At least 1 billion people in the country have this problem with their teeth! Why is periodontitis so common?

Ge Shaohua | Dean of Shandong University School of Stomatology

What are common oral diseases and periodontitis?

There are actually two main types of common oral diseases:

One type is dental caries, which is what we usually call tooth decay. Our teeth are damaged and it will cause toothache.

Another type is periodontitis. Periodontitis is actually very common. Many people believe that as people age, their teeth become loose. In fact, it is periodontitis that causes loose teeth.

Periodontitis is a chronic infectious disease caused by microorganisms in dental plaque. It is a very common oral disease.

Patients with periodontitis usually experience symptoms such as red and swollen gums, bleeding when brushing teeth, and bad breath. Some more serious patients will find that their teeth are getting bigger and bigger, gums are shrinking, and even loose teeth and loss of energy when eating, which are all common symptoms of periodontitis.

Periodontitis is the leading cause of tooth loss among adults and the number one killer of oral health.

The harm and causes of periodontitis

Periodontitis is a bacterial infectious disease. The main cause of periodontitis is bacteria, which we usually call dental plaque.

In fact, dental plaque mainly adheres to the surface of our teeth. If it is not removed in time by brushing teeth or other methods, it will gradually calcify and deposit to form hard tartar.

Of course, in addition to the factor of dental plaque, if you do not brush your teeth well, do not use interdental brushes or dental floss, and do not have the habit of regular dental check-ups, it will also lead to the accumulation of dental plaque and tartar, and then cause periodontitis.

In addition to dental plaque factors, there are some other factors, such as smoking, which can aggravate the severity of periodontal disease. Of course, there are also some systemic diseases, such as diabetes, which are also one of the risk factors for periodontal disease.

The incidence of periodontitis in my country

At present, according to the results of the fourth national oral epidemiological survey, the prevalence of periodontal disease in my country is still relatively high.

In adults of different age groups, from 35 to 44 years old, from 55 to 64 years old, and from 65 to 74 years old, the periodontal health rate of people in these age groups is less than 10%.

Moreover, the prevalence and severity of periodontitis increase with age.

For example, in the age group of 55-64 years old, only 5% of people have healthy periodontal health.

Simply based on this ratio, there are at least 1 billion people in our country suffering from periodontal problems.

It can be said that periodontitis is the biggest obstacle for most of us to have a healthy oral cavity in the second half of our lives.

Of course, there may be certain differences between different regions due to different oral hygiene habits or different economic levels, but generally speaking, this is the trend.

What complications can periodontitis cause?

Periodontitis is not just a dental problem; it also increases the risk of heart disease, diabetes and other diseases.

We say, "A single spark can start a prairie fire," which can very vividly describe the chain reaction that periodontitis triggers in our body.

You can imagine that a person has 28 teeth and suffers from severe periodontitis. The total area of ​​his periodontal band would be as big as his palm, and such a large inflammatory ulcer surface would always exist.

This means that there is a very large bacterial base hidden in your mouth.

Moreover, due to factors such as loose teeth, chewing, or bleeding from brushing teeth, these bacteria and their metabolites can easily enter the small blood vessels of the periodontium through the small wounds caused by brushing teeth, and then reach the whole body through blood circulation, affecting the health of the whole body. For example, the heart, brain, and lungs can all detect periodontal bacteria that "cross the ocean" from the blood circulation.

Of course, these bacteria also have their toxic products, which can cause some systemic inflammatory reactions. Therefore, not only can the harm of periodontitis cause teeth to loosen and fall off, but it can also cause health problems throughout the body.

So why does periodontitis cause systemic diseases throughout the body? It may be related to the fact that it enters the blood circulation and then the bacteria reach various organs through the blood circulation.

It has been discovered that systemic diseases associated with periodontitis include cardiovascular diseases, diabetes, premature birth and low birth weight, respiratory diseases like the ones just mentioned, digestive system diseases, rheumatoid arthritis, and Alzheimer's disease, which affects our memory in old age.

Among them, cardiovascular diseases are one of the culprits that we all know are harmful to human health. The pathogenic bacteria of periodontitis can enter the blood vessels and the heart, leading to cardiovascular and cerebrovascular abnormalities. In fact, when we perform surgery on atherosclerotic plaques, we will find periodontal pathogens inside the atherosclerotic plaques. And studies have shown that the more severe the periodontitis, the higher the incidence of atherosclerotic plaques and ischemic stroke.

Of course, in addition to this, there is also a two-way relationship between periodontitis and diabetes. Diabetes can affect periodontitis, and of course, periodontitis in turn affects the body's metabolism and blood sugar control, which can promote the occurrence and development of type 2 diabetes.

Periodontitis can also cause some premature births and low birth weight (infants), which may pass through some blood barriers in the mother and then enter the fetus.

Studies have shown that women who receive good periodontal care before delivery have a significantly lower incidence of premature low birth weight babies than those pregnant women with unhealthy periodontal health, which is reduced by about 82%.

Therefore, women of childbearing age should undergo periodontal examination as early as possible before pregnancy to reduce the risk of premature birth and low birth weight.

In addition, digestive system diseases like stomach diseases, because Helicobacter pylori is the pathogenic bacteria of stomach diseases such as chronic gastritis and gastric ulcers, the periodontal zone of patients with periodontitis is a reservoir of Helicobacter pylori, which may increase the risk of stomach diseases, and also affect the clearance of Helicobacter pylori in the stomach and the recurrence of stomach diseases.

Rheumatoid arthritis and Alzheimer's disease are also closely related to periodontitis.

How to treat periodontitis? Can it be cured?

In fact, regarding the treatment of periodontitis, I think people’s concepts and awareness need to be strengthened.

In clinical practice, we often encounter patients who ask: "Doctor, which anti-inflammatory drug is most effective in treating periodontitis?" In fact, what I want to emphasize here is that periodontitis is not caused by getting angry. The fundamental way to cure it is not to reduce the heat, nor to use various brands of toothpaste or various anti-inflammatory drugs, but to control dental plaque.

Some patients come to see a doctor only after they have a periodontal abscess. After the inflammation is eliminated, they stop the treatment and want to wait until all the teeth have fallen out before getting a denture. In fact, this concept is very wrong.

One of the goals of periodontitis treatment is to remove dental plaque, eliminate inflammation, and prevent recurrence of the disease.

During the treatment process, first of all, the patient needs to continuously learn and master the methods of teeth cleaning and plaque control under the guidance of a dentist, and then on this basis, a very good treatment effect will be achieved.

Of course, all patients need to receive basic periodontal treatment, which is what we usually call scaling and tooth washing. Scaling is to remove the deeper tartar and plaque on the root surface. Of course, the periodontist will judge the severity of your condition based on the results of the examination and then choose the appropriate treatment measures. In addition to the most basic treatment to remove dental plaque, some patients may need periodontal surgery, bone grafting surgery, and gingival surgery to further correct the shape of his alveolar bone and gums to improve the appearance and function.

The formation of dental plaque is inevitable, and even if we remove the dental plaque, it will re-form within 24 hours. Therefore, to prevent periodontitis, we must of course remove dental plaque, but we can only remove dental plaque by brushing our teeth well, using dental floss, and using interdental brushes.

I think the most effective and economical measure to prevent periodontitis is to maintain good oral hygiene habits, develop the habit of brushing your teeth in the morning and evening, brushing for at least 3 minutes each time, and insist on using dental floss and interdental brushes.

For example, if you don't clean your teeth properly, even if you brush your teeth well, there will be some parts of your teeth where dental plaque cannot be removed. In this case, you should develop a habit of going to a regular dental hospital for a checkup every six months, so that the dentist can help you remove the parts that you cannot clean yourself, and then complete some periodontal cleaning and other oral treatments. In addition, you should manage your own health well. If you are a smoker, you should actively quit smoking, and if you have diabetes, you should actively control your blood sugar. These effective measures can effectively prevent the progression of periodontal disease.

In the clinic, some patients would ask me, "Doctor Ge, can I cure periodontitis?"

In fact, there is no such thing as a radical cure. Some of my patients may be over 50 years old and have never been to a dentist. Their periodontitis is very severe and many of their teeth are loose. The purpose of periodontitis treatment is only to control the development of the disease.

When we talk about periodontal health, we are also talking about the health of an individual, which is relatively healthy. So, for a person in his 50s, the periodontal damage is very serious, the teeth are loose, and the gums are shrinking. I can't restore his periodontal health to the level of his 20s. I can only say that through treatment, his inflammation can be controlled and prevented from developing further, and it can be maintained at this level, and a certain degree of repair and regeneration can be achieved. Then, the teeth that are not loose now can be prevented from becoming loose, and the current state can be maintained, and a certain degree of functional recovery can be achieved. This is the goal of our periodontitis treatment.

Of course, for a very young person, such as someone in his 20s, there is only inflammation of the gums, no absorption of the alveolar bone, and no formation of the periodontal band. At this time, through periodontal treatment, we can restore his gums to a very good condition, and his alveolar bone will also be maintained in a relatively stable state. If he maintains it normally at this time, he can maintain periodontal health throughout his life, and there will be no problem of loose teeth throughout his life.

So to solve the problem fundamentally, I think we should understand it from different perspectives.

How to prevent periodontitis? What suggestions are there?

The first thing is to maintain personal oral hygiene.

In fact, I have already said something just now, that is, we need to brush our teeth well. Even brushing our teeth alone is not enough, we also need to use the brush between teeth.

As a periodontist, I am very good at brushing teeth, but my brushing efficiency is only 60%-70%, which means that 30%-40% of dental plaque cannot be cleaned up. It is in the gaps between teeth. I need to use dental floss to clean this part of dental plaque. Of course, we also use some auxiliary cleaning measures, such as interdental brushes, and some people even have some water flossers. For some patients who have implants or restorations, if their implants and restorations are not easy to clean with a toothbrush, they can use some water flossers.

Of course, I think it is very important to control plaque and develop good oral hygiene habits.

Another point is that you must see a dentist regularly. Because dental diseases may not have symptoms at first. When the symptoms become obvious and you go to the dentistry, the oral disease, especially periodontitis, is already very serious. If you can go for regular checkups, for example, once every six months, the dentist will find your minor problems. These minor problems are very easy to solve, and they take very little time and money, but they can solve big problems.

Of course, the doctor will also point out any problems you have with your oral cavity so that you can better maintain your oral hygiene.

This article is a work supported by the Science Popularization China Creation Cultivation Program

Team/Author: Deep Science

Reviewer: Yuan Fusong, deputy chief physician, Peking University Stomatological Hospital

Produced by: China Association for Science and Technology Department of Science Popularization

Producer: China Science and Technology Press Co., Ltd., Beijing Zhongke Xinghe Culture Media Co., Ltd.