The gums may then become swollen, sore, or infected; this is referred to as gingivitis. In general, gum disease can be treated or prevented by maintaining a good oral health regime. However, if it is left to develop, it can result in periodontitis, which weakens the supporting structures of the teeth.

Gum disease, which is also called periodontal disease, is widespread. According to the Centers for Disease Control and Prevention (CDC), almost half of adults in the United States have some degree of gum disease.

The mechanisms behind periodontal disease are relatively well-understood, and newer research shows that this health problem may play a role in the development of a number of other conditions, including Alzheimer’s disease, cancer, and respiratory disease. In this Spotlight, we will cover some of the surprising links between gum disease and disparate health issues.

Gums and the brain

Although spatially the gums are near the brain, one wouldn’t normally associate dental complaints with neurological conditions.

However, some studies have found a link between periodontal disease and tooth loss and cognitive function. One study looking at cognitive performance followed 597 men for up to 32 years. The authors conclude:

Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.

Researchers have also linked periodontal disease with an increased buildup of beta-amyloid in the brain — the neurological hallmark of Alzheimer’s.

Other experiments have produced evidence that one type of bacteria commonly found in cases of periodontitis — Porphyromonas gingivalis — can be found in the brains of individuals with Alzheimer’s.

Following on from that discovery, in a more recent study, researchers showed that P. gingivalis infection boosts the production of beta-amyloid in the brain.

Periodontal disease was associated with a small, but significant, increase in overall cancer risk.

In this study, the researchers paid particular attention to an enzyme produced by P. gingivalis called gingipain. They found that this protease was toxic to tau, another protein that plays a pivotal role in Alzheimer’s.

It is worth noting that other researchers have concluded that beta-amyloid is produced in response to a pathogen. The way we view Alzheimer’s is slowly changing.

In the future, scientists hope that targeting gingipain enzymes might help stop neurodegeneration in some people with Alzheimer’s disease. They have already designed a gingipain inhibitor, which they are testing in humans.

The dentist or surgeon will numb the tooth first to make the person more comfortable. While a tooth extraction may still be unpleasant, it can be key for relieving dental pain and preventing future problems.

In this article, we outline the different types of tooth extraction and why people need them. We also describe preparation and what to expect after the procedure.

What is tooth extraction?

A tooth extraction is the removal of a tooth.

Dentists and oral surgeons remove teeth for various reasons. Some examples include:

• dental cavities
• gum disease
• dental infections
• trauma or injury to the tooth or surrounding bone
• wisdom teeth complications
• preparation for a dental prosthesis
• ˛preparation for dental braces, if the teeth are very crowded
• baby teeth not falling out at the proper age

Types

The right type of tooth extraction depends on the tooth’s shape, size, position, and location in the mouth.

Dental surgeons may classify extractions as simple or surgical. A simple extraction involves a tooth that is visible above the gums and that a dentist can remove in one piece.

A surgical extraction is more complicated and involves the removal of gum tissue, bone, or both. The surgeon may need to remove the tooth in pieces.

Wisdom teeth are the last to erupt and usually the first to require extraction because in many people, they are impacted. This means that they have not fully emerged from the gums.

Wisdom teeth extraction is a common procedure in oral surgery.

Preparation

A person will have a consultation with their dentist or oral surgeon prior to the extraction.

During the consultation, the doctor will ask for a thorough medical history. They will also ask about any medications that the person is taking.

Some people need to stop or start taking certain medications in the days leading up to the surgery, depending on the amount of teeth, bone, or both to be removed.

A person may also receive certain medications on the day of the surgery.

Stopping blood thinners

Many people take blood thinning medication to prevent the formation of blood clots in vessels. These medications can lead to more bleeding during surgery.

A dental surgeon can usually control bleeding at the site of the extraction by:

• using topical clotting medications on the gums
• packing the tooth socket with foam or dissolvable gauze
• stitching up the extraction site

Using gauze and applying pressure after the procedure can also help stop bleeding.

However, anyone who takes blood thinners should let their dental surgeon know during the consultation.

In order to tell whether the person should temporarily switch to a different blood thinner or stop taking this type of medication, the surgeon may need to see the results of a recent blood test.

Typically, people do not need to stop taking blood thinners prior to tooth extractions. Anyone considering stopping this treatment should consult their dentist or physician first.

Starting antibiotics

In a few circumstances, a dentist may prescribe antibiotics before a tooth extraction.

For example, they may do so to treat dental infections with widespread symptoms, such as a fever or malaise, along with local oral swelling.

Toothaches without swelling do not require antibiotics. Always take antibiotics exactly as directed by a doctor, and avoid unnecessary use.

A person may need antibiotics if they have a high risk of infective endocarditis, an infection of the heart valves or the interior lining of the heart chambers.

According to the American Heart Association (AHA), people with certain heart conditions have an increased risk of developing this infection following dental surgery.

The AHA and American Dental Association recommend, therefore, that people with any of the following take antibiotics prior to dental surgery to reduce the risk of infection:

• a prosthetic cardiac valve
• a history of cardiac valve repair with prosthetic material
• a cardiac transplant with structural abnormalities of the valve
• certain congenital heart abnormalities
• a history of infective endocarditis

Anesthesia during surgery

The person will receive an injection of local anesthetic close to the site of the extraction. This will numb the area so that the person will not feel any pain. The numbness will continue for a few hours after the surgery.

A person can request additional anesthetic or sedative medication to minimize anxiety during the procedure. The dentist or surgeon may offer:

• nitrous oxide, also known as laughing gas
• an oral sedative medication
• intravenous, or IV, sedation
• general anesthetic

A person who receives general anesthetic will be completely asleep during the procedure.

Some dentists do not have the options above at their offices. If a person requires any of these, they should let their dentist know during the consultation, and the dentist may refer them to an oral surgeon.

Our results showed that treatment with hydrogen peroxide similar to those found in whitening strips is enough to make the original collagen protein disappear, which is presumably due to the formation of many smaller fragments.

Kelly Keenan

The team is not yet sure whether this damage is permanent or if there is any way of reversing it. In the future, the researchers also plan to find out whether hydrogen peroxide affects not just collagen, but also other proteins that dentin contains.