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Gum Disease

(Periodontal Disease)

by Dr Fils Onokoko Djulu, DDS, Dental Surgeon

Gum disease is widespread and affects billions of people around the world. This is a common problem in adults and children. It is an infectious disease, caused by the presence of bacteria responsible for inflammation of the tissues that surround and support the teeth. The essential role of the gums is to support the teeth in place. It therefore covers the roots and protects them against bacteria and aggression. 


  1. CAUSES OF GUM DISEASE

The main cause of gum disease is plaque due to poor oral hygiene. Gum disease always starts with the accumulation of bacteria in the gums that causes an infection. These bacteria when they encounter food form what is known as dental plaque. When put together, plaque or biofilm is formed. Plaque is invisible at first, then as it grows, it appears to the naked eye as a sticky, yellowish-white layer that is deposited on the surface of the teeth. At this stage, rinsing the mouth with water cannot remove this plaque, only brushing which can disorganize and eliminate the plaque.


Bacterial plaque is essentially composed of bacteria, salivary proteins and some food debris of toxins secreted by bacteria. So, when this dental plaque accumulates, it ends up hardening following the incorporation of mineral salts from saliva and calcifies to form what is called dental tartar. The latter is a calcification of existing plaque deposits on the teeth or any other solid surfaces in the mouth. 


Plaque causes swelling, an infection of the gums commonly known as gingivitis, and over time this sometimes progresses to periodontitis, i.e. the destruction of the supporting tissues of the teeth. Since dental plaque is the factor that determines periodontal disease, there are some general and local factors that aggravate this disease. These factors include:


Tobacco: Other causes that promote responsible gum disease, especially smoking. In fact, the nicotine consumption contained in tobacco leads to the destruction of the supporting tissues of the teeth due to a decrease in the supply of oxygen and nutrients to the mouth. In the gums. In addition, smoking decreases the immune response to fight infections. Nicotine, the tar contained in tobacco smoke, is also deposited on the surface of the teeth, aggravating the inflammation of the gums. When tobacco use is combined with alcohol, the risk of gum disease is even higher. Cannabis also promotes gum disease.


  • Diabetes: In addition, diabetes is one of the causes of periodontal disease. People with diabetes should pay special attention to their oral hygiene, as they are more prone to periodontitis, infectious diseases where the inflammatory response destroys the tissues that support the teeth. Periodontal disease is considered the sixth complication of diabetes. One in two diabetic patients has periodontal disease.


  • These complications are closely related to diabetes, as they are both "causes and effects" of one of the most important aspects of diabetes. Decreased saliva production, sweeter saliva, unbalanced bacterial flora and decreased resistance to microbial infections, make people with diabetes more vulnerable to oral infections.


  • On the other hand, inflammation in the gums or caused by infection increases insulin resistance, making it more difficult to balance blood sugar. So, people with a fragile immune system are also more likely to develop gum disease. 


  • Medications: Taking certain medications such as contraceptives, stress and hormonal changes, or menopause also contribute to gum disease. In pregnant women, periodontal disease significantly increases the risk of preterm birth, and low birth weight is one of the most common causes of perinatal death.


  • Other causes: Local factors, in particular: dental malposition, narrow interdental space, furcations, coronary fillings or ill-fitting dental prosthetic crowns, gum injuries due to overly aggressive brushing promote mechanical retention and therefore the accumulation of dental plaque responsible for (gingival) gum diseases.


    2. DIFFERENT PERIODONTAL GUM DISEASES


GINGIVITIS: is an inflammation of the gums caused by the deposition of bacteria at the neck of the tooth. It most often results in redness, bleeding when brushing, swollen gums and the gums become sensitive to probing. Gingivitis is reversible with proper treatment, and this is enough to achieve gum healing. Gingivitis is very common and is the most common gum disease. It affects nearly 99% of the world's population. It also affects children and adolescent girls.


Regular and thorough brushing of the teeth goes a long way in preventing gum disease. Also scaling will be mandatory to remove the scale. Bleeding gums are likely to heal after three days, a week, or two weeks of careful brushing. 


Brushing should be regular and done at least twice a day for two to three minutes to 5 minutes. Brushing disturbs the local anaerobic climate and the resident flora recovers. Regular dental visits, i.e. at least once a year for check-ups and cleanings and examinations, are essential elements for good oral health and are therefore a better removal of plaque and gum disease. 


PARODONTITIS: is a deep inflammation of the gums and bone that supports the tooth, leading to the proliferation of germs along the tooth root. It is another and most advanced form of gum disease. It is characterized by bleeding gums, bad breath, tooth mobility, receding and retracting gums. In addition, bacteria can migrate, through the inflamed gums, into the circulation and cause distant complications, such as: diabetes, heart, kidney, liver disease, memory loss, etc. Similarly, inflammation of the gums does not remain localized and can impact the entire body. Of note, periodontitis is responsible for tooth loss.


When the gums progress to periodontitis, treatment becomes much more complicated. Only the dentist can treat periodontitis by:

  • Tips on oral hygiene;
  • Scaling and root planning (depending on the rate of tartar build-up and risk factors for periodontal disease);
  • Visits to the dentist for a dental check-up every six months. An in-depth examination is carried out: mucous membrane, periodontium, teeth, salivary flows, to detect possible lesions of the teeth and gums at an early stage;
  • Management/treatment of periodontitis will depend on the severity of the infection (diseases). 

Brushing should be regular and done at least twice a day for two to three minutes to 5 minutes. Brushing disturbs the local anaerobic climate and the resident flora recovers. Regular dental visits, i.e. at least once a year for check-ups and cleanings and examinations, are essential elements for good oral health and are therefore a better removal of plaque and gum disease.


PARODONTITIS: is a deep inflammation of the gums and bone that supports the tooth, leading to the proliferation of germs along the tooth root. It is another and most advanced form of gum disease. It is characterized by bleeding gums, bad breath, tooth mobility, receding and retracting gums. In addition, bacteria can migrate, through the inflamed gums, into the circulation and cause distant complications, such as: diabetes, heart, kidney, liver disease, memory loss, etc. Similarly, inflammation of the gums does not remain localized and can impact the entire body. Of note, periodontitis is responsible for tooth loss. When the gums progress to periodontitis, treatment becomes much more complicated. Only the dentist can treat periodontitis by:

  • Tips on oral hygiene;
  • Scaling and root planning (depending on the rate of tartar build-up and risk factors for periodontal disease);
  • Visits to the dentist for a dental checkup every six months. An in-depth examination is carried out: mucous membrane, periodontium, teeth, salivary flows, to detect possible lesions of the teeth and gums at an early stage;
  • Management/treatment of periodontitis will depend on the severity of the infection (diseases).


  3. PREVENTIVE TREATMENT OF GUM DISEASE


The best prevention of gum disease is rigorous hygiene and regular visits to the dentist; Brush your teeth well after each meal twice a day with a soft toothbrush so as not to further damage the gums. Brush for at least two to three minutes;


Brush with the right technique (vertical); Use a soothing, non-abrasive toothpaste. Some dental pastes are recommended for sensitive gums as well as gum disease treatments;


Use dental floss/toothpick. Interdental brushes; Flossing removes plaque from between the teeth. Water propellers can also be used for deep cleaning;


Apply a specific gel; An antiseptic gel can be used topically to help calm the inflammation of the gums;


Rinse your mouth. Use an antiseptic mouthwash two to three times a day after each brushing; Do not exceed ten days of treatment without medical advice;


It depends on the mouthwash used; Chlorhexidine-based mouthwashes are not recommended for long-term use. 


REFERENCES


  1. Can children contact one of the gums: www.cliniquedentairealainquinn.com, June 1, 2022. Dr. Alain Quinn.
  2. Periodontal diseases: how to diagnose and treat them? www.smileparter.fr, July 27, 2022.
  3. Articles written by Marion Michelet and checked by Dr. Jana Bacharova, dental surgeon at the El cedro Tenerife clinic.
  4. Understanding Gum Disease: www.amili.fr, July 6, 2023. Identify early signs of gum disease: www.sunstargun.com, January 27, 2023.
  5. Periodontal disease: Dental Aid Africa Foundation. By Dr. Tom Van der Colk, dentist-ocupuncturist Kigali, 13 December 2004.
  6. Complications of teeth and gums: www.federationdes diabétiques.org
  7. Periodontal disease: www.americanhospital.org, February 12, 2020. 8. Tips: Gingivite-automédicationlasanté.net


AUTHOR CONTACT

Dr. Fils ONOKOKO DJULU, DDS, Dental Surgeon ;

Phone : +243982133064

Email : fistononokoko2019@gmail.com

Adress : Av. Dei Q-OUA/Basoko C/Ngaliema, concession Procoki

Democratic Republic of Congo

Universal Health Care in DRC: How Close Are we?

By Dr. Vuvu, PharmD • February 14, 2021
Universal Health Care in the Democratic Republic of Congo: How Close Are We? By Fiston Vuvu, PharmD, cMSc Africa Health Policy Institute A growing consensus for access to quality health care has led to universal health care (UHC) becoming a global health priority. Achieving UHC serves the purpose of increasing population coverage and providing financial risk protection (1) in case of health catastrophe.(1) Low to middle income countries (LMICs), such as the Democratic Republic of the Congo (DRC), are joining the call for universal public coverage. Existing evidence supports that UHC is prerequisite to sustainable economic development and poverty reduction.6 Thus, in DRC, policy interest for UHC has even grown pointedly since the ascension to power of the newly elected President, Felix Tshisekedi, who has committed himself to provide public health coverage to every Congolese citizen. However, the biggest question remains whether it is even possible to imagine the feasibility of UHC in the Democratic Republic of Congo. This publication will address this pertinent question and will also provide decision-makers with support evidence to make informative decisions in implementing UHC in the country. Universal health care in the DRC: Where are we? The DRC, one the world mineral-rich country, has experienced decades of improper governance, corruption, and repeated episodes of civil wars. Today, most Congolese in poverty with less than $1.90 per day. (2) According to the World Bank, the country has the potential of becoming one of the richest economies in Africa if improper governance can be remediated. In the recent years, the DRC economy has continuously expanded with a growth rate of passing from 2.4% in 2016 to 4.1 % in 2018.(4) The slow country economic expansion has also met ongoing legislative efforts to adopt UHC in the country. In 2014, for instance, the DRC adopted legislative resolutions and policy recommendations from the General Assembly of the National Steering Committee of the health sector to effectively decentralized the health system and established major health reforms. This was followed by the introduction in 2016 of a new bill to implement UHC in the country.(2) However, more key health reforms are still needed to fully implement UHC in the Democratic Republic of Congo. Financing UHC in DRC: From out-of-pocket payments to prepayment pooled sharing As with most LMICs, financing public health coverage is a major barrier in achieving UHC in DRC due to limited economic resources and weak institutional capacity of government. Out of pocket (OOP) payments, averaging $4.8-$10 USD,(1) remain the commonly used mechanism to pay for health care services. These payments are often paid directly to the health care providers at the point of service. A practice that has largely contributed in the impoverishment of many Congolese households. Supporting evidence has shown that relying heavily on OOP payments expose health care users to financial catastrophe.(2,3) As the DRC advances in the journey toward UHC, it is important for decision-makers to consider alternatives financing mechanisms with prepayment options, such as community-based health insurance (CBHI). The latter consists in pooling risks and resources at the community level where participating households voluntarily pay a predetermined amount of money in return for a healthcare service benefit package. For instance, in Katako-Kokombe (Central DRC), a CHBI was proved successful in providing health coverage to local population in areas where government or employer-based health insurance was minimal.(5) Universal health care in the DRC: Affordability and “Willingness to pay.” Increased access and affordability of insurance premiums will be two of the main factors to consider in adopting any health insurance schemes in the country. A survey completed in certain geographical areas of the DRC found that 9 out 10 Congolese households were willing to subscribe to a microinsurance health plan. However, 40% of the respondents felt that the premium--set at $6.65 per person annually--was too expensive .(3) The willingness to pay for the contribution to a voluntary health insurance scheme was $5.16 per household per year or $0.71 per individual.(3) Taking these figures into consideration, it is therefore important for any insurance schemes to consider lowering premiums when designing health coverage package. It is also imperative for the Congolese government to finance many health insurance initiatives as most Congolese will not be able to afford insurance premiums. Universal Health Care in DRC: What is next? The journey toward universal health care will require the country to continue the path of economic growth expansion. The latter will lead to more health reforms which consequently would stimulate utilization of health care services. The feasibility of implementing universal health coverage in the Democratic Republic of the Congo is difficult at this point of time. However, decision- and policymakers will need to continue with the efforts of sustain economic growth, of promotion of health policy reforms, and development of healthcare infrastructures to accommodate growing healthcare demands of the entire Congolese population. References 1. Savedoff, W., de Ferranti, D., Smith, A. and Fan, V. (2012). Political and economic aspects of the transition to universal health coverage. The Lancet, 380(9845), pp.924-932. 2. Laokri, Samia et al. “Assessing out-of-pocket expenditures for primary health care: how responsive is the Democratic Republic of Congo health system to providing financial risk protection?.” BMC health services research vol. 18,1 451. 15 Jun. 2018. 3. Gerstl, Sibylle, et al. “Who Can Afford Health Care? Evaluating the Socio-Economic Conditions and the Ability to Contribute to Health Care in a Post-Conflict Area in DR Congo.” PloS One, Public Library of Science, 24 Oct. 2013. 4. World Bank. World Bank Country and Lending Groups. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519. Accessed September 3, 2019. 5. Shako, Modeste Ngongo, Jack Kokolomami, and Yves Kluyskens. "Introducing a microhealth insurance in Katako-Kombe, DRC: constraints and challenges," Public Health, Vol. 30, No. 6, 2018, 887-896. 6. Abiiro, Gilbert Abotisem, and Manuela De Allegri. “Universal health coverage from multiple perspectives: a synthesis of conceptual literature and global debates.” BMC international health and human rights vol. 15 17. 4 Jul. 2015.

Africa and The road to Universal Health Coverage

By Vuvu FV • December 13, 2020
Investment in Africa’s health systems is key to inclusive and sustainable growth. Strong economic growth in recent years has helped reduce poverty to 43 percent of the population. Yet, as Africa’s population expands—it is estimated to reach 2.5 billion by 2050—the region faces a critical challenge of creating the foundations for long-term inclusive growth. Many countries still contend with high levels of child and maternal mortality, malnutrition is far too common, and most health systems are not able to deal effectively with epidemics and the growing burden of chronic diseases, such as diabetes. These challenges call for renewed commitments and accelerated progress toward Universal Health Coverage (UHC) - the principle that everyone receives needed health services without financial hardship. Most African countries have integrated UHC as a goal in their national health strategies. Yet, progress in translating these commitments into expanded domestic resources for health, effective development assistance, and ultimately, equitable and quality health servives, and increased financial protection, has been slow. Countries that achieve their UHC targeyts by 2030 will eliminate preventable maternal and child deaths, strengthen resilience to public health emergencies, reduce financial hardship linked to illness, and strengthen the foundations for long-term economic growth. There is no one-size-fits-all approach to achieving UHC - strategies will depend on local circumstance and national dialogue Despite the great diversity of African countries, many are facing common challenges. This framework proposes a set of actions for countries and stakeholders involved in the UHC process. It is intended to stimulate action by demonstrating that progress toward UHC is not only possible, it is also essential. Source: https://www.worldbank.org/en/topic/universalhealthcoverage/publication/universal-health-coverage-in-africa-a-framework-for-action

Health Policy in Africa: Current status, future, and opportunities

By Vuvu et al. • March 21, 2001
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