Chapter 8
Gum Diseases

Periodontitis refers to inflammation “around” (peri-) the “tooth” (-odons), namely our gums and the bones that support our teeth.

Periodontitis is not something to ignore. It is of concern because the mouth is not isolated from the rest of ourselves. Inflammation in the mouth can antagonize our general health, weaken our immune health, and lead to chronic inflammation not just in the mouth but throughout the body.

The American Academy of Periodontology now estimates that about 47 percent, or 65 million, American adults have mild, moderate, or severe periodontitis.

The question is: Is periodontitis inevitable and preventable?
The answer: Preventable (entirely).

However, often periodontitis can be a “silent disease,” presenting without a single recognizable symptom. With the exception of very small changes to our gum tissues, sometimes only observable by trained professionals, we may appear entirely symptom free. As periodontitis advances, we move further and further away from a healthy mouth, inflammation becomes chronic, and we set up a cascade of inflammation throughout the body. In more severe situations, it cannot be reversed. We must not wait until it’s too late.

However, before discussing diseased gums, we need to be able to recognize healthy gums.

Healthy Gums

If we think of our gums as holding our teeth in place, then it makes sense that our gums are firm and not spongy.

Healthy gums don’t allow our teeth to jiggle when we walk. They rise up to greet each tooth at its edge and then fall away slightly before rising up again to greet an adjacent tooth. Healthy gums fill the spaces between our teeth. Some people say that our gums “grasp” the bases of our teeth.

What is Gum Disease?

Here we focus on two of the most common types of gum disease, gingivitis and periodontitis. Together these encompass the “mild,” “moderate,” and “severe” forms of gum disease that are rampant in the U.S. adult population.

Gingivitis
Simply put, gingivitis is inflammation of the gums. It is the mildest form of gum disease. Gingivitis is preventable. It is easily reversed with proper oral hygiene, attention to food and drink, regular dental cleanings, and an overall regard for well-being.

Typically, gingivitis is caused by an accumulation of plaque, a biofilm of microorganisms, which attaches to our teeth. Over time, when not removed, irritation results along the gum line. Left unattended, this sticky bacteria-laden deposit hardens and becomes tartar, a hard calcium deposit that we surely want to avoid.

If gingivitis is allowed to persist, a vicious cycle begins. The gums remain swollen and begin to trap even more bacteria. This is how the disease progresses.

Gingivitis may not always lead to chronic periodontitis, however all chronic periodontitis is precededby gingivitis.

Periodontitis
Periodontitis is the next rung on the periodontal disease ladder. It is characterized by the spreading of inflammation beyond the gum tissue to the supporting structures of the teeth, including the bone around the teeth. Once referred to as “pyorrhea,” periodontitis is irreversible. Although we can stop its progression, whatever destruction occurs as a result of periodontitis remains permanently. When bone is lost, it’s lost. For good.

Coming to Grips with Chronic Periodontitis

The first step is identifying the disease. This means scheduling a dental appointment. If gum disease is present, a dental professional’s interpretation of symptoms following an examination will shed light on how best to intercede.

Intervention Strategies
There are both surgical and nonsurgical techniques available to us. A less invasive nonsurgical intervention is everyone’s preferred first choice.

A dentist or dental hygienist may perform nonsurgical periodontal treatment, sometimes called “deep scaling” or “scaling and root planing.” Scaling removes deposits of plaque and tartar both above and below the gum line. The clean tooth surface will be smooth, providing ample opportunity for the gums to “tighten” around the tooth. Inflammation will slowly subside because irritants, plaque and tartar, have been removed.

For the majority of people, scaling constitutes an initial intervention, although maintenance will last a lifetime. Follow-up dental interventions will include periodontal probing. This is done periodically to monitor pocket depth. If surgery is warranted, a general dentist or periodontist will make recommendations accordingly. However, we should realize that surgical interventions can be avoided in all but extreme situations with a commitment to care.

Herbal Interventions
Herbal remedies--topically, systemically, and as mouth washes--can be used with considerable success, from supporting and sustaining healthy gums and everyday care through the care of chronic periodontitis. The key is blending herbs to address symptom experiences and possible pathogens in the mouth.

Mouthwashes are suggested for the routine care of our mouths. Antimicrobial herbs, such as sage, rosemary, thyme, and stevia, form quite palatable, even delicious, bases. While these herbs each have antimicrobial activity, the addition of calendula, cleavers, yarrow, and myrrh can be added if gingivitis or periodontitis is of concern.

As disease progresses we look toward changing the balance of a formula. It would be simple to provide a fixed formula for each stage of inflammation. However, this would leave little if any room for understanding herbal formulation or gaining confidence when it came to adjusting a blend of herbs to meet a changing situation. Perhaps most importantly, such an approach fails to consider the individual.

Mouthwashes can be a pleasure to formulate. They are also medicines and are best formulated to meet the current needs of each person.

In the presence of a shifting microbial population, it is important to moderate herbs to enhance immune responses while also providing antiseptic and antimicrobial support, enhancing oxygenation of the tissues and astringing (tightening) the gums.