Dr Tank talks bacteria and periodontitis
In the second of a 3-part blog our Specialist Periodontist, Dr Manoj Tank, follows on from his first blog, which introduced periodontal disease (gum disease) and the importance of good quality prevention techniques, with a more in depth look at periodontitis.
It’s us versus the bugs
Did you know that we have as many, if not more, bacteria in and on us than we have human cells? What a disconcerting thought. I once heard a man call into a popular breakfast radio station and declare himself not to be human but instead a ‘symbiont’. Symbionts are a combination of different species living together physically in harmony for each other’s benefit (‘symbiosis‘). You know what, as crazy as he did sound that morning, he was probably right.
We have trillions of bacteria living with us in their little communities. You are likely to have heard someone refer to bacteria in the gut as ‘good bacteria’. You’ve also heard of probiotic yogurts and you may even have come across probiotic tablets! What happens when you take antibiotics? Anybody had an upset stomach? Yes me too. Many antibiotics (‘broad spectrum antibiotics’) will impact all the bacteria in the body, good and bad. But as soon as the bacteria are gone, they will return! The question really is, when they return what sort of communities will they form? If they form good bacterial communities then we can rest and take a breather. But if those pesky bad bacteria win the race, we enter something know as ‘dysbiosis‘ – where the balance between the bacterial community and it’s human environment is no longer favourable. Upset stomach…
The impact of bacteria on our gums
So guess what (you’ve guessed it already haven’t you?) we have good bacteria in the mouth too. We need to help maintain that because the bad bacteria will come along eventually and grow upon the good bacteria (this complex of bacteria growing upon each other is called a ‘biofilm‘). This leads to a shift in the bacterial community, causing dysbiosis around our teeth (hopefully now it makes sense why I spent so much time talking about this in the previous paragraph)!
Once we have that, it becomes the war of bugs versus us. I’m sorry to say the bugs will probably win. So our body drafts in more and more white blood cells (our noble defence cells), but it needs to create space for them to fight the bugs – so our periodontal ligament (the bit that holds the tooth in its bone socket) gets broken down.
When more space is needed, the surrounding bone gets broken down too, forming gum pockets (effectively a Grand Canyon for the bacteria to live in between tooth and gum). And this keeps happening whilst we still have those bad bacteria active within the gums.
Eventually the tooth loses so much bone support that it becomes loose and ultimately the tooth could fall out all by itself. The above image shows this progression of periodontitis and the below example shows a case of advanced periodontitis with drifting and tooth loss.
Before we think about how to stop this terrible process in its tracks (this will be blog 3), I should just note some situations that could put someone at greater risk of developing periodontitis.
Risk factors for periodontitis
Smoking – there has never been a better time to stop smoking. We all know how harmful it can be to the body in general but it also has a big impact in the mouth. The worse problem is oral cancer, a debilitating disease which can result in permanent facial disfigurement and removal of important functional parts of your mouth (e.g your tongue). More commonly, smoking directly affects the bone surrounding your teeth and it creates an environment in your gums that is favourable to the growth of bad bacteria. Smoking speeds up the gum disease process 10-fold and prevents successful treatment outcomes too. See your doctor for the best smoking cessation advice and methods. E-cigarettes (or ‘vapes’) have now been officially recommended by Public Health England as a good first step in stopping smoking altogether alongside other well-documented and successful methods.
Diabetes – this disease affects the whole body in various ways. Controlling it is extremely important for your general health and well-being. Plenty of scientific research has clearly demonstrated that poorly controlled diabetics are at a greater risk of periodontitis and amazingly the relationship is bilateral – this means that periodontitis patients are at a greater risk of diabetes too! Control one, control the other too.
Obesity – overweight and obese individuals have been shown to be at a heightened state of inflammation across the body. This in itself has been proven to increase the risk of periodontitis progression. Those who work really hard at their diet and weight loss are shown to decrease their body’s inflammatory state and also improve their gum condition too.
There are many more conditions that have links to gum disease. There are even some medications that can affect your gums too. Please discuss this with your dentist, hygienist or periodontist to see if you may be affected.
In the third and final blog, I will discuss the treatment of periodontitis and the teamwork approach that we need to take in order to achieve treatment success.
BDS (Brist) MJDF RCS (Eng) MClinDent (Perio) MPerio RCS (Eng)
Manoj is our Specialist in Periodontics, which means he has carried out further intensive training after his initial dental degree to master the clinical understanding and treatment approaches to periodontal conditions and diseases that can occur in the mouth. He has been working at our Camberley practice in Surrey since 2013 and provides all aspects of non-surgical and surgical periodontal treatment including dental implant treatment. He is also trained in “drill-free dentistry” techniques such as laser treatments and air polishing.
He accepts referrals from other dentists in the region and has been involved in the teaching of dental students and qualified dentists. He is a Faculty member of the British Society of Periodontology, in recognition of his involvement in teaching and education, and in 2018 he will be on its Executive Council. Manoj is also a member of the European Association for Osseointegration and has presented clinical cases and research both nationally and internationally, winning the Ron Wilson Research Prize awarded by Kings College London.
Manoj adopts a gentle, caring and understanding approach and works with his patients to gain the very best treatment outcomes. You will always feel safe in his hands and he will always be open to answer any questions you may have.