While most Bermudians are aware of the disproportionately high prevalence of diabetes throughout the population, very few understand that there is an equally ominous infectious disease that affects even more people.

Periodontitis, or gum disease, is caused by the bacteria that live in the mouth. When bacterial deposits, or plaque, accumulate on the teeth, the gums get inflamed, swollen and sometimes bleed. That is called gingivitis. More than 85 per cent of the population has gingivitis to one extent or another. In more than one third of those people, the chronic inflammation leads to a loss of the attachment that holds the teeth in place — and that is called periodontitis.

The progression of gum disease occurs when the gum tissue, which in health is attached tightly to the teeth, separates away from the teeth, causing pockets to be formed around the root surfaces. Inside these pockets live bacteria in the same concentration as in the bowel. As the pocket gets deeper, the bone below begins to erode away, until eventually there is nothing left to hold the tooth in any more, and the tooth is lost because of periodontitis, which is the most common cause of tooth loss in adults.

Why is tooth loss important? Just ask someone who has no teeth. Dentures are rarely the end of dental problems. People without teeth, particularly lower teeth, can never eat, speak or function well ever again. The longer someone is without teeth, the more difficult these tasks become, since the jawbone will continue to deteriorate after the teeth are gone. The quality of life for those without a healthy dentition has been shown to be a significant challenge for patients as well as their families.

A more dangerous role that this hidden epidemic is causing in the Bermudian population is its role in overall systemic health. This is owing to the chronic inflammatory process that occurs from the infestation of oral bacteria. Blood sugar becomes much more difficult to control. The incidence of stroke, heart attacks and other cardiovascular disorders can be four times higher in patients with gum disease.

Periodontitis is also linked to arthritis, Parkinson’s disease, dementia and even some cancers. Each year, researchers discover more correlations between gum disease and systemic disease. Imagine having an ulcerated, bleeding, pus producing wound anywhere on your body the size of the palm of your hand. This is the size and nature of the inside of the gum tissues of someone with periodontitis.

How has this become such a serious health issue in Bermuda? Screening for gum disease is part of routine dental care and involves a full mouth set of X-rays and a measurement of the depth of the pockets around the teeth. While most dentists in Bermuda take these steps, some do not. For these practitioners and their patients, it is accepted that the process of tooth loss begins in early adulthood.

One by one, teeth are removed, and possibly replaced, until a full denture is required. Some dentists even promote this type of care, advertising dentures in beautiful young models. Some dentists offer therapy for gum disease such as rinses, pills or laser treatment, none of which have been shown to have an effect on the long-term progression of disease.

Gum disease is not transmissible, meaning that you cannot give it to or get it from someone else. However, there are genetic factors. If there is a history of tooth loss in your family, you may be more predisposed to tooth loss yourself. There are other factors that can make you more susceptible to gum disease, such as smoking, diabetes, tooth grinding, and poorly aligned teeth.

Like high blood pressure, most symptoms of gum disease are silent. However, there are many things that may suggest the need for further diagnosis and treatment. If you have already lost one or more teeth from bone loss, an abscess or looseness, it is likely that other teeth are involved. Gums that occasionally bleed, teeth that are loose, have moved or have spaces that have increased in size are all symptoms of gum disease.

Bad breath can be caused by many factors, but the most common one is periodontitis. Finally, people who already have a history of diabetes, heart disease, stroke or arthritis may have had gum disease all along as a predisposing factor.

Of further concern in Bermuda is not just the prevalence of periodontal disease, but the prevalence of rapidly progressive periodontitis. This alarming variation of gum disease is when bone loss begins in juveniles, resulting in tooth loss in patients from 18 to 35 years of age.

The good news is that even the most susceptible patients can be stabilised, as long as they receive a diagnosis and it is treated before it is too late. Depending upon the stage of disease, treatment may be conservative or more aggressive to halt the progress of bone loss.

In more advanced stages, regeneration of the lost bone is sometimes required to save teeth. More good news is that all of the evidence-based treatment of periodontitis is available here in Bermuda, avoiding the need for multiple costly trips abroad.

The American Academy of Periodontology has a website with more information on gum disease at www.perio.org.

David S. Samuels has been a periodontist for nearly 30 years in Boston and has been practising in Bermuda since 2012. He is the former president of the Massachusetts Dental Society, chairman of the Board of Registration for the Commonwealth of Massachusetts and general chairman of Yankee Dental Congress, one of the world’s premier and largest dental conferences. A former Associate Professor at Tufts University School of Dental Medicine, Dr Samuels is a recognised leader in the field of periodontology and oral health. He works with all of the dentists in Bermuda, and is located at Smiles, Inc, 12 Dundonald Street, Hamilton (296-0990)