Statistically, more than half the world population between the ages of 18 and 64 have issues with their gums. Bad news if you’re one of them; good news if you’re not. From gingivitis and gum recession to periodontitis, it’s no wonder the bacteria creating these disorders like living in our mouth so much: it’s warm and dark, and the food we eat nurtures them.

Gum recession can certainly be independent of gum disease. It can be the result of aggressive brushing, smoking, vaping, or a genetic predispositon. Some people are born with insufficient gingiva that stops the muscle in the alveolar mucosa from pulling the gum down. So regardless of how proficient they are in caring for their oral health, their gum will continue to slowly retract.

The earliest indicator of gum disease is gingivitis, being the symptom of accumulated plaque and bacteria infecting the gum line. It’s beatable and treatable; and one of the most important reasons for six-monthly check-ups with your dentist. Gingivitis can be reasonably asymptomatic or sporadic in its presentation, remaining undetected – except by the trained eye of a clinician.

So don’t be laissez-faire about those appointments.

Periodontitis causes gum tissue to pull away from the tooth. If the bacteria causing it provokes immune system to attack, the biological response is to destroy anything in its path – including bone. Ultimately, tooth loss happens because there’s no healthy gingiva to support it, and no bone for roots to anchor. Bone is such an incredibly tough and rigid substance there’s the general misunderstanding that aside from growth, it’s basically unchanging; but throughout your life it responds to everything you do to your body.

This osseous tissue can do only two things: add more bone, or take it away. And daily life records a lot within the skeletal system, as well as in the teeth.

Stress markers, known as enamel hypoplasia, are lines or grooves across the dental surface because the formation of dental enamel has been interrupted, and indicates a childhood of malnourishment or disease. Excess surface bone growth is the remnant of infection or trauma; anaemia leaves lesions on the top of the skull.

This is how the broad science of palaeontology gives new stories to old bones – certainly by raw observation, but also by analysis of the isotopic composition of fossilised skeletal and dental remains. Within them, oxygen, strontium, nitrogen, and carbon are stable isotopes: atoms of the same element and number of protons, but containing different neutrons. They are the narrators of more than just the age, sex, migration patterns, chronic illnesses and diet of an individual; testing for specific isotopes layers this lattermost view of their long-ago life.

Both the history, and the future of the human race pivots on the co-evolution and relationship we have with bacteria and viruses. Identifying the DNA of ancient pathogens is being done with fascinating regularity. We can, for instance, find the smallpox virus in mummified remains from the 1600s, and classify the microfossils of bacteria in bones from the Byzantine era.

Yet our understanding or microbes is so limited we have no idea how they actually evolve. We’ve been culturing bacteria for just little more than a century, which is such a short period of observation.

We know that mammals mutate randomly, and at a consistent rate. We estimate the divergence in species by counting the mutations between different groups, and guessing common ancestries. Every species has a different molecular clock, which is what determines the pace of their evolution.

The only way to learn more about bacteria is to consider bigger time scales. Rather than simply seeing the last century of it, the archaeological record allows us to look into any sample that can be radiocarbon dated.

There’s emerging evidence of a relatively low incidence of oral diseases in pre-historic humans, yet periodontal disease is currently the sixth most prevalent health disorder in the world. Diet and food texture are certainly contributing factors; with the industrial revolution hugely responsible for the change to a more dysbiotic oral microbiota – the consequence of which is an imbalance of microorganisms and ill health.

We know gum disease has been with us for a long time. Tree resin chewing gum from a teenage girl who lived in western Sweden 10,000 years ago, was found to contain a number of bacteria that indicated severe periodontitis. We also know the systemic effect it has on our health.

What we are still to know, is how to cure it.

The range of available treatments – from antibiotics, to invasive surgeries – manage and slow its progress by reducing the infection, and to a degree, rebuilding lost bone. Dentistry’s ongoing focus on periodontitis is because intractable bacterial attachment and drug resistance mean that conventional remedies are becoming much less effective – and there have been some incredible breakthroughs

Excellent experimental results have been shown with natural ingredients like quercetin, resveratrol, baicalin and curcumin. However, most have poor solubility, and there are some safety issues.

So nanotechnology stepped in with its delivery system, and there’s high promise in the complex treatment of this disease.

Copper is an essential trace mineral with a crucial role in the maintenance of healthy bones, connective tissue, and the central nervous system. It supports immune function and the creation of red blood cells. Research highlights the importance of copper in gum care and repair, the prevention of oral infection and long-term good dental health.

Smart hydrogel can control the release of nanomedicines through stimuli-responses that include pH, reactive oxygen species (ROS), light, enzymes, and a variety of changing chemical compositions. Nanoparticles address the challenge of drug delivery for periodontal disease. They ensure stable cell targeting, and retention in the oral cavity, rather than absorption by rest of the body as is the case with standard antibiotics.

The release of active ingredients into the targeted periodontal pockets reverses the excessive immune response that causes damage to gum and bone tissue.

ROS cycling-induced copper ion oxidation has proven a favourable strategy. Not only does it have antibacterial properties, it promotes the repair of all the tissue that supports and surrounds the tooth: gingiva, alveolar bone, cementum, and periodontal ligament.

Controlling the bacterial infection, reducing inflammation and promoting regeneration are the essential strategies for combating this global health issue. Nanozyme technology doesn’t rely on pharmaceutical antibiotics, it’s topical and non-invasive.

The mouth’s complex microbial community of up to 700 species of microorganisms offers some challenges for nanotherapeutics, but overall it’s displaying great potential at preclinical levels.

Life leaves a trace. In thoughts, in bones, in teeth, and DNA. It’s a tool we continue to learn from, and it now spans biology with technology – something that sometimes feels so dark. Still, the idea of it properly treating an oral disease with more than a billion sufferers worldwide has warmth; and we’ve got to nurture that.

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