“We’re the gum gardeners,” says dental hygienist Elaine Tilling, education and project manager at TePe. “Revolting phrase, isn’t it? But healthy gums are so important to your overall health.” When we think of dental issues, it’s usually cavities, corrective braces or a half-day off work after having our wisdom teeth out that come to mind. But for Tilling and her fellow hygienists, the health of our gums should occupy much more of our brain space. “I think more people are increasingly aware of gum health, which is a delight,” she says. “But I don’t think we’re there yet. Gum disease is preventable, but 47% of the UK population will have advanced gum disease at some point in their 40s, 50s or later.” That’s almost half of us. The most obvious symptom of gum disease is bleeding when you brush your teeth. Women, because of fluctuating hormone levels, may notice more bleeding at particular points in their menstrual cycle, when pregnant or during menopause. This can also be accompanied by red or swollen gums, but it is hardly ever painful. This early stage of gum disease is known as gingivitis. If left untreated, it will progress to become more serious – and we do tend to ignore it, says Tilling – sufferers may also notice bad breath, a bad taste in their mouths, the loosening of teeth and even abscesses. This is periodontitis, where the tissues and bone that support the teeth are also infected. It’s periodontitis that causes teeth to fall out. Just like in your nightmares. “Many people expect to lose their teeth as a natural part of the ageing process,” says Tilling. “But that doesn’t have to be the case. With good personal care and advances in dentistry, there’s no reason why we shouldn’t all reach old age with our own teeth. The days when 70-year-olds were wearing dentures have already gone.” It’s shocking to discover that gum disease can also affect much more than our teeth. “A gum infection doesn’t just sit in the mouth,” says Tilling. “The bloodstream will take it around the whole body. If you were to unravel your gums [when infected], you would see an infected area the size of the palm of your hand; that’s the surface area for bacteria to enter the bloodstream.” Those with type 1 and type 2 diabetes will find it harder to fight infections, and gum disease can hamper a diabetic’s ability to control their blood sugar levels. In the US, patients with gum issues are required to see a periodontist before undergoing heart surgery. “And we’re heading that way in the UK too,” says Tilling. “The very same bacteria in periodontitis can also colonise the heart.” Medical research has also linked poor gum health to preterm low birth weights, rheumatoid arthritis and dementia. ”Any condition that has a link to inflammation could be affected by inflammation from your gums.” It is, however, easy to take care of the soft tissue in your mouth, although some of us are more susceptible to infection than others. “Around 8% to 18% of the population will be genetically predisposed to the condition,” says Tilling. But the advice is the same for everyone. A balanced diet plays a large part – think more vegetables and calcium-rich foods, less sugar and fizzy drinks. You knew that, right? But mostly, says Tilling: “It’s about cleaning. And that can sound like a criticism when you say it to people and that’s also a problem; nobody likes to be told they’re not cleaning something properly. Especially if they’ve brushed their teeth that way since they were four or five.” So how should we be looking after our teeth? We should be brushing twice a day, for at least two minutes. A manual toothbrush can be as effective as an electric one if used really thoroughly, with care taken to cover all areas of the mouth (dental hygienists can often tell if a patient is left or right-handed by looking at the mouth areas they have missed). Tilling also advises that bigger isn’t better when it comes to toothbrush heads: a small head with medium, round-ended bristles would be more useful. “But cleaning with just a toothbrush is not enough,” she says. “You have to clean the spaces between the teeth to prevent gum disease. That means interdental floss for patients with tight gaps between their teeth and interdental brushes for patients with bigger gaps. I don’t care what toothbrush you’re using or what their adverts say, evidence shows that nothing cleans between the teeth better than floss or an interdental brush.”