Dental Education Lecture: Genes vs. Effort
Today we see two patients with quite opposite characters.
Mr. Shi is in his forties and has severe gum disease. X-ray shows a lot of tartar between the teeth and under gum line (black arrowheads in Fig.1-3). Fig.1 and 2 show the right and left back teeth (top and bottom), respectively, whereas Fig.3 shows the front teeth. The presence of tartar is due to the fact that Mr. Shi does not floss at all. The gum disease is so severe that we need to take out one of his molar teeth right away (#2 in Fig.1). One of his front teeth has a big abscess (red arrowheads in Fig.3) and is probably difficult to save. Besides he has not received proper dental care for long long time. Two of wisdom teeth (#1, 32 in Fig.1) are in bad position, the third one has a huge cavity (C in Fig.2). Food is easily trapped there. He is aware of his gum condition and worries lots. He asks whether gum disease is genetics-related, because his father has lost all of his teeth. The answer is that gum disease does have gene influence, but gene plays a minor role as compared to poor oral hygiene/accumulation of germs, plaque and tartar. If he wants to save his remaining teeth, he should finish all of necessary treatment and double or triple his effort to keep his teeth clean on daily basis. This includes right ways of brushing and flossing.
Mrs. Duan is our second patient with different attitude. She has also had gum disease, because she has lost five teeth, one in the back (#2 in Fig.4, 2nd molar on the right top, as compared to #15, 2nd molar on the left top) and four in the front (not shown). But her gum disease is now under good control. From X-ray shown in Fig. 4 and 5, we cannot see a single piece of tartar between the back teeth. She has started dental cleaning for a while and flosses every single day. Although Mrs. Duan is twelve years senior to Mr. Shi, her gums look much younger and prettier.
Gum disease is very common and very special. It is triggered by germs in our mouth and made worse by our bad immune reaction. The latter is related to genes, which we cannot change. In fact, gum disease is an auto-immune disease. Our body tries to kill offending germs and at the same time kills ourselves (our gums and bone) by accident (like suicide). All is due to invasion of germs. But if we keep germs on tooth surfaces to minimum, our bad genes may not work against ourselves. How to keep germs to minimum? Brush and floss religiously and see dentist regularly. If we have family history of gum disease, we need to double our effort of good oral habit. Wait and worry does not help anyone of us. As mentioned above, gum disease is quite common. It affects almost all of us. Take care of yourself. See you next time.
Xin Wei, DDS, PhD, MS 1st edition 04/03/2010, last revision 04/04/2010