Brain Health and Periodontitis

As part of SCI’s vision to drive authentic conversations about quality-of-life for the elderly, we will publish posts throughout the year that focus on best-in-class organizations that are committed to a future of healthy and happy seniors.

In our second article on oral health, we explore gum inflammation (gingivitis), the loss of alveolar bone (periodontitis), and the links between oral health with general and brain health. As with most health matters, prevention is crucial so TePe Oral Hygiene Products AB has provided oral care tips and recommendations to help prevent and reverse periodontal disease below. In the event that you suspect gum inflammation, contact your dental professional for further advice and service.

Periodontitis definition

Periodontal diseases are infections which affect teeth and gums, and are prevalent in some form in about 20-50% of the global population (Nazir, 2017). The diseases affect adolescents, adults, and older individuals and is a serious cause of public concern. Smoking, lack of proper oral hygiene practices, medication, age, stress, and genetics are some risk factors related to periodontal diseases. While tooth loss, dental cavities, and gum disease are common, they are not part of normal aging (An 2009).

Periodontitis and Alzheimer’s disease

Increasingly studies are showing links between periodontal diseases and Alzheimer’s disease. In January 2019, a new study published in the journal Science Advances researchers found evidence of DNA and toxic enzymes, known as gingipains, released by P. gingivalis, the bacterium which causes adult periodontitis in the brain tissue, spinal fluid, and saliva from people with diagnosed with and suspected to have Alzheimer’s disease. Within some trials, the scientists tested drugs that blocked gingipains and found they were able halt the neurodegeneration (Dominy et al, 2019). In another study jointly led by the University of Southampton and King’s College London, “a link was found between gum disease and greater rates of cognitive decline in people with early stages of Alzheimer’s Disease. The presence of gum disease was associated with a six-fold increase in the rate of cognitive decline in participants over the six-month follow-up period of the study”.

Periodontitis causes

Our mouths are full of bacteria. Some of these are naturally occurring and essential to maintaining a healthy oral-ecosystem. Others are destructive and grow on particles of food which are not fully removed during brushing and rinsing. These bacteria, along with mucus and other particles, form a sticky, colourless “plaque” on teeth. Plaque that is not removed can harden and form “tartar” that only a professional can clean. Over time, tartar becomes increasingly harmful and causes inflammation of the gums which is known as ‘gingivitis’. Some symptoms of this disease are bleeding and swollen gums. With daily brushing, flossing, and professional cleaning, gingivitis can be reversed. If left unchecked, however, it can worsen and lead to periodontitis. “In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.” (NIH, US)

Periodontitis Stages, Prevention and Treatment

According to TePe Oral Hygiene Products AB, one should take note of the following symptoms as they may be indicative of periodontitis:

Healthy gums

Healthy gums are pale, pink and firm. There is no bleeding when you brush or clean between your teeth.

Small fibres, the periodontal ligament, hold the tooth in its socket. The gum tissue covers the bone and fits firmly around the tooth like a collar. The small crevice between the tooth and the gum tissue forms the gingival sulcus.

Gum inflammation

An inflamed gum tissue is characterised by redness and swelling. The gums may bleed when you brush or clean between your teeth.

A sticky film, bacterial plaque, constantly forms on your teeth. If you don’t clean properly, plaque will be left behind, especially between the teeth and along the gum line. When plaque accumulates in these areas it causes gum inflammation.

Periodontitis

If the bacterial plaque is not removed, it grows in the gingival sulcus where the toothbrush or interdental brush does not reach. On the root surface of the tooth, the plaque hardens into tartar with a raw surface where bacteria attach even easier. As the supporting bone gradually breaks down, the tooth loses more and more of its attachment. The gum inflammation has developed into periodontitis.

It is a slow process, often unnoticed and without pain. To arrest the loss of attachment, professional treatment is mandatory. Untreated, the bone loss will continue to progress. In time the tooth will become loose and in the worst case may be lost. Smoking, heredity and some systemic diseases are factors that may enhance the risk of developing periodontitis.

Prevention and treatment

TePe Oral Hygiene Products recommends good oral hygiene habits to prevent gum inflammation and periodontitis. Periodontal disease can be hard to detect, so be observant of visible signs such as redness, swelling and bleeding gums. If you suspect gum inflammation, contact your dental professional. The professional treatment includes deep cleaning and removal of plaque and tartar. You will also get oral hygiene advice, recommendations of suitable cleaning devices and instructions about their use.

The cooperation between you and your caregiver is of utmost importance for a successful result, even after treatment is completed. Regular checkups in combination with your own home care are crucial to prevent the problems from coming back.

Toothbrushing

Brush the inside, outside and biting surfaces of the teeth with a toothbrush and fluoride toothpaste, every morning and every night. Angle the brush so that the filaments reach the gum line. Brush with light pressure using small movements

Brush between your teeth

If you have gum inflammation or periodontitis it is even more important to clean between your teeth, where the toothbrush does not reach. An interdental brush is efficient and easy to use. Use every day, even if the gums are sore and bleed.

Choose the right brush size

It is important to use an interdental brush of the right size. Your dental professional can help to select the correct brush size/sizes for you.

A brush of the right size should fill the interdental space and present some resistance when inserted, but should not be forced into the space. Move the brush back and forth a few rimes in each interdental space. Look in the mirror for easier use.

Check your brushing technique

Plaque is difficult to see, especially between the teeth. You can easily check if all areas have been properly cleaned by using a disclosing tablet. Red colour shows new plaque and blue old plaque.

Oral health cost effectiveness

Gum inflammation and periodontitis can be prevented through good oral hygiene. Professional deep cleaning and removal of plaque and tartar may be an expensive but a necessary investment in the long run. The cost of treating periodontitis and related diseases is far greater than seeking professional help for treating early symptoms or even getting appropriate advice on oral hygiene practices, recommendations of suitable cleaning devices and instructions about their use. “Studies have shown that for every dollar spent on preventive dental care – $8 to $50 can be saved in restorative and emergency treatments” (College of Dentistry, UIC).

For older individuals who seek professional treatment, the cooperation with caregivers is of utmost importance to ensure a successful outcome, even after the completion of the treatment. Regular check-ups in combination with one’s own care provider is crucial to prevent the problems from coming back.

With age, the body’s resistance to diseases is reduced, in part due to the natural process of ageing but sometimes exacerbated by side-effects of medication, other ailments, or negligence of overall health and hygiene. Amongst seniors, oral health often sees significant deterioration due to disregard, forgetfulness, and stigma (Gil-Montoya et al, 2015). However, ensuring good oral hygiene is not difficult and investing a few extra minutes in the oral care routine goes a long way in protecting the mouth and the body against diseases.