Changing the Way We Should Explain Gum Disease to Our Patients

For years, as dentists, we looked in our patients' mouths, commenting on the amount of “tartar buildup” and bleeding, and telling them to brush and floss more often. As they would stand up, we would say, “See you in six (or three months” for your next cleaning. At times we probably made our patients feel bad. “But, Doc, I don’t get it. I brush twice a day, floss almost every day, and you are still telling me that my gums are not healthy.”

While brushing and flossing frequency are important as well as regular professional cleaning, we now know that there are so many issues at play in determining the extent, severity, and outcomes of treatment, for each individual patient.

I, for one, have changed the way I explain gum disease to my patients. There are many of my patients that despite excellent compliance with teeth brushing and flossing, still suffer from periodontal disease. As dental professionals, we all learned about refractory periodontitis when we were in school and we explained to our patients that despite our best efforts, some of us just keep losing bone around their teeth. While this is still accurate, I have changed my entire way of explaining gum disease to my patients.

Now, when educating my patients on periodontal disease, the days of pointing the finger for lack of brushing and flossing are gone. I ask them to think about periodontal disease as they would any other disease: cardiovascular disease, diabetes, and even cancer. We talk about how lifestyles will increase the risk of cardiovascular disease. If you smoke, don’t exercise, eat fatty foods, of course your risk of a heart attack and stroke is higher. But, how do you explain the young, “healthy” individual, who does not smoke, exercises, eats healthy, and still has a heart attack? We have heard stories of the professional and college level athletes who have heart attacks while playing their sports. I would suggest that they are “pretty healthy” individuals.

With this new way of addressing the disease, perhaps we could get our patients to accept our approaches to the condition, modifying how we as dental professionals address our patients.

We need to make our patients understand that periodontal disease, like any other disease, is multifactorial. That genetics or the effectiveness of how our immune system responds to the bacteria that causes gum disease, plays a huge impact on disease progression. This could be hard for our patients to accept. I find it hard to accept!

I have seen so many patients come in with teeth covered in plaque and calculus. I know that a toothbrush has not hit the surfaces of their teeth often, and that they have not been to a dental office in quite some time. Still, there is no bone loss! Their tissues may be inflamed, there may be some bleeding, but the bone has been resilient.

Then there is the opposite, which can be the most difficult patients to manage. These are the patients that come into the practice every three months for their hygiene appointment, they brush and floss after every meal, they use water flossers, and mouthwashes. Yet despite all the effort, we still watch the bone shrink.

We now know of some ways to help control this with some medications, which is beyond the scope of this article. The point is that we need to have our patients understand that periodontal disease is a chronic disease, like any other disease that can affect our bodies. There are some risk factors that we can control and some that we simply cannot. If we want to get our patients to better understand the disease, its process, and the limitations of treatment, it is of paramount importance that they understand these concepts.