Maintain Your Oral Health to Avoid Periodontitis

With better dental hygiene, gingivitis is reversible—but if you don’t take care of your teeth, periodontitis will develop.


As periodontitis progresses, bad breath may become a problem and your gums may recede from your teeth, making them appear longer.

© Christoph Hähnel |

You’ve heard since the time you were small that brushing your teeth is vital to stave off oral hygiene problems. Even so, the Centers for Disease Control and Prevention report that nearly half of all Americans aged 30 and older have some degree of periodontitis (gum disease). The number increases in older age groups, with about 70 percent of people age 65 and older affected.

Periodontitis is something you should guard against because study data has linked the inflammation triggered by periodontitis to heart disease and other health risks. Research also suggests a link between periodontitis and dementia.

Do You Have Periodontitis?

Periodontitis usually develops because of poor oral care, though you also are at greater risk for periodontitis if your diet is poor, you smoke or chew tobacco, are obese, and/or take medications that cause a dry mouth (for example, diuretics such as hydrochlorothiazide, which is used to treat high blood pressure).

Sugar in the foods you eat interacts with bacteria that are naturally present in your mouth and together they form plaque. If you don’t thoroughly brush and floss your teeth, plaque can build up and form tartar that penetrates your gum line. Plaque also causes gingivitis, which is the first stage of periodontitis and typically causes redness of the gums and bleeding when you brush and floss your teeth.

With better dental hygiene, gingivitis is reversible—but if you don’t take care of your teeth, periodontitis will develop. Signs that you may have periodontitis include puffy, bleeding gums that feel tender when touched. As periodontitis progresses, bad breath may become a problem and your gums may recede from your teeth, making them appear longer. Eventually your teeth may loosen and fall out. But keep in mind that inflammation from periodontitis can spread throughout your body—it isn’t just your teeth that are impacted.

Periodontitis and Your Heart Health

People with severe, chronic periodontitis have large amounts of bacteria in their mouths, which means they’re more likely to have bacteria in their bloodstream. This may be the link underpinning the connection between periodontitis and cardiovascular disease. Oral bacteria can travel to the heart via the bloodstream—and bacteria that are commonly found in areas of dental inflammation and infection have been isolated in the atherosclerotic plaques (cholesterol deposits) in the coronary arteries (blood vessels of the heart). People with periodontitis also are more likely to lose teeth, and this can affect their diet—which, in turn, can impact cardiovascular health.

A study presented at the American Heart Association’s Epidemiology and Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions in March 2018 found that adults who lose two or more natural teeth between the ages of 45 and 69 may have a 23 percent greater risk for coronary heart disease. Study participants with fewer than 17 natural teeth (compared to 25 to 32 natural teeth) at the beginning of the study were 25 percent more likely to develop coronary heart disease. “We assumed that tooth loss might affect inflammation, unhealthy dietary intakes and the microbiome in the human body, which in turn may affect heart health,” said study leader Lu Qi, MD, PhD, professor of epidemiology at Tulane University School of Public Health and Tropical Medicine.

Periodontitis and Your Mental Health

Research has suggested that older adults who report not brushing their teeth daily face a risk of dementia that is 22 to 65 percent greater than that experienced by their peers who do brush daily. The same study also noted that adults who have lost some of their natural teeth also have an increased dementia risk. It is not clear what underpins the association between poor dental hygiene and dementia, and it is possible that it may be a two-way street, with poor dentition leading to inflammation that harms cognition, and dementia aggravating the poor dentition—in other words, people with dementia may forget to brush their teeth.

Periodontitis and Other Health Issues

Periodontitis has also been linked to respiratory diseases, rheumatoid arthritis, and stroke. A 2017 study linked it some bacteria that are associated with periodontitis to a greater risk for esophageal cancer.

Preventing Periodontitis

In addition to reducing the risk of dangerous bacteria build-up and inflammation, maintaining good oral health and keeping your own teeth can also help you maintain a proper diet that provides sufficient nutrition to keep your mind and body healthy.

Two simple steps you can take to improve your dental hygiene are brushing twice a day and flossing once a day. Brush your teeth before you sleep and as soon as you wake up. Rinse your mouth once a day with an antiseptic mouthwash for 45 seconds after you brush—mouthwashes that kill bacteria may help reduce inflammation.

Regular brushing and flossing can help reduce the amount of tartar that collects on your teeth, which is important because tartar can damage tooth enamel and weaken your teeth. It takes undisturbed plaque about 24 hours to mineralize into tartar on your teeth that you won’t be able to remove by brushing—it will have to be scraped off.

If you find it difficult to brush and floss your teeth because of health problems that affect your manual dexterity (for example, arthritis or stroke), invest in a battery-powered toothbrush. Also consider using a water flosser, as there is evidence that these are better than manual flossing when it comes to thoroughly removing plaque from between teeth and beneath the gum line.

Also be sure to schedule a dental checkup twice a year, and if you have risk factors for periodontitis, consider hygiene appointments every three months rather than the usual six-monthly sessions.

If you have advanced periodontitis, your dentist may prescribe oral or topical antibiotics to destroy oral bacteria.

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This article was originally published in 2018. It is regularly updated. 

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Kate Brophy

Kate Brophy is an experienced health writer and editor with a long career in the UK and United States. Kate has been Executive Editor of the Icahn School of Medicine … Read More

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