Gum disease (Periodontitis) is a complex disease that results from chronic bacterial infection of the gum and bone supporting the teeth. Chronic bacterial infection brings about the inflammatory process which over time destroys the supporting tissues, namely, the bone and gum. If left untreated, this disease leads to so much loss of gum and bone that the teeth become mobile and are finally lost. It is reported that the most frequent cause of loss of teeth in adults is periodontitis.
Like other complex diseases such as cardio-vascular, Alzheimer’s or Crohn’s disease, periodontitis is known to be caused by variations in multiple genes, with each gene interacting with various life-style and environmental factors to bring about, cumulatively, the diagnosable condition in question ( according to a 2012, article published in Periodontology 2000, a high-impact, authoritative journal in the field of periodontics) no single gene or definitive types of genes effectuate periodontitis or any other “complex” disease. Furthermore, different environmental factors, such as smoking or stress, impact the ultimate penetrance (manifestation of the gene aberration) of the disease.
The end result of current investigation of the complex nature of periodontitis is that it is not predictable how the genetic, life-style and environmental factors could lead to the manifestation of the disease. Nevertheless, it is known that genetics, life-style and oral environmental factors are risk factors to be considered on an individual basis. For example, if one of your parents has lost teeth from periodontitis, and you have been a smoker and have been under long-term stress, it can be said that you are at high risk for periodontitis. This means even if you have been receiving regular dental care, your dentist may find, at some point in time, some signs of emerging gum disease. Furthermore, even if you received treatment, such as “deep cleaning” or even gum surgery, there is a likelihood of serious recurrence of the disease if you do not eliminate smoking and reduce stress in your life as recommended by your dentist or hygienist.
But there is good news. If you do not already have periodontitis and you do eliminate the life-style and environmental facts, such as smoking and stress, the genetic factors may not find “penetrance” or manifestation in the form of periodontitis. You probably would not develop periodontitis if you follow basic oral hygiene instructions and see your dentist regularly. Even if you have been diagnosed for periodontitis, reducing the non-genetic causative factors would contribute to a better prognosis, or prospect of recovery. Hence you are urged by your dentist and hygienist to eliminate as much as possible oral environmental factors by brushing, flossing and adopting other oral hygiene habits on a consistent, regular basis. And that is why they advise you as to diet and exercise in order to bolster your immunological resistance to gum infection.
In short, whether or not you come down with periodontitis, it’s the luck of the draw. If you do not have the genetic variations in your genome (genetic makeup), you are unlikely (although not impossible) to suffer from severe gum disease. If you have the genetic makeup for gum disease, even normal routine dental care may not be enough to prevent you from periodontitis. You best bet is to continue to see your dentist regularly and follow his/her recommendations if when signs of periodontitis appear.
If periodontitis is discovered in its early stages, it is treated with excellent prognosis. Even if diagnosed in its advanced stages, new, exciting, non-invasive methods are now available to treat the disease and save your teeth and smile for a life time. These new methods, as described in previous columns, take into account all the aforementioned genetic, oral environmental and stress factors and are proven to be efficacious over the long term.
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