Dental Treatments. Gum disease; A silent epidemic

by vickz0302 (student)

University Degree Medicine and Dentistry

Gum disease

The problem

“Most people have at least one case of mild gum disease during their lifetime. In the UK, it is estimated that 50-90% of the adult population has some degree of gum disease.” [1]

Gum disease is a silent epidemic. The above statement describes a disease which isn’t seen as harmful to many people but the truth is, it is. Gum affects a large amount of the UK population and many people across the world. It is the biggest causation of tooth loss. This in itself is a big reason why Gum disease remains a problem for Dentists today. Another reason why Gum disease is a problem is that it is incurable. This means that there is no solution present today that eliminates Gum disease – only improves the state of the condition. A large percent of the population have Gum disease and it affects all ages – although it affects adults the most, it is the biggest cause of tooth loss and it is incurable. Tooth loss affects many people in many ways. One of which is embarrassment due to bad breathe. Another is more serious – not being able to eat certain foods which can affect diet choices but mainly life expectancy.

Gum disease is a problem in itself; however there are connections with Gum Disease and other diseases. Some theories explain that periodontal disease can lead to heart disease. This is because when oral bacteria enter the bloodstream, it can attach to fatty plaques in the coronary arteries and cause blood clots. This can lead to Coronary artery disease. The artery walls thicken due to the plaques. The plaques restrict blood flow and limit the amount of nutrients entering the heart. With a lack of oxygen and nutrients it can lead to Heart attacks. It is said that those with periodontal disease are twice as likely to suffer from coronary artery disease then those without periodontal disease (link on phone). Gum disease also has connections with strokes, pregnancy problems, diabetes and respiratory diseases. Therefore Gum disease is a problem to an individual’s health as it can affect the body more than one way.

Gum disease describes swelling, soreness or infection of the tissues supporting the teeth. There are two main forms of gum disease: Periodontal disease and Gingivitis. Gingivitis refers to the inflammation of the gums. The gums around your teeth become red and swollen. As you brush your teeth, these gums are likely to bleed. Periodontal disease is more serious than Gingivitis. Having Gingivitis for a longer time period can lead to periodontal disease. Periodontal disease mainly affects the tissues supporting the teeth. As the disease progresses, the bone supporting the teeth in the jaw is lost. This makes the tooth become loose. Without any treatment the teeth can fall out. Tooth loss is most likely to occur from periodontal disease, even more than tooth decay. So, it can be said to be the biggest causation of tooth loss. [2]

In essence, gum disease is incurable and affects a large amount of the UK population. It harms the patient in various ways dependent on what stage the disease is progressed up to. Although its affects may not be serious in the short run, in the long term it can affect other areas of the body other than just the mouth. It is the biggest cause of tooth loss and has many negative consequences. Many people are not aware of the seriousness of the disease when in actual fact it is.

A solution:

There are many solutions to treat gum disease. One of the most effective solution is:

Scaling or root planning – this is one of the most effective solutions before gum disease becomes severe. The important thing about this treatment is that it is there to prevent gum disease from reaching a further stage. This is a form of non-surgical treatment.

This treatment cleans between the gum and the teeth all the way down to the roots. Before dentists proceed with this treatment, a local anesthetic is used. A local anesthetic numbs a particular part of the body. It can be in either 2 ways; the first is through injection of the particular area, the other is the medication is rubbed onto the area which needs to be numb. In this treatment, the anesthetic is injected to numb the gums of the patient and the roots of the teeth. If this is used, the gums and lips of the patient are likely to be numb for a couple of hours.

[3]

What the diagram shows is a health tooth seen on the left side and a tooth with periodontal disease shown on the right. The biggest difference you can see is the tooth with periodontal disease has reduced bone level. Root planning and scaling is a treatment which removes plaque tartar which is also seen on the right hand side of the diagram. The plaque tart seen on the right hand side of the diagram creates an environment in which allows bacteria to stay and multiply. It causes gums to bleed and become inflamed.

The treatment works and aims for one main goal – to remove the plaque and calculus. This is the main cause of periodontal disease and so root planning and scaling removes this plaque tartar.

Ultrasonic tip Ultrasonic tip

[4]

Planning and scaling are 2 different things, but both aim and try to prevent from gum disease reaching a worse stage. Both treatments use the same equipment. An ultrasonic tip is used shown in the above diagram.

Scaling cleans the teeth to remove deposits above the and below the gum line. It aims to reduce the amount of plaque tartar produced so there is a healthy environment around the gums and teeth. The ultrasonic scaler is used to remove this plaque tartar which is on the crown of the tooth.

Root planing is slightly different but also attacks the problem of gum disease. The process involves smoothening the surfaces of the roots. It smoothes the rough roots of the tooth. What this allows is that the gum can heal. Allowing the gums to heal creates a healthy environment around the teeth and the gums therefore the gums are less likely to bleed. The ultrasonic scaler gets rid of the rough areas on the roots of tooth where bacteria are in large quantities. The removal of these bacteria helps the gums to be healthier as these bacteria contribute to the disease.

Both root planning and root scaling are effective ways to treat periodontal disease. In periodontal disease, a periodontal pocket is usually formed.

[5]

The diagram on the left shows a patient with a pocket forming. This pocket forms when gums are usually inflamed due to large amounts of bacterium. When gums are inflamed, more cells arrive at this area to try and get rid of these bacteria. A periodontal ligament attaches the tooth to the bone. However the periodontal ligament in a patient with periodontal disease is usually destroyed or lowered, creating a gap known as the periodontal pocket. The deepness of a periodontal pocket can be measured by an instrument known as the periodontal probe which can be seen on the diagram on the right. The deepness of this pocket is usually between 1.5-3.5mm in a normal patient. However a patient with periodontal disease is likely to have a pocket deeper than this.

Root planing and scaling are effective treatments which can remove plaque tartar and calculus. But it can also reduce the gap of the periodontal pocket.

[6]

This is a preview of the whole essay

Root planing and scaling are effective treatments which can remove plaque tartar and calculus. But it can also reduce the gap of the periodontal pocket.

[6]

The diagram shows that 10% of patients who received Scaling and Root Planing improved by reducing the height of the periodontal pocket by 2mm or more in study 94-003. In this study, 25% of patients that received Scaling and Root planing but also having a PerioChip used in the treatment improved by reducing the height of the periodontal pocket by 2mm or more. Therefore using the PerioChip along with the treatment increased the percentage of patients that improved by 15%. This shows that the PerioChip is effective. In study 94-002, the percent of patients improved by 19% by using the PerioChip along with the treatment.

Evidently, the graph supports the use of this PerioChip. The graph shows that the PerioChip used with planing and root scaling improves the depth of periodontal pocket in terms of 2mm or greater after 9 months. In both studies, the use of the PerioChip with planing and root scaling improved the depth of the periodontal pocket by greater than twice compared to performing planing and root scaling itself. From the graph therefore we know it is more effective using the PerioChip along with planing and root scaling. Both studies show that there was an increase when using the PerioChip along with Scaling and Root Planing rather than just Scaling and Root planing alone. So, the data provides support for the use of the PerioChip as an adjunct as it improves and reduces the size of the periodontal pocket.

So why is the PerioChip so effective? Well, it helps rebuild the periodontal ligament and eliminates oral bacteria. The chemical Chlorhexidine is an antiseptic. An antiseptic is a substance which reduces the chances of an infection occurring. Its main effect is it destroys bacteria in the body by travelling through the lymphatic system which is part of the immune system. Chlorhexidine is designed to reduce dental plaque and oral bacteria. As the PerioChip is placed into the patient’s periodontal pocket, the Chlorhexidine eliminates most bacteria at the sight. As it does this, the periodontal ligament can start to grow and rebuild, thus enabling the depth of the periodontal pocket to reduce. [7]

A PerioChip is used as an adjunct. An adjunct is something that is added to something else. In this case, a PerioChip is added to the Scaling and Root planing treatment. As seen from the graph, the use of this adjunct is more effective than the treatment by itself.

A PerioChip is basically a chip that is placed into the periodontal pocket once Scaling and Root planing are done. The important thing about a PerioChip is it contains a chemical known as Chlorhexidine. This chemical is fundamental element which makes the PerioChip and is in several mouthwashes. However, a PerioChip is specifically created to ensure this chemical reaches the periodontal pocket – this cannot be done by regular mouthwash.

When producing a treatment such as the PerioChip, many studies have been performed to ensure that there are no major side effects of the Chip. Many safety checks must be performed for allow it to be sold to the population. The graph was produced from the findings of the Multicenter studies. The graph shows 2 studies that were performed, both producing different data. However, the trend is similar showing that the use of the PerioChip as an adjunct is much more effective than using Scaling and Root Planing alone.

As the PerioChip is available for the global population today, I think that the results from the findings are extremely reliable and valid. The company producing the data have a good reputation and considered having a representative sample which makes the data more reliable. There were 2 studies performed which also increase the reliability and so it is fair to say that the graph produced is extremely valid. Both studies show that the Periodontal Pocket reduces more in depth when the PerioChip is used along with Planing and Root scaling. So, the data is reliable as the there was more than one study which shows the same outcome.

“In studies, over twice as many sites treated by the Chlorhexidine chip and RSI underwent > 2mm probing depth reductions compared to sites that were treated by RSI alone.”

“Research studies have shown that the placement of a chip in pockets ≥5mm in depth every three months provides the most effective treatment strategy”. [8]

Again, these quotes support evidence for the PerioChip. The first quote states more than 2 sites treated with Chlorhexidine chip reduced the size of the periodontal pocket than using scaling and root planing alone. Therefore, it is fair to say that the chip is effective along with the usual treatment of planing and root scaling. The first quote provides support for the chip along with the usual treatment.

The second quote stats it is ‘the most effective treatment strategy’ for periodontal pockets greater than or equal to 5mm. This means that the treatment with the chip is effective. The quote also states that this is only true if the chip is replaced every three months. This quote also provides support for the chip as it states the findings from studies completed on the chip.

The book specialises in Non-Surgical Periodontal treatment. This means the book is likely to be written with expertise from the authors as they specialise in this area of gum disease. The quotes support the PerioChip and also show that using the PerioChip reduces the depth of the periodontal pocket.

“It releases Chlorhexidine for seven to ten days to control plaque bacteria and as Chlorhexidine is not an antibiotic, there is no risk of antibiotic resistance developing with repeated use.”

“It takes less than 30 seconds for a dentist or hygienist to insert, with no specific training or instruments required. Once inserted the chip simply dissolves after several days in the periodontal pocket, so no return visit for removal is needed, and the patient's normal lifestyle, diet and oral hygiene regime are not affected.” [9]

The first quote states that the PerioChip has ‘no risk of antibiotic resistance’. This is a real benefit of the chip. This is because the PerioChip if efficient in eliminating oral bacteria in the periodontal pockets. Therefore it is fair to say the PerioChip is effective in doing its job therefore is a good adjunct to use with Scaling and Root planing.

The second quote states how easy it is to use the PerioChip. The fact that the chip takes ’30 seconds for a dentist or hygienist to insert’ shows that the Chip is designed easily to use. Not a lot of skill is required to insert the chip into the periodontal pocket. In addition, the PerioChip ‘dissolves’ meaning that a dentist or a hygienist do not need to remove the chip once it’s been used.

Both quotes support the PerioChip as an appropriate solution. It is effective and many dentists use the PerioChip today. There are little or no side effects of the treatment with the use of the PerioChip making it an appropriate treatment for dentists to use on patients. The only thing dentists should be aware of are the side effects of the anesthetic and the cleanliness of the instruments used. When taking everything into consideration, the use of the PerioChip with Root Planing and Scaling are appropriate as dentists have implemented this non-surgical treatment into reality. A lot of studies have been done on the PerioChip and it has been used for over 50 years now. Therefore it is fair to say that the tests and studies involved when producing the Chip show it is appropriate to use as a treatment for patients with Periodontal disease today.

Dentists use this treatment at it’s the easiest method to prevent gum disease from worsening. It is there in place so that gums bleed less, swell less and is less discomforting compared to other methods. The method is very simple and doesn’t require much equipment. However once the treatment is provided, patients with gum disease can continue if the patient doesn’t commit to oral hygiene.

As the PerioChip is used by dentists today, showing it is an effective solution. Scaling and Root Planing tends to be used when patients attend their checkups every 6 months. It is therefore an appropriate solution as the chip doesn’t have any major side effect. The only issue with Planing and Root scaling is some tissue may be damaged; however dentists can overcome this issue. In effect, Scaling and Root planing are appropriate solutions and the PerioChip is also appropriate as it is sold worldwide, meaning that its effects do not harm the patients compared to the benefits they receive from using it.

A Social issue:

Gum disease is the major cause of tooth loss. One of the biggest social problem about gum disease is many people of the UK population don’t realise they have Gum Disease. Those who do know about Gum disease don’t seem to take it seriously due to the prevalence of it. People don’t realise that untreated Gum disease can lead to tooth loss and that Gum disease is the biggest cause of tooth loss. Many people are embarrassed of tooth loss:

“In an AGD member survey, more than 86 percent of general dentists reported social embarrassment as one of the greatest problems associated with tooth loss.” [10]

The survey shows that the effect of tooth loss cause social problems. It affects the person when eating for example, when chewing food or finding it hard to eat certain things. Not only this, but tooth loss affects a patient emotionally and psychologically. Quality of life is likely to be lower than those who have all their natural teeth. Social embarrassment is likely to occur, negatively harming a patient with tooth loss.

An Ethical implication:

Root Planing and Scaling depends on the operator. If the dentist or the hygienist doesn’t use the right equipment, for example when picking the ultrasonic equipment, then the treatment may not be as effective. If the treatment isn’t effective, it may make patients believe they no longer need to worry about the disease. This therefore is an ethical implication as it is not right to make someone believe their treatment was effective when it wasn’t. In addition, some dentists may not feel the need to treat the patient as they may feel that the patient can clean the plaque tartar by usual tooth brushing and flossing. However, this isn’t fair – it shouldn’t be available for some people and not others. This links to the economic implication – with the government providing less money, dentists will only perform treatment to those who need it, when it should be available for everyone no matter how much plaque tartar is in the mouth.

Usually, dentists often send patients to dental hospitals where dental students offer the treatment as it is time-consuming for dentists to perform. Patients are likely to have to wait 4 hours over 2 appointments to get the treatment and so they may not attend both sessions so many people may skip appointments for this reason. As many of the students are not yet qualified and are under graduates, they may not perform the best effective treatment. If they have not mastered the treatment then they are likely not to perform a better root planing and scaling treatment. So, not all the calculus and plaque may be removed. This means that the scaling and root planing may not be ethically right as the patient may think that the treatment has worked when the operator may have not performed it efficiently.

This affects the patient as they may think that the treatment has cured them – when in actual fact it may not have been effective meaning that patients can be sufferers of the disease. Furthermore, even if the Root Planing and Scaling treatment if performed correctly, often patients consider that they are cured, however, this is not the case. It is not right for undergraduate dental students being the operator of such important treatments. This is an ethical issue to consider as the treatment good help prevent the disease from worsening.

A Social implication:

There is no cure to Gum disease but dentists can prevent it from worsening. It is essential that patients brush teeth twice a day and use fluoride toothpaste once the treatment is provided. Often, patients don’t commit to oral hygiene and so a large proportion of the population can still be at risk of Gum disease and tooth loss. Therefore, patients can still be at risk of having tooth loss as the solution may not be effective. The solution mainly relies on the patient’s willingness to commit to oral hygiene so it may not be useful. This is a social issue. Dentists can only help the patient to a certain extent, but large amounts of the population do not commit to oral hygiene. So, even if the treatment is effective, the disease may still progress if the patient doesn’t commit to oral hygiene.

Economic implications:

When the treatment is provided, patients must commit to oral hygiene and buy the right products. The right products include mouthwash with fluoride, toothpaste with fluoride and floss. When committing to oral hygiene, patients must brush their teeth twice a day. All these commitments of buying oral products add to the cost of living for households. In current economic climates, households are less willing to spend more and are likely to save their money. Therefore, once the Scaling and Root Planing treatment is provided, many patients will not buy these products as they do not see the long term benefit of doing so.

In addition, the government have introduced spending cuts. The spending cuts affect the NHS which includes dental practises. This means that dental practises are likely to be less efficient in terms of equipment, amount of dentists and employees in such institutions that help organise appointments. These spending cuts affect the number of patients that are likely to receive such treatment. When spending cuts are introduced, dentists may only provide treatment those who critically suffer. This means that those with minor conditions of gum disease are likely to not be given treatment which may affect them in the long term of developing periodontal disease. Dental Practises are likely to consume less PerioChip’s thus meaning the solution may not be used on a large scale during a recession depending on the government. Although the treatment if cost effective, in a recession the number of patients receiving this form of treatment is likely to be lower, which could raise ethical issues as everyone should be entitled to receiving treatment no matter what stage the disease has progressed.

Benefits

There are many advantages of Root Planing and Scaling. One major benefit is that it is much cheaper than surgical treatments to tackle Periodontal Disease. The treatment only requires an anesthetic (not all the time) and basic equipment such as an ultrasonic tip.

Another benefit is that the treatment works efficiently. The treatment eliminates bacteria in the periodontal pocket which allows tissue to heal and grow. So, it effectively stops the progression of the disease. It is much easier to clean the teeth once the plaque tartar and calculus is removed.

The main advantage is it prevents tooth loss. The treatment allows the periodontal pockets to be cleaner, thus eliminating more bacteria which means that the periodontal pocket can rebuild and grow. As this occurs, the periodontal ligament becomes stronger and so the tooth is held more firmly which means it is less likely to be detached from the bone so the patient will keep their natural teeth longer. Bleeding and swelling of the gums reduce and the inflammation of the gums reduce providing a healthier environment in the mouth. [11]

It is also an economic benefit. It is cheaper for the government to provide non-surgical treatment to surgical treatment as less equipment and expertise is required. Although it may be considered time-consuming, it is much quicker compared to other surgical treatments. It is also cheaper in a way that it prevents tooth loss from occurring. It is much more expensive to make dentures and other treatments to replace natural teeth in adults.

Overall, the benefits will allow the UK population to be healthier. With health standards rising, the standard of living increases, creating a better environment for people to live in. The reputation of a country is partially based on living standards, and in effect, preventing tooth loss contributes to increasing life expectancy and standard of living. The reputation will therefore be better for a country with a good healthy population.

Risks/ Drawbacks

Scaling and Root Planing may not be effective in reducing calculus and tartar. Therefore patients may still suffer from the disease. The success of the treatment depends on the person doing the treatment (usually a dentist) and the equipment used. Specific skills are required to perform the treatment properly and effectively.

Also, Scaling and Root Planing may cause the teeth to be sensitive. When performing the treatment, tissues and important cells may be removed. However, dentists can advise patients to use fluoride containing mouthwash and toothpaste. This overcomes the risk of sensitive teeth as fluoride helps strengthen the tooth.

The main drawback is Periodontal Disease isn’t curable. Although there are treatments to help reduce the effect of it, it remains incurable. In addition, dentists can only help with disease up to a certain extent. The treatment may be effective; however, managing the problem is mainly in the control of the patient. If the patient doesn’t commit to oral hygiene then the disease may worsen. Patients must be motivated on a daily basis to commit to oral hygiene if the disease is to be managed effectively. [12]

Another solution involves a simpler method – committing to oral hygiene.

This is a simpler method to prevent gum disease. This solution involves seeing the dentist regularly, brushing teeth twice a day, flossing and upgrading to oral hygiene products such as using toothpaste with fluoride.

Brushing twice a day helps remove bacteria from teeth and also prevents plaque forming. Flossing removes food pieces from the roots of the teeth which cannot be removed by brushing. It removes plaque which helps prevent gum disease or makes the condition of gum disease less harmful. Fluoride toothpaste is also essential for healthy gums and teeth. Fluoride in toothpaste helps strengthen the enamel of the tooth which is the outer most layer of the tooth. Also bacteria on the teeth produce acid, fluoride in toothpaste minimises the amount of acid produced by these bacterium. The fluoride in toothpaste works with saliva to build a strong enamel thus protecting the tooth from plaque and sugars. Fluoride in toothpaste prevents cavities forming, tooth loss and helps ensure the teeth and gums are healthy. [13]

Another possible solution:

In my opinion, I think that education is needed. The government should teach about dental hygiene in primary, secondary schools and in the workplace. It essential for the general public to know about Gum disease and its association with other illnesses or diseases. Many people do not know of the symptoms of gum disease and therefore educating the public would cater for this issue.

Bibliography

[1] The NHS, (2010), Gum Disease, [online]. Available from:

The NHS is the National Health Service. The site is funded by ‘The department of health’. They aim to produce information which is ‘trustworthy’ on all the information they produce. The website claims that the information shouldn’t be ‘unbiased’ and ‘approved by a clinical expert’. The information therefore produced is likely to be very reliable. As it is one of the biggest organisations and have people with expertise to check the information produced, it is likely to be extremely accurate which increases the validity of the information produced. The information is recent as it was published in 2010, so it can be said to be representative of the UK population today making it more credible.

[2] Bupa, (2011), Gum disease, [online]. Available from:

[3] , Scaling and Root Planing, [online]. Image available from:

[4] Meadowbrook Dental, (2011), Scaling and Root Planing, [online]. Image available from:

[5] Associates in Periodontics, (2009), About Periodontal disease, [online]. Image available from:

[6] PerioChip, (2010), Clinical results, [online]. Graph available from:

The data produced is extremely valid (graph). The findings are likely to be representative of the US population. The study was a multicenter study. The studies have likely to include both genders and a variety of ethnicities and age groups. This means that the study was a controlled study that was carried out by several institutions to come to a general conclusion about a trend. The use of several institutions means that the findings are likely to not be bias, increasing the validity of the data produced. The PerioChip is an effective adjunct with Scaling and Root Planing today which has undertaken many studies. The PerioChip is sold by pharmaceuticals and is used by dentists today, meaning that the studies performed supported the effectiveness of the Chip. The data was produced in 2010. This is extremely recent which means it represents the trends of the US population today. This makes the data credible and I think it is valid and reliable as other sources support the data produced.

[7] RxList, (2010), PerioChip drug description, [online]. Available from:

[8] Peter A Heasman., Philip M Preshaw. and Pauline Robertson. (2004). Successful Periodontal Therapy A Non-Surgical Approach. Ed. Quintessence Publishing Co Ltd.

[9] Arveen Bajaj, AB, British Dental Journal, (2005), Periodontics: Reducing Pocket depth, Issue number 199, page 199.

The British Dental Journal is one of the biggest Journals produced in medicine today. It specialises in dentistry and has produced many issues. The information produced in this type of journal is likely to be peer reviewed and marked by other scientists or dentists. This means that more people are likely to repeat the findings or information produced which increases the reliability of the information produced. Due to this peer marking system, it is very hard to publish an article in this journal. Therefore, any information published is likely to be of high standards which increases validity of the data produced. I think that the article in the BDJ is extremely reliable and valid as it peer reviewed and checked thoroughly before being published, so its information must be accurate. It provides support for the graph showing that the PerioChip is an effective and an appropriate solution.

Also, the information published in this specific article gives support to the graph produced on the website: . The article in the British Dental Journal gives support to the effectiveness of the PerioChip. This means the data produced in the graph is likely to be valid as another source stated the same results. The study is likely to be of a high standard as it took into account the sample size so the findings can be representative of the general population. I think that the data produced in the graph is therefore extremely reliable. However the information was published in 2005, which means there could be new information published which may show some negatives of the PerioChip.

[10] Redhawk Family Dentistry, (2007), Tooth loss, [online]. Available from:

[11] Toothiq, (2011), Scaling and Root Planing: Advantages/benefits, [online]. Available from:

[12] Toothiq, (2011), Scaling and Root Planing: Disadvantages/risks, [online]. Available from:

[13] Kids Health, (2011), About Fluoride, [online]. Available from: