep reading.
Gum Disease and Inflammation
For reasons unknown to me, medicine and dentistry are at opposite ends of healthcare. Your medical insurance does not cover most of what happens in your mouth. Decaying teeth and bad gums are not covered by your health plans. Don't get me wrong, if it was covered, then dentistry might be going the way of the physicians’ offices (with long wait times and offices of unhappy patients). Physicians have little training in oral disease, as if what happens in the mouth doesn't affect the rest of the body. There could be nothing further from the truth.
Physicians do often talk about the need to reduce inflammation in the body. They are quick to prescribe anti-inflammatory medications all having many side effects. What would you say if I told you I had a way to reduce inflammation without any side effects? Interested??? Read on…
In reality, the mouth is the number one source of inflammation in the body. The reason for this is that your teeth are unlike any other part of your body. Teeth have a presence both inside and outside your body. The root of the tooth (which is inside your body) is encased in bone with a ligament called the periodontal ligament surrounding it. The crown of the tooth is the part of the tooth that you see. It is above the gum line and exists outside the body (yes-the inside of your mouth is outside of your body). The gum tissue is the tissue that covers the bone within your mouth and extends up onto the crown of the tooth. The tissue at the gum line is designed to form a gasket around each tooth. This gasket protects the periodontal ligament and surrounding bone from an invasion of anything that is in the mouth that can potentially cause breakdown of the system. This is where it all happens.
Understanding this gasket system is important to understanding the process of gum disease and how it affects systemic health. If you brush your teeth and your gums bleed, then it basically means you have blown a gasket. Your insides are leaking out (blood). I find it amazing at how most people don't think twice about their gums bleeding. If they had blood coming out of any other part of their bodies, there would be a very high level of concern. The reason gums bleed is because there has been some level of assault on the tissue. It is most often plaque, calculus (tartar) and food accumulation combined with an unhealthy dose of bacteria that are working its way into the gum tissue at the neck of the tooth. There are times when dentistry is the culprit. This occurs when dental restorations extend too far below the gum line and invade the attached tissue. The tissue wants to attach itself to the tooth but it can’t. This is similar to walking around with a splinter in your foot. In active periodontal disease (also called periodontitis) the surface area of affected tissue can approach 81 square inches. Imagine walking around with a festering wound on your body which is that large.
Are Bleeding Gums Bad?
So are bleeding gums that bad? If your eyes were bleeding would that be bad? Yes, it is bad. Gums bleed because of inflammation (I'm not sure why eyes bleed). The body begins to react to the invasion we spoke of earlier by increasing blood flow to the area. Your gums get red and puffy. In this condition, a tooth brush or flossing can easily make them bleed. Interestingly enough smoking increases the risk of gum disease though gums can bleed less because nicotine constricts blood vessels. This masks one of the signs of gum disease while affecting the disease process in a negative way. In general, any inflammation in the body is bad as increased levels of inflammation have been linked to many diseases.
The Process of Disease
How do infected gums cause systemic disease? There are two mechanisms that periodontal disease can potentially contribute to systemic illness:
1)The body responds to the invasion of the periodontal ligament by increasing levels of inflammatory proteins to fight the invaders. The reaction is triggered locally but these proteins travel through the circulatory system affecting all cells in the body. IL-1, IL-6, TNF and C-reactive protein (aka CRP it is often in the news) can all increase when there is a periodontal infection.
2) The second problem is that the invaders cause ulcerations in the gum tissue (which is why the gums bleed so easily as the holes are already there). Through these ulcerations bacteria can make their way into the circulatory system. Brushing teeth that are periodontally diseased can actually cause a transient bacteremia (bacteria in the bloodstream). These bacteria and the body’s response to it can wreak havoc on the system.
Periodontitis and Cardiovascular Disease
Cardiovascular disease is the leading cause of global deaths (31 percent of all deaths). Periodontal disease has been linked to cardiovascular disease. The bacteria associated with gum disease has been found in the clots in the heart of patients with acute myocardial infarction (heart attacks). The inflammatory protein CRP has been considered a marker for increased risk of cardiovascular disease. The higher the level of CPR in your blood the more at risk you are of a heart attack.
Periodontal Disease and Rheumatoid Arthritis (RA)
A patient of mine recently shared with me the story of a how a flare up of his RA was cured by treating his extensive gum disease. He is sure that the connection is real. He is a musician who was unable to play his music until he treated his gum disease.
Periodontal Disease and Diabetes
It is believed that the relationship between gum disease and diabetes is a two-way street. Diabetes increases the risk factor for gum disease and vice versa. Gum disease can contribute to insulin resistance which can contribute to diabetes and the inflammation in the mouth doesn’t make controlling blood sugar any easier. I once saw a patient with diabetes who had been unable to get his blood sugar under control for years. He came into the dental office after having one of his teeth fall out due to gum disease. A rampant untreated infection in his mouth spewing out toxins was causing his body to go into fighting mode to control it. Is it any wonder that his physicians were unable to get his diabetes under control?
It’s a Long List…
The list of other diseases thought to have a connection to periodontal disease:
• Chronic respiratory disease
• Ischemic stroke
• Pneumonia
• Chronic kidney disease
• Cognitive impairment including Alzheimer’s disease
• Metabolic syndrome
• Psoriasis
• Obesity
• Cancer-14% increase in risk with moderate periodontal disease
It really is quite a long list of diseases that have possible links to periodontal disease. Taking better care of your teeth and gums can go a long way toward keeping you healthy and is relatively easy. We can debate any of these connections that have been made between what goes on in your mouth and how it affects systemic illness, but we can’t debate the fact that keeping your mouth healthier is a good thing. I’ve never had a patient that was sorry for taking better care of his/her mouth.
The Treatment of Periodontal Disease
For some home remedies may help treat gum disease at an early stage, but these tend to be only effective at an early stage in the process. At the Center for Cosmetic Dentistry we treat of gum disease starting with a thorough evaluation of gum tissue by periodontal charting. This procedure measures pocketing and checks for bleeding around teeth. Deep pockets (greater than 4mm) are difficult to clean and maintain. Cleaning of teeth at the gum line and deeper cleanings of pockets below the gum line can reduce pocketing to some degree. Pockets which don’t respond to these cleanings are treated by either surgical or non-surgical procedures depending on the situation. The goal of periodontal treatment is to reduce pocketing and to reestablish the gasket at the gum line. Once this is achieved routine maintenance, which often means getting your teeth cleaned every 3 months, can keep gum tissue healthy.
So What This Means To You...
Yes, your gums can be killing you whether you wish to acknowledge it or not. You can choose to do something about it. You won’t go wrong if you start to take better care of your mouth today. So brush well, floss and see a dentist regularly. Make sure your dentist checks your gums for gum disease and if present get it under control. If you have any questions we are here to help. Make better choices today for a better life tomorrow.