Bacteria, Periodontal Disease & Your Health

Bacteria are in my mouth?
Yes, many, many, bacteria enter your mouth every time you put anything in your mouth, eat or drink, kiss, swim, or even brush your teeth!  These are reasons why you want to wash your vegetables, fruit, meats, etc. before cooking, refridgerate or freeze foods promptly, select carefully who you are intimate with, and clean and change your toothbrush regularly, for starters.  Although your mouth will never be completely bacteria-free, it is important to keep the level of bacteria as low as possible. 

What is a bacterial infection and how does it effect my health?
Simply, it is a response from your body that too many bacteria are collected in one place and the body is having a hard time tolerating them or destroying them.  First, it is important to mention that bacteria are living organisms.  They eat (sugars), and they produce waste products.  It is usually the waste products that irritate your body the most.  In your mouth, these are strong acids.  There are many different breeds of bacteria and, therefore, varying levels of pathogenicity (harmfulness) associated with these different types.  Incidentally, these various acids are the chemicals that burn holes in tooth enamel which we refer to as cavities.  So, if these are strong enough to burn a hole into the hardest structure in your body, imagine how they will harm one of the most tender tissues in your body--your gums.  These acids break down the layers of tissue and form sores at the site of infection.  Often these are very tiny and often undetected (without pain) by the host.  These are portals (doorways) for bacteria to enter into your body and bloodstream.  They like the bloodstream because there is food (blood glucose) and even oxygen for the Staphylococcus Aureus bacteria, the most common form found to influence heart disease, atherosclerosis (hardening of the arteries) and cerebral vascular accidents (strokes).

What is gingivitis and periodontal disease?
These are infections of bacteria in the periodontium (the tissues which support and anchor the teeth in your jawbones).  The bacteria mentioned above, especially certain types that prefer dark, warm, unoxygenated environments, move into the area between the tooth and the gum.  This space is called the sulcus.  

What is most relevant is how the body responds to this presence of bacteria.  This depends upon the host's resistance. Resistance depends upon the person's immune system strength, the level of nutrition in one's diet, the level of stress and the amount of sleep in one's life, and the frequency and thoroughness of one's oral hygiene routines.  Some other obstacles can be systemic health conditions, the use of medications, smoking, alcohol consumption, and high acid contents in one's diet (especially coffee).  

So the acids penetrate the gum tissue and the raw sores trigger the body to try to heal itself.  It will first try to repair the tissue as it would a cut on your finger, with red and white blood cells often eliciting a swelling and redness--Gingivitis.  Now the clock starts, because the body gives a certain amount of time for this process.  Each person's time limit will be unique to them; this may depend upon genetic factors, stress, nutrition, immune system strength, etc.  

If the body chooses it will need another approach, a second form of healing will be initiated.  The body sends 'receptor' cells to get identification of the 'foreign matter' that has invaded.  The bacteria have a cell wall that is made with a matrix of collagen, so the receptor cells report this information to the brain.  The brain sends a command to produce a chemical, an enzyme called collagenase, and deposit it in the sulcus where the bacteria are.  To some degree, this will destroy some of the bacteria, but research has found this not to be very successful overall, because so many people have periodontal disease which persists for years and years.  The unfortunate consequence of the body putting this enzyme into the sulcus is that this enzyme destroys any collagen it comes into contact with--and guess what the fibers (called the periodontal ligament) are made of that attach the gum to the tooth and anchor the tooth to bone ?  Collagen!  This is Periodontal Disease, a permanent loss of the attaching supportive structures for the teeth.  

How do I know if I have this infection?
Periodontal Disease will be noticeable when the gums are measured  during a periodontal examination where the dental hygienist measures how deep the sulcus space is.  A shallow measurement of 1 to 3 millimeters is ideal.  An absence of bleeding is also a good sign.  Healthy gums do not bleed when measured.  An exception to this rule is in smokers, who will have constricted blood flow to peripheral areas.  If measurements of 4mm or above are detected it will be important to identify the source of the problem.  More often it will be related to the presence of bacteria.  In selected cases, strong biting forces that aren't distributed equally can cause periodontal inflammation and destruction around the affected teeth.  Dr. McBride can evaluate your bite to rule out this possibility.

A microscopic bacterial examination can then provide progress in the diagnosis.  Because there are so many different breeds of bacteria, it is important to try to identify what type is causing the inflammation.  Some bacteria are easier to destroy than others, some are more harmful than others.

An examination of radiographs (x-rays) is necessary to look at the level of 'crestal' bone between the teeth.  Bone can appear lost horizontally or vertically.  Horizontal bone loss shows a loss of bone between many teeth, like plateaus.  Vertical bone loss involves single teeth and appears like there was a land slide in the direction of the involved tooth.  When bone loss is present, the dental hygienist will look for recession.  

Recession is the name for exposed root surfaces due to the loss of attachment.  Sometimes, though, recession can be present on the cheek sides of the teeth where bone loss is present but undetectable by the view of radiographs, it is seen visually.  This has been commonly referred to as toothbrush abrasion, although this manifestation is seen in the mouths of cats, dogs and monkeys that don't use toothbrushes.  This is not to say that one cannot do damage with a toothbrush, on the contrary!  But dentists now realize that there are other dynamics that contribute to recession, namely, the bite and function of the teeth.  If recession and a pocket in the sulcus is present, these measurements are added together to equal the total loss of attachment.

So what if I have Periodontal Disease?
Well, of course, you have the option to not do anything if you have Periodontal Disease, but two things could happen.  One is loss of teeth, eventually.  This can be slow or rapid, there is no way to predict from person to person.  The second is a risk of heart disease, atherosclerosis (hardening of the arteries), cerebral vascular accident (stroke), premature birth, low birth weight, or complications of diabetes.  These conditions, like tooth loss, are unpredictable and occur due to bacteremia, a consequence of periodontal disease lesions on the gum tissue.

The good news is that, contrary to what was believed years ago, periodontal disease is curable.  It was once thought that once you have it, there's no cure, your only hope is to maintain it.  But we have found that the infection is much like any other (Strep throat, conjunctivitis, bronchitis), with adherence to some home work like new brushing methods, flossing, using antibacterial brushing agents, rinses or irrigants, vitamins and doing these things as frequently as recommended, we have always seen success.  Of course, there can be individuals that need a hygienist's and periodontist's attention or treatment too to achieve an eradication of periodontal infection, but it is possible.  But the infection can return, much like the infections listed above that occur in other parts of the body, if you come in contact with enough bad bacteria again.  And, since, bacteria do enter your mouth many times throughout the day, it will be a good daily routine that maintains good dental health.  See "Periodontal Therapy" and "Home care instructions" for more information.

What is bacteremia?
This is what they call the presence of bacteria in the bloodstream, most often entering the body from diseased gum tissue in the mouth.  Obviously, this is not a good thing for the body.  Bacteria like it though, because they have everything they need and there really isn't anything that is going to kill them, at least in normal conditions.  The bacteria nest with sticky cholesterol lipids on artery walls and heart valves.  Sometimes these plaquey deposits can become dislodged and move through the arteries which can lead to a blockage of the artery, if this happens in the brain, a stroke occurs.  Bacteremia can complicate diabetes, yet control of Periodontal disease has been shown to improve diabetic condtions.  Also pregnant mothers with periodontal disease and bacteremia have a risk of premature or low birth weight babies.  For more information, skip back to "What is a bacterial infection..." (above).

What about antibiotics?
Antibiotics do destroy bacteria, but cannot be used daily without causing resistant strains of bacteria to form.  This is a global health issue which we would not want to encourage, so we don't resort to antibiotics except in the worst case scenarios.  As well, it really is a backwards solution to Periodontal disease.  Attack upon bacteria with floss, brush, rinse, irrigator, vitamins and time has been the most successful long term control of the health of one's mouth.  

BUT, there is a common use for antibiotics in dentistry for specific people.  This is prophylactic (pretreatment preventive) antibiotics for persons with a health history which indicates previous rheumatic fever, heart murmur, mitral valve prolapse or use of Phen-Fen.  Despite the fact that bacteremia can occur daily in individuals with Periodontal disease/Gingivitis while brushing, flossing, etc., bacteremia will be in a higher amount during and following a dental visit which involves periodontal measuring, exploration under the gum, cleaning under the gum or treatment into the pulp of a tooth.  Therefore, a patient with a health condition from the list above will be at risk of dangerously high doses of bacteria traveling through their bloodstream which could cause a fatal infection (bacterial endocarditis).  A bulk dose of an antibiotic taken 1 hour prior to their dental visit can prevent this infection from development and give everyone peace of mind.  This one time bulk dose has not been proven to influence to the bacteria into formation of resistant strains, so it is a safe regimen.  If you require prophylactic antibiotics, please call our office, disclose your health status and any allergies or medications you currently take, and Dr. McBride can prescribe the appropriate antibiotic and dose for you.

What is a periodontal abscess?
A periodontal abscess is a pocket of pus (white blood cells) and bacteria located at the base of a tooth's root.  It most commonly originates from bacteria which had been left undisrupted in the sulcus around a tooth for a  long enough period of time to cause loss of the attachment of the gum and the bone to the tooth.  A tooth with a periodontal abscess probably had a periodontal pocket measurement that was deeper than the host's toothbrush bristles, floss or other tools could reach into and keep clean.

If you believe that you have a periodontal abscess, schedule an appointment as soon as possible for Dr. McBride to evaluate.  If in fact it is a periodontal abscess, Dr. McBride may refer you to see a periodontist who would clean out the infection as well as make every attempt to save the affected tooth.

Sources:  written by Melisa Yeo, R.D.H., edited by Robert P. McBride, D.D.S., references to statistical information mentioned are available upon request.