World Oral Health Day (WOHD), 2016

World Oral Health Day is celebrated every year on March 20. As declared by the FDI World Dental Federation, it is an international day to celebrate the benefits of a healthy mouth, to promote worldwide awareness of issues pertaining to oral health and to highlight the importance of oral hygiene. The theme this year is ‘It all starts here. Healthy mouth, healthy body’.

Oral health refers to the health of the mouth, which includes the teeth, gums, and supporting tissues. Taking good care of these tissues can prevent disease in them and, in turn, protect one’s general health. Good oral healthwhich implies better oral hygieneis crucial to living a comfortable life.

Gum disease (periodontal disease) is one of the most prevalent diseases and also the major cause of tooth loss. Statistics show that approximately 95% of the adult population in India suffers from gum disease. The American Dental Association found that advanced gum disease, or periodontitis, is related to diseases of the body, and determined that people with advanced gum disease are 40% more likely to have a chronic health condition.

Gum disease is primarily caused by plaque, a colourless, sticky film that builds up on the teeth and contains different types of bacteria. If plaque is allowed to accumulate, it begins to calcify and develops into a hard coating in the form of calculus or tartar. Early symptoms may include gum swelling, bleeding gums, tenderness over the gums and bad breath. At this point, gums may be loose but are still attached high on the teeth. This inflammation of the gums is called gingivitis and is the first stage of gum disease.

When gingivitis is left untreated, calculus slowly begins to break down the gum and bone support of the teeth, leading to formation of a ‘periodontal pocket’ between teeth and gums. It is followed by bone destruction. This advanced stage is called periodontitis. As the disease progresses, more amount of bone gets destroyed, the teeth loosen and eventually fall out, or may need to be extracted.

Periodontal disease is often ‘silent’, meaning symptoms may not appear until an advanced stage. Also, there are associations between it and certain other systemic conditions.

Heart disease: Individuals with severe periodontal disease are almost twice as likely to have cardiovascular disease as those with healthy gums. It is believed that bacteria from inflamed gums can enter the bloodstream and stimulate production of certain proteins that can affect the heart by causing blood platelets to stick together, leading to clot formation. Thickening of the arteries (atherosclerosis) can lead to obstruction of blood flow, resulting in heart attack or stroke. Studies have also established that aggressive treatment of gum disease can reduce the incidence of atherosclerosis.

Diabetes: Diabetes is a metabolic disorder in which the body does not produce or properly use insulin, resulting in increased blood sugar level. Gum disease is considered as one of the leading complications of diabetes. The link between diabetes and periodontal disease is a two-way relationship, where diabetes increases incidence and severity of periodontal disease and where severe periodontal disease increases insulin resistance, leading to poorer glycemic control over time. Patients with poorly controlled diabetes are about three times more likely to get periodontal disease than non-diabetics, as the bacteria from the gums thrive on the glucose-rich bloodstream. Smoking increases the risk of periodontal disease tenfold for diabetics. A number of intervention studies have shown that treatment of periodontal disease improves glycemic control.

Pregnancy: Research has suggested that women with severe periodontal disease during pregnancy may be at increased risk for having premature or low birth-weight babies. Oral bacteria release toxins, which reach the placenta through the mother’s bloodstream and interfere with the growth and development of the foetus. At the same time, the oral infection causes the mother to produce labour-triggering substances too quickly, potentially inducing premature labour and birth. These complications may be reduced through proper oral health care and early treatment of gum disease.

Additionally, emerging evidence suggests that gum disease may be linked to many other systemic conditions including respiratory diseases, osteoporosis, kidney diseases, Alzheimer’s disease and arthritis.
 Treatment of periodontal disease depends on how much damage it has caused. Since periodontitis affects more than just the gums, it cannot be controlled only with regular brushing and flossing. The primary goals of periodontal treatment are to promote reattachment of healthy gums, to reduce swelling, depth of pockets, risk of infection, and stop further damage. Treatment of periodontal disease is often extensive and requires a systematic approach by a periodontist (specialist for gum diseases). Prevention is key to maintaining good oral health and avoiding the risk of gum disease and other possible systemic conditions.
 Scientific studies have proven a molecular level link between gum diseases and systemic conditions. So, a gum infection is one of the many potential risk factors for a number of systemic conditions. Fortunately, it is a modifiable risk factor, which means we can prevent the fatal impact of gum diseases on various systems.