Periodontal (gum) Disease Introduction

If you have been told you have periodontal (gum) disease, you’re not alone. Many adults in the U.S. currently have some form of the disease. Periodontal disease ranges from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.

Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.

What causes gum disease?

Bacteria causes gum disease. Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional dental cleaning can remove tartar.

Gingivitis

The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleanings in our office. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.

Periodontitis

When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth.”) In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are slowly destroyed. The teeth may eventually become loose and have to be removed.

Risk Factors

  • Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.
  • Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.
  • Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.
  • Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medications can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep gums clean.
  • Illnesses. Diseases like cancer or AIDS and their treatments can also negatively affect the health of gums.
  • Genetic susceptibility. Some people are more prone to severe gum disease than others.

Who gets gum disease?

People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.

What can I do to prevent gum disease?

  • Brush your teeth after meals or at least twice a day (with a fluoride toothpaste)
  • Floss every day. We prefer you floss in the evening before going to bed
  • Visit us routinely for a check-up and professional cleaning
  • Don’t smoke, Do eat properly to get enough vitamins and minerals.

How do I know if I have gum disease?

Symptoms of gum disease include:

  • Bad breath that won’t go away
  • Red or swollen gums
  • Tender or bleeding gums
  • Painful chewing
  • Loose teeth
  • Sensitive teeth
  • Receding gums or longer appearing teeth

Any of these symptoms may be a sign of a serious problem, which should be checked immediately. At your visit here we will:

  • Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.
  • Examine your gums and note any signs of inflammation.
  • Use a tiny ruler called a ‘probe’ to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.
  • We may also:
    • Take an x-ray to see whether there is any bone loss.
    • Refer you to a periodontist if your disease is in an advanced stage.

How is gum disease treated?

The main goal of treatment is to control the infection and to reduce the bacteria in the mouth. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that you keep up good daily care at home, follow our instructions and keep your scheduled appointments.

Deep Cleaning (Scaling and Root Planing)

In our practice, we removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.

Medications

Medications may be used with treatment that includes scaling and root planing, but they cannot always take the place of surgery. Depending on how far the disease has progressed, we may still suggest surgical treatment. Here are some medications that are currently used:

Prescription antimicrobial mouthrinse

A prescription mouthrinse
containing an antimicrobial called chlorhexidine

To control bacteria when treating
gingivitis and after gum surgery

It’s used like a regular
mouthwash.

Antiseptic “chip”

A tiny piece of gelatin filled with
the medicine chlorhexidine

To control bacteria and reduce the
size of periodontal pockets

After root planing, it’s placed in
the pockets where the medicine is slowly released over time.

Antibiotic gel

A gel that contains the antibiotic
doxycycline

To control bacteria and reduce the
size of periodontal pockets

The periodontist puts it in the
pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.

Antibiotic microspheres

Tiny, round particles that contain
the antibiotic minocycline

To control bacteria and reduce the
size of periodontal pockets

The periodontist puts the
microspheres into the pockets after scaling and root planing.  The particles release minocycline slowly over time.





Enzyme suppressant

A low dose of the medication
doxycycline that keeps destructive enzymes in check

To hold back the body’s enzyme
response  —  If not controlled, certain enzymes can break down gum tissue

This medication is in pill
form.  It is used in combination with scaling and root planing.

Oral antibiotics

Antibiotic tablets or
capsules

For short term treatment of an
acute or locally persistent periodontal infection

Tablets or capsules taken by
mouth

Surgical Treatments

Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. I may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the you the patient, and for me as well as my hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will shrink to fit more tightly around the tooth. This sometimes results in the teeth appearing longer.

Bone and Tissue Grafts. In addition to flap surgery, you may need a bone or tissue grafts. Grafting is a way to replace or encourage new growth of bone or gum tissue destroyed by periodontitis. A technique that can be used with bone grafting is called guided regeneration, in which a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow.

Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask me what the level of success might be in your particular case.

Can gum disease cause health problems beyond the mouth?

Scientists are increasingly observing a connection between oral health and heart conditions. In a study published in the International Journal of Cardiology, researchers looked at two groups of patients-those who had suffered a recent heart attack and a control group-and found that the heart patients had noticeably worse oral health compared to the controls. This doesn’t prove that bad teeth and gums caused the heart attacks, but it does indicate an association between the two.

In an article written by Dr. Ranit Mishori and published in the March 14, 2010 issue of the Parade, Dr Mishori further writes that gum disease threatens more than your heart. In theory, the toxins in plaque can cause harm wherever they go. In fact, scientists are finding more and more links between oral health and conditions such as diabetes, kidney disease, preterm labor, osteoporosis, Alzheimer’s disease, and even certain types of cancer.

With deep cleaning and removal of bacterial buildup, gum disease can be reversed-if it’s caught in the early stages.