Brush your teeth twice a day and don't forget to floss.
This is the mantra for good oral health but many of us are guilty of neglecting it from time to time.
World Oral Health Day is marked on March 20 every year and it's a timely reminder for us all to understand the importance of healthy gums for overall wellness.
According to the Global Burden of Disease Study 2017, oral diseases affect close to 3.5 billion people worldwide.
Periodontal disease or gum disease is also a prevalent oral health condition in society; with other less common conditions being oral cancer and oral dental trauma, the latter being a result of physical or facial injuries due to motor accidents.
IMU Healthcare's Oral Health Centre periodontist, Dr Lew Pit Hui, says global statistics from the World Health Organisation (WHO) reveal that severe periodontal disease affects nearly 10 per cent of the world's population.
Periodontal disease is an inflammatory condition that affects both the hard and soft tissue structures that support the teeth. It is caused by the accumulation of dental plaque which is a combination of microorganisms (bacteria and microbes) and salivary proteins on tooth surfaces.
"Gingivitis occurs in the early stages of periodontal disease whereby the gums appear red and swollen due to inflammation, which is our body's natural response to the presence of plaque. If gingivitis is left untreated, it may progress to periodontitis, a more serious form of gum disease," says Dr Lew.
In severe periodontitis, gums may separate from the teeth with bone loss
occurring simultaneously and teeth may eventually fall out. The most devastating outcome from oral health conditions is tooth loss which impacts mouth functions like speech and mastication.
"If we lose teeth, in particular the molars, we may lose the ability to chew our food properly which may in turn affect our nutritional intake and overall health."
Losing our front teeth meanwhile will impact self-esteem because it affects how we look and also results in the inability to pronounce words properly.
There is also the financial burden of replacing missing teeth. The cost of oral health conditions not only affects individuals but also the government as there is considerable economic burden in the treatment and management of oral healthcare in the public sector.
Oral health issues generally lead to a reduced quality of life. According to the National Oral Health Survey of Adults (NOHSA) 2010, up to 94 per cent of Malaysians have periodontal conditions with 48.5 per cent suffering from periodontitis and 18.2 per cent afflicted with severe periodontitis.
Common symptoms of periodontal disease include red or swollen gums; bleeding from gums or blood in the sink after brushing; halitosis (bad breath); longer looking teeth or receding gums; loose teeth; increasing spaces between teeth; calculus (tartar) on teeth and tooth sensitivity. However, not all patients will have noticeable symptoms. Gum disease also has well-established links with major medical conditions such as diabetes mellitus, cardiovascular disease and rheumatoid arthritis.
The National Health and Morbidity Survey 2019 reveals that 1 in 5 Malaysian adults have diabetes and that amounts to approximately 3.9 million people aged 18 and above, afflicted with the condition.
The bidirectional relationship between periodontitis and diabetes is such that patients with periodontitis have a higher risk of diabetes mellitus with higher levels of insulin resistance and poorer glycemic control. Conversely, diabetic patients are three times more likely to be afflicted with periodontitis. The poorer the glycemic control, the more severe the periodontitis.
However, diabetics with well-controlled blood sugar levels do not have an increased risk for periodontitis says Dr Lew.
Where cardiovascular disease is concerned, robust evidence from observational and epidemiological studies suggests a positive association between periodontal disease and cardiovascular disease, especially severe periodontitis.
Periodontal disease may also increase the risk of future atherosclerotic cardiovascular disease.
As both periodontal disease and cardiovascular diseases are complex chronic inflammatory diseases which share similar risk factors like stress, diabetes and diet; inflammation in the gums may contribute to the systemic inflammatory burden of the body which may increase the risk of cardiovascular disease.
Emerging evidence from epidemiological and clinical studies have also revealed that periodontal disease is more common and severe in patients with rheumatoid arthritis.
Studies also show a significant association between obesity and periodontal disease. There is a higher risk for obese or overweight individuals to develop periodontitis.
As one in five Malaysians have been identified by the National Health and Morbidity Survey 2019 as being obese and overweight, this is a worrying issue.
Other health conditions or factors that may predispose individuals to oral health problems include poor immunity or individuals who are immunocompromised due to illnesses like HIV/AIDS, and patients who are under cancer therapy.
They may have an increased risk of getting gum disease, while reduced saliva flow may predispose them to root caries.
Lifestyle factors like smoking also increase the risk and severity of gum disease. Stress, which lowers one's immunity and a non-healthy sugary diet of carbonated drinks and excessive alcohol consumption contributes to caries or periodontal disease too.
Hormonal fluctuations in puberty and pregnancy may exacerbate gum inflammation and hypertension drugs may also contribute to gingival enlargement.
Genetics is also a factor so individuals with family members that have periodontitis should keep a lookout for the condition and ensure strict oral hygiene says Dr Lew.
Good oral health practices are key to keeping your pearly whites healthy and gum disease at bay.
Dr Lew advises brushing your teeth with fluoridated toothpaste twice a day and using dental floss or an interdental brush to clean the gaps between your teeth.
"Do schedule a dental check-up once every 6 months, refrain from smoking and drinking alcohol excessively, eat a balanced diet, and maintain physical activity and regular exercise," she adds.
It is important to remember that gum disease can lead to tooth loss and it is not just a disease that afflicts the elderly.
In fact, it is a largely silent disease unlike tooth decay which is usually characterised by pain and swelling.
But the key message is that gum disease is largely preventable and treatable when identified in its early stages.