Most people understand the relationship between sugar and dental cavities. But in general, people don’t know what gum disease is or how it affects those with chronic kidney disease (CKD).
When I first started working in the early 1980s, bonded fillings and preventive dental sealants for children were pretty new. Thanks to dental research, most patients who have cavities get bonded fillings instead of the old silver ones. Children have fewer cavities because of those sealants. And we now know that soft drinks (even if they’re sugar free) often lead to cavities and sensitive teeth because of the phosphoric acid they contain. That’s another reason for patients with CKD to avoid them!
Dental research has shown how gum disease affects overall health.
Let’s start with a few basics:
Gingivitis is a reversible, low-grade bacterial infection of the gums. It’s diagnosed when gums bleed easily and look red or swollen, but all of the bone holding the teeth in position is still present. Gingivitis goes away quickly with regular brushing and professional dental cleaning.
What’s periodontal disease (gum disease)?
When gingivitis is left untreated, infection makes the gums and the bone structure around the teeth recede. Unlike gingivitis, periodontal disease is not reversible. Patients rarely feel any discomfort until a lot of damage has been done.
What are the risk factors for gum disease?
- Smoking. Not only is it easier for smokers to get gum disease, it’s more difficult to treat in this population.
- Hormonal changes in girls or women. These changes can make gums more sensitive and make it easier for gingivitis to develop.
- Diabetes. It raises the risk for developing infections, including gum disease.
- Other illnesses. Cancer or AIDS and their treatments can negatively affect the gums. Patients with CKD have a higher incidence of gum disease as well.
- Medications. Hundreds of prescription and over-the-counter medications can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to gum disease. Many dialysis patients experience chronic dry mouth. And some kinds of blood pressure medication and immunosuppressants can cause abnormal overgrowth of the gum tissue, making it hard to keep the teeth and gums clean.
How is gum disease treated?
In the 1980s, gum disease was usually treated with hydrogen peroxide and baking soda. Today, dental professionals know that brushing with 100% hydrogen peroxide is too acidic and can cause teeth to become hypersensitive to heat and cold. And although baking soda is a good cleaner, it’s too abrasive to use every day and can cause tooth enamel to wear away prematurely, also making teeth hypersensitive to heat and cold.
Today, most patients with gum disease receive a deep cleaning by their dentist or are referred to a gum specialist, known as a periodontist, who performs minor gum surgery as well as deep cleanings. Since gum disease can’t be cured, patients often see their dentist more frequently to keep bacteria from building up.
How does gum disease affect CKD?
In patients with CKD, the bacteria from gum disease can cause inflammation or infection and wreak havoc in the immune system.
In patients who also have diabetes, infection can affect insulin levels, but gum disease is often overlooked as a potential source of infection. Patients who have trouble controlling their blood sugar should ask their doctor whether gum disease could be a contributing factor.
Dialysis patients, who are on fluid restrictions and prescription medications, produce less saliva and can’t eliminate mouth bacteria efficiently. Good brushing and regular dental visits, as well as one of the many over-the-counter saliva products, can help keep bacteria to a minimum.
Kidney transplant recipients are at higher risk for infection because they take immunosuppressive medications, which also make the gums swell. Frequent trips to the dentist are in order.
What can be done to prevent gum disease?
Clearly, if we’re not careful, gum disease can sneak up on us and cause problems elsewhere in the body. People with CKD should ask their doctors and dentists if their gums are healthy. Brushing and visits to the dentist aren’t just about preventing cavities; they help prevent or control gum disease also.
About the Author
Cher Thomas, RDH is a registered dental hygienist. She received a kidney transplant in 1999 from her brother and was a 2005 recipient of the RDS-Sunstar/RDH Award of Distinction. Cher lives in Galveston, Texas.
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