Periodontitis, Gum Bleeding and Other Dental Problems

Dr. FUNG Kin Yue, Clive

Honorary Consultant in Periodontics, HKSH

Specialist in Periodontology

Periodontitis is characterised by chronic inflammation of gums, bones and connective tissues surrounding and supporting the teeth. Without proper oral hygiene, a sticky film of bacteria, i.e. plaque, may develop on tooth surfaces and in gingival margins, later calcify and become calculus. The rough and hardened surface of calculus may further promote plaque formation and cause deterioration in gum health and develop periodontitis.

Periodontitis: Silent and Insidious with No Clear Symptoms 

Tooth brushing and flossing are the keys to good gum health. Lack of proper dental care can lead to plaque formation. The bacteria in plaque will produce toxins that irritate and inflame the gums, i.e. gingivitis. If untreated, gingivitis may worsen and affect the connective tissues of the teeth. The gums may detach from and expose the roots of tooth creating periodontal pockets or causing gum recession, i.e. attachment loss. These destructive impact on the structure of supporting tissues is irreversible.

Early periodontitis often goes unnoticed due to the lack of clear symptoms, resulting in severe health consequences. For diagnosis, a periodontal probe is used by dentists to locate and measure the depth of periodontal pockets, sometimes we need to take X-ray to examine bone loss.

Periodontitis and Cardiovascular Diseases

Periodontitis shares similar risk factors with cardiovascular diseases (e.g. heart disease and stroke), such as smoking, stress, obesity, diabetes, poor diets, etc. In case of gum bleeding, the bacteria in plague may reach the coronary artery through blood circulation and form plaque inside, resulting in thickened arterial wall and even thrombosis. It can further deprive the heart of oxygen supply and causes myocardial infarction. Research showed that the risk of developing cardiovascular diseases was one time higher in periodontitis patients than normal people. Stroke may also occur if thrombosis develops in the brain.

In light of the close correlation between oral health and cardiovascular diseases, those with a history of bacterial endocarditis are required to take antibiotics before treatment of periodontitis to prevent transient bacteremia.

Tooth Pain and Cavity

Sometimes tooth pain may originate from a different location in body than teeth and is mistaken for mere tooth problems. For example, one may feel tooth pain, which is in fact a “referred pain” caused by angina pectoris, and thus fails to take note of the underlying heart problems. Research showed that atypical pain history was found in 30% of patients with cardiovascular diseases. Unlike normal tooth pain, referred pain can occur on either or both sides of the gums, usually on the left. The pain may radiate to the cheeks without swelling, and may even get worse after the use of anti-inflammatory medications.

You should consult a dentist or medical specialist if you have any of the symptoms above. For dental treatment, cancer patients should have those hopeless tooth extracted prior to radiotherapy and chemotherapy to avoid prolonged wound bleeding or avascular bone necrosis of an extraction socket during cancer treatment.

Myocarditis

In case of periodontitis, myocarditis may occur if bacteria enter the bloodstream through the wound during tooth extraction and reach the heart through blood vessels or lymph vessels. Periodontitis patients are advised to delay tooth extraction in case of inflammation, or only proceed after taking anti-inflammatory medications.

Periodontitis and Diabetes

Diabetes can delay wound healing and is thus interrelated with periodontitis in terms of chronic inflammation. Periodontitis is the sixth chronic complication of diabetes. Research indicated that the risk of having periodontitis was 1.9 times higher in diabetes patients than the general population, and the percentage of periodontitis patients with diabetes was almost two times higher than those without periodontitis. More severe periodontitis, poorer treatment outcome and late recovery are the possible complication  in diabetes patients. The toxins and substances produced by bacteria in plaque will also diminish insulin effectiveness and worsen diabetes in periodontitis patients. Effective treatment of periodontitis can lead to lower Hemoglobin A1C level and less dependence on insulin or other medications.

Gum Bleeding and Other Dental Problems: Signs of Severe Illnesses?

Gingivitis or periodontitis is the major cause of gum bleeding. Sometimes abnormal bleeding may occur due to issues related to systemic diseases:  

• Use of antiplatelet drugs of varying components
• Bleeding conditions, such as haemophilia, leukaemia, etc.
• Impaired immune system due to diabetes or during cancer treatment
• High blood pressure or use of antihypertensive drugs

If you wake up in the morning with oral bleeding or blood streaks in your mouth, you should have a gum check-up to see if it has to do with gum inflammation caused by periodontitis. Bleeding may continue due to other serious conditions, e.g. nasopharyngeal cancer and problems in the throat and oesophagus, and require immediate medical attention.