Periodontal (Gum) disease in Africans

By: Cassidy Revel, RN, BSN. Health and Wellness Writer and DLHA Volunteer, with editorial support and medical review by the DLHA Team.

 

Patient with severe periodontal (gum) disease. Image credit: Blackdoctor.org. Click on image to enlarge.

 

 

Highlights

• Periodontal disease is an advanced gum disease that includes the structures that support teeth 

• It is highly prevalent, and even more so in Africa 

• Smoking greatly increases the risk for periodontal disease 

• Periodontal disease increases risk for heart attack and stroke 

• It often leads to tooth loss 

• Prevention, education, access to oral healthcare, and smoking cessation are our greatest tools for fighting periodontal disease 

 

 

What is periodontal (gum) disease?

 

Periodontal disease is simply a disease of the gums. It starts as gingivitis, an inflammation of the gums. It manifests as swollen, painful or bleeding gums and bad breath. When left untreated, the inflammation and plaque buildup from the teeth can turn into a chronic infection of the gums called periodontal disease. When it becomes advanced enough to be periodontal disease, it doesn’t just affect the gums but also all supporting tissues of the tooth, such as the bone and ligaments.It is a more severe disease that can result in loss of teeth. 

 

 

How common is gum disease in the African population? 

 

According to the World Health Organization, since the 1990’s Africa has seen an increase of over 257 million for those who suffer with oral diseases. Why is this? 

 

Oral and dental health is not a high priority in many African countries. Research shows that oral diseases, including periodontal disease and tooth loss, affect marginalized groups far more. African countries have 90% less dentists per patient compared to other countries globally. There are also less educational materials and policies in place to guide the African population in treating oral health issues. [3]
 

 

Risk Factors for gum disease

 

• Poor oral hygiene

 

Poor oral hygiene is a preventable risk factor for periodontal disease. 
 

• Smoking 

 

Smoking (or tobacco use in any form) is one risk factor that is strongly associated with periodontal disease and the advanced consequences of it and in fact, smoking doubles your risk of developing it. This is because it weakens your immune system and makes it harder to fight off infections, including those that cause periodontal disease. 

The amount of cigarettes a person smokes and the number of years as a smoker proportionally correlates to their increased risk of periodontal disease. 

 

The link between tobacco and periodontal disease is so strong that one study even found that exposure to secondhand smoke still puts you at higher risk for developing it than someone who is not exposed to smoke. [4]
 

• Other health conditions

 

Health conditions such as stress, diabetes, immune deficiencies (such as AIDS), and dry mouth increase the likelihood of developing it, as well as hereditary oral health conditions. Periodontal disease also has a connection to pregnancy and hormonal changes. [1]

 

 

How do you know if you have gum disease?

 

You assumably have gum disease if you have any or all of the following:

• Gums that are red, swollen or sore 

• Gums that easily bleed 

• Bad breath

• Tooth sensitivity

• Pain with chewing

• Loose teeth or gaps between teeth becoming wider 

• Obvious signs of infection, such as pus 

 

Visit with your healthcare provider or dentist early if you have any of the above conditions in order to prevent further damage to your oral health.

 

 

How is gum disease diagnosed?

 

Gum disease can be easily suspected when your dentist takes a history from you and examines your mouth for evidence of inflammation. Some diagnostic tests are then performed for confirmation. First an X-ray of the mouth will be taken to evaluate for bone loss. A small marked metal instrument called a “probe” is used to explore the depth of the pockets between the gums and teeth. Normal pockets in a person with healthy gums measure between 1-3 millimeters; anything deeper can signify periodontal disease. [2]

 

 

Consequences of gum disease

 

Periodontal (gum) disease is one of the most prevalent conditions that can result in long-term health consequences. Though it starts in the mouth, it affects the whole body and can lead to serious ailments. People diagnosed with periodontal disease increase their risk of stroke or heart attack by two to three times. Smoking and unhealthy diets (especially those high in saturated fats) further increase the risk of these cardiovascular events. [5]

 

With periodontal disease, the body has increased inflammation from the gums that continues or is not quickly resolved. This chronic inflammation can lead to a condition called “atherosclerosis”. Atherosclerosis is plaque that builds up inside the arteries causing them to harden. The hardening of these arteries is what eventually can lead to heart attack or stroke. [6]

 

 

How is gum disease treated?

 

Soft tissue grafts are a type of treatment for diseased gums that can be considered in less severe situations, where the gum tissue is receding from damage. However, tooth extraction is the most common treatment for loose, sensitive teeth that accompany severe gum disease, especially for low-income populations. Tooth extraction does not cure periodontal disease, but it may be a necessary step towards improving oral hygiene and getting rid of infection.  

 

According to Harvard University, there are studies underway to develop an oral topical liquid that treats both inflammation and periodontal disease, as well as the atherosclerosis that could develop from poor oral health. Perhaps one day in the future, these studies will bring about a new treatment that can help globally those living with periodontal disease. 

 

How can I prevent having gum disease?

 

Prevention and education are two of the most useful ways to make an impact on Africa’s oral and dental health crisis. 

 

Treatment in the earliest stage possible is more likely to yield results. When gingivitis (a mild form of gum diseases) starts, it can be reversed by regular brushing and flossing, as well as tobacco cessation. Twice yearly visits to the dentist for cleanings and removal of plaque are optimal.

 

Implementing public health programs in African countries for tobacco cessation would also be helpful in decreasing the number or people who develop periodontal (gum) disease in their lifetime, as smoking is directly related to the disease. [7]

 

Suggestions for population-wide prevention of gum disease in Africans

 

According to the World Health Organization, as of 2023, “Half of the countries in the African region do not have oral health policy documents.” Some policy suggestions that could be implemented include: 

• Carrying out consistent public health education programmes in the language of respective communities [9]

• Adding routine preventative dental care to primary care services 

• Making dental care more affordable by funding preventive dental care services under Social insurance or Universal Healthcare Coverage programs

• Promoting and funding mobile dental services to take preventive dental services into rural communities

• Correcting the inadequate oral health workforce for primary care service delivery through expansion and funding of more training facilities

• Teaching children and adolescents in school, topics of tooth decay, oral hygiene, and nutrition for better oral health [8]

 

 

Conclusion

 

Periodontal disease can have a serious impact on not just oral health but overall body health. Prevention and early treatment of gingivitis is crucial. Good oral hygiene (such as regular brushing and flossing) and dental visits twice yearly are essential for healthy teeth and gums. 

 

Sources:

1. Centers for Disease Control and Prevention. Periodontal disease. Last update 10 July 2013. Accessed January 10, 2024. Available from: https://www.cdc.gov/oralhealth/conditions/periodontal-disease.html

2. National Institute of Dental and Craniofacial Research. Periodontal (Gum) Disease. Last update Oct 2023. Accessed January 10, 2024. Available from: https://www.nidcr.nih.gov/health-info/gum-disease#:~:text=Diagnosis&text=How%20it%27s%20done%20The%20dentist,a%20sign%20of%20periodontal%20disease

3. World Health Organization African Region. Africa burdened with largest global increase of oral diseases 20 March 2023. Accessed January 7, 2024. Available from: https://www.afro.who.int/news/africa-burdened-largest-global-increase-oral-diseases.

4. Centers for Disease Control and Prevention. Smoking, Gum Disease, and Tooth Loss.  Last update 5 May 2022. Accessed January 7, 2024. Available from: https://www.cdc.gov/tobacco/campaign/tips/diseases/periodontal-gum-disease.html#how-related.

5. Harvard Health Publishing. Gum disease and heart disease: The common thread. Published 15 Feb. 2021. Accessed January 7, 2024. Available from: https://www.health.harvard.edu/heart-health/gum-disease-and-heart-disease-the-common-thread#:~:text=Known%20as%20atherosclerosis%2C%20this%20fatty,not%20be%20a%20direct%20connectionh.

6. John Hopkins Medicine. Atherosclerosis.(n.d.).Accessed January 7, 2024. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/atherosclerosis#:~:text=Atherosclerosis%20is%20thickening%20or%20hardening,activity%2C%20and%20eating%20saturated%20fats.

7. Chikte U, Pontes CC, Karangwa I, Kimmie-Dhansay F, Erasmus RT, Kenge AP, Matsha TE. Periodontal Disease Status among Adults from South Africa—Prevalence and Effect of Smoking - PMC. Int J Environ Res Public Health. 2019 Oct; 16(19): 3662. Published online 2019 Sep 29. doi: 10.3390/ijerph16193662. 

8. Shomuyiwa, D.O., Bridge, G. Oral health of adolescents in West Africa: prioritizing its social determinants. glob health res policy 8, 28 (2023). https://doi.org/10.1186/s41256-023-00313-2.

9.  Osuh, M.E., Oke, G.A., Lilford, R.J. et al. Oral health in an urban slum, Nigeria: residents’ perceptions, practices and care-seeking experiences. BMC Oral Health 23, 657 (2023). https://doi.org/10.1186/s12903-023-03303-5  

 

Related:

Dental care in Africa: Challenges and solutions

The right ways to maintain your dental health

 

 

Published: January 12, 2024

© 2024. Datelinehealth Africa Inc. All rights reserved.

Permission is given to copy, use and share content for non-comercial purposes without alteration or modification and subject to attribution as to source