Other conditions that affect periodontal health

There are a number of general conditions which can affect your chances of developing periodontitis and potentially put you into a high-risk category. Sometimes, the effects of the disease itself increase your risk of gum problems – for example, in diabetes; in other cases, the medications prescribed may have a damaging effect – for example, phenytoin taken for epilepsy or nifedipine for high blood pressure.

High blood pressure

If you suffer high blood pressure, you should be aware of the possible effects of your prescribed medication on the health of your gums. This knowledge allows you to take steps to protect yourself against gum problems and tooth loss.

High blood pressure medications and thickening of the gums
If you have been diagnosed with high blood pressure, it is likely that you will have to take antihypertensive medications over a long period. One group of antihypertensive medications, known as calcium antagonists – for example, nifedipine, amlodipine and felodipine – can cause a troublesome overgrowth of the gums in some susceptible individuals. This is not only unsightly but can cause difficulty in chewing if it is allowed to advance. Furthermore, the enlarged and misshapen gums make effective tooth cleaning impossible and enable plaque to accumulate. This results in inflammation of the gums (gingivitis), which may progress to the destruction of the tooth-supporting tissues (periodontitis) and possible tooth loss.

What can you do to tackle the problem?
Although the blood pressure medication may be responsible for causing changes in the size and shape of the gums, the presence of dental plaque around the teeth remains the most important factor in causing periodontitis, because the inflammatory changes are triggered by periodontal bacteria. Furthermore, gum overgrowth tends to be worse in sites where bacteria accumulate readily and usually begins between the teeth. This sets up a vicious cycle, because the overgrown areas then become even more difficult to clean because of the extra gum tissue. Efficient plaque removal is therefore the key to limiting the gum overgrowth and preventing inflammation, tissue destruction and tooth loss.

Daily care at home
If you are taking antihypertensive medications, it is essential that you maintain a regular and thorough oral hygiene routine at home, including careful tooth brushing and interdental cleaning, with small brushes or floss. Your dentist will demonstrate the correct techniques for your mouth. Fluoride toothpastes, mouthwashes and gels will help provide protection against tooth decay.
Professional care
Your dentist will be able to provide personalised preventive care to care for your gums, including professional tooth cleaning, medical treatments and advice. It is advisable to have your teeth professionally cleaned at least twice a year; at these visits, all soft and hard deposits are removed by a specially trained professional (a dentist or hygienist) and your oral hygiene practices are reviewed and adjusted if necessary. These measures are often successful in reducing mild overgrowth of the gums and will help prevent further enlargement.In some cases, when the gum overgrowth is advanced despite thorough cleaning, it may be necessary to consider minor surgery to remove some of the overgrown gum tissue and give better access for cleaning. This option would be discussed fully with you, after careful consideration by the professional team responsible for your care, including your medical specialist, dentist and/or periodontist.
Changing medication or dosage
It is sometimes possible to reduce the dosage of blood pressure-lowering medication or to consider switching to an alternative medication. This is something which should never be undertaken independently, but requires a full consultation with the medical practitioner who is responsible for your prescription, so that you can be sure that your blood pressure continues to be adequately controlled.

The long-term success of treatment depends on the combined efforts of you and your dental professional.

Are you diabetic and more than 40 years old?

If the answer is yes, please read the important information below, which relates to your dental health.

Diabetes mellitus – a condition in which the body is unable to control its sugar levels properly – is an increasingly common disease in Western countries, affecting at least 5% of the population. In fact, it is thought likely that only about half of people affected with diabetes have actually been diagnosed. Overall, 80% of known diabetics are more than 40 years of age, with just 0.05% below the age of 15 years.

Dentists now know that, in patients with diabetes, untreated periodontal disease progresses very rapidly, often leading to early tooth loss. In addition, wound healing following dental extractions is often very slow and inefficient in these individuals. Other problems that might be encountered are abscesses (painful infections), gingivitis with ulcers or sores, and fissures or cracks at the corners of the mouth. Anti-diabetic medications may also cause a patient to suffer from a very dry mouth, which makes dental decay more likely.

Diabetes and periodontal disease
Patients with Type 1 (primary, insulin-dependent) diabetes and the more common Type 2 (non-insulin dependent) diabetes each have a three times greater risk of periodontitis, compared with non-diabetic individuals. There is also a higher chance that they will suffer bone loss and experience an active and rapid form of the disease. In turn, the presence of unrecognized or untreated periodontitis makes it more likely that their diabetes will be poorly controlled. Therefore, treatment of periodontal disease in diabetic patients is crucial, not only to preserve the teeth, but to help prevent possible complications of uncontrolled diabetes.

It is important – and heartening – to realise that a patient with well-controlled diabetes has no greater risk of periodontal disease than a non-diabetic person. This is why it is very important to make sure that blood sugar levels are under good control when combating periodontal disease – the better the diabetic control, the more successful periodontal treatment will be.

Kidney disease and dialysis
One potential complication of diabetes mellitus, especially when it is poorly controlled, is irreversible damage to the kidneys. This damage may progress over time until kidney function is severely impaired and either dialysis or a kidney transplant is necessary.

It is very important for the overall health of patients with kidney disease that their mouth should be free from inflammation and bacterial build-up. However, oral hygiene can be a low priority for dialysis patients, because of the demands of their treatment for kidney disease, with the result that periodontal disease and tooth decay are commonly seen. This is an added disease burden for the body and is likely to weaken its ability to cope with the systemic disease. Excellent oral hygiene and treatment of all decayed teeth is essential.

What measures can you take to help yourself?

Personal care at home
Your cooperation with the oral hygiene recommendations of your dentists is vital to the success of preventive treatment. It is essential that you maintain a regular and thorough cleaning routine at home, including careful tooth brushing twice daily and interdental cleansing once daily. Fluoride toothpastes, mouthwashes and gels will help provide protection against tooth decay.
Professional care
Your dentist will be able to provide personalised preventive care to care for your gums, including professional tooth cleaning, medical treatments and advice. It is advisable to have your teeth professionally cleaned at least twice a year; at these visits, all soft and hard deposits are removed by a specially trained professional (a dentist or hygienist) and your oral hygiene practices are reviewed and adjusted if necessary. It is very important to attend regular follow-up appointments, so that your condition can be closely monitored.

For the best treatment result, it is crucial that your diabetes is under excellent control.

The long-term success of periodontal treatment depends on the joint efforts of you and your dental practitioner.

Organ transplant recipients and the risk of periodontitis

Before organ transplantation is carried out, the mouth should be free of periodontal disease and dental decay. Therefore, it is important to arrange to be examined by your dentist in advance of the operation, so that decisions can be made about any necessary treatment, in conjunction with your transplant specialist.

After the transplant procedure, you will need to take long-term immunosuppressive therapy in order to prevent organ rejection and this will place you at increased risk of periodontal disease. One of the most commonly used immunosuppressive drugs is called cyclosporine A. Medications to lower blood pressure, such as calcium antagonists, are also often prescribed to transplant recipients. In many people, these medications cause a thickening of the gums, known as gingival hyperplasia, after a few months of treatment and this outcome is known to be more likely if inflammation is already present in the gums. The gum enlargement develops mainly between the teeth, appearing as small swellings, but it may develop into more generalised bulging of the gums. The overgrown gums partially cover the teeth and make plaque removal very difficult, leading to the onset of inflammation.

What measures can you take to help yourself?

Personal care at home
Your cooperation with the oral hygiene recommendations of your dentists is vital to the success of preventive treatment. It is essential that you maintain a regular and thorough cleaning routine at home, including careful tooth brushing twice daily and interdental cleansing once daily. Fluoride toothpastes, mouthwashes and gels will help provide protection against tooth decay.
Professional care
Your dentist will be able to provide personalised preventive care to care for your gums, including professional tooth cleaning, medical treatments and advice. It is advisable to have your teeth professionally cleaned at least twice a year; at these visits, all soft and hard deposits are removed by a specially trained professional (a dentist or hygienist) and your oral hygiene practices are reviewed and adjusted if necessary. It is very important to attend regular follow-up appointments, so that your condition can be closely monitored.

If a combination of oral hygiene measures and professional cleaning is not enough to reduce or limit the gum overgrowth to a manageable level, your dental practitioner might suggest that you have surgery to trim and reshape the gum, to improve the appearance, function and access for home care. Your dentist will liaise with your physician to make sure that you have the correct antibiotic and steroid cover for this procedure.

Phenytoin use in epilepsy

If you need to take phenytoin to control your epilepsy, read on to find out how your medication could put you at risk of periodontal disease and what you can do about it.

Phenytoin is an anticonvulsant drug, which is sometimes used in the treatment of epilepsy. In some people, it causes an overgrowth of the gums which makes cleaning of the teeth very difficult. As a result, bacterial plaque accumulates and triggers inflammatory changes in the gums, leading to gingivitis and, potentially, periodontitis. The enlargement of the gums is more likely to happen if the patient’s oral hygiene is poor or if there are already inflammatory changes present in the gums when treatment is started.

What measures can you take to help yourself?

Personal care at home
Your cooperation with the oral hygiene recommendations of your dentists is vital to the success of preventive treatment. It is essential that you maintain a regular and thorough cleaning routine at home, including careful tooth brushing twice daily and interdental cleansing once daily. Fluoride toothpastes, mouthwashes and gels will help provide protection against tooth decay.
Professional care
Your dentist will be able to provide personalised preventive care to care for your gums, including professional tooth cleaning, medical treatments and advice. It is advisable to have your teeth professionally cleaned at least twice a year; at these visits, all soft and hard deposits are removed by a specially trained professional (a dentist or hygienist) and your oral hygiene practices are reviewed and adjusted if necessary. It is very important to attend regular follow-up appointments, so that your condition can be closely monitored.