Periodontal Disease

The word periodontal means “around the tooth”.  Periodontal disease attacks the gums and the bone that support the teeth.  Plaque is a sticky film of food debris, bacteria, and saliva.  If plaque is not removed, it turns into calculus (tartar).  When plaque and calculus are not removed, they begin to destroy the gums and bone.  Periodontal disease is characterized by red, swollen, and bleeding gums.

Four out of five people have periodontal disease and don’t know it!  Most people are not aware of it because the disease is usually painless in the early stages.

Not only is it the number one reason for tooth loss, research suggests that there may be a link between periodontal disease and other diseases such as, stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy.  Researchers are determining if inflammation and bacteria associated with periodontal disease affects these systemic diseases and conditions.  Smoking also increases the risk of periodontal disease.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

Signs and symptoms of periodontal disease:

  • Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
  • Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
  • New spacing between teeth – Caused by bone loss.
  • Persistent bad breath – Caused by bacteria in the mouth.
  • Pus around the teeth and gums – Sign that there is an infection present.
  • Receding gums – Loss of gum around a tooth.
  • Red and puffy gums – Gums should never be red or swollen.
  • Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.
  • What is Periodontal (Gum) Disease?
  • Diagnosis
  • Treatment
  • Periodontal Scaling & Root Planing
  • Maintenance
  • Mouth - Body Connection
  • Periodontal Disease, Heart Disease and Stroke
  • Periodontal Disease and Diabetes

The term “periodontal”means “around the tooth.”  Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition which affects the supporting and surrounding soft tissues of the tooth; also the jawbone itself when in its most advanced stages.

Periodontal disease is most often preceded by gingivitis which is a bacterial infection of the gum tissue.  A bacterial infection affects the gums when the toxins contained in plaque begin to irritate and inflame the gum tissues.  Once this bacterial infection colonizes in the gum pockets between the teeth, it becomes much more difficult to remove and treat.  Periodontal disease is a progressive condition that eventually leads to the destruction of the connective tissue and jawbone.  If left untreated, it can lead to shifting teeth, loose teeth and eventually tooth loss.

Periodontal disease is the leading cause of tooth loss among adults in the developed world and should always be promptly treated.

Types of Periodontal Disease

When left untreated, gingivitis (mild gum inflammation) can spread to below the gum line.  When the gums become irritated by the toxins contained in plaque, a chronic inflammatory response causes the body to break down and destroy its own bone and soft tissue.  There may be little or no symptoms as periodontal disease causes the teeth to separate from the infected gum tissue.  Deepening pockets between the gums and teeth are generally indicative that soft tissue and bone is being destroyed by periodontal disease.

Here are some of the most common types of periodontal disease:

  • Chronic periodontitis – Inflammation within supporting tissues cause deep pockets and gum recession.  It may appear the teeth are lengthening, but in actuality, the gums (gingiva) are receding.  This is the most common form of periodontal disease and is characterized by progressive loss of attachment, interspersed with periods of rapid progression.
  • Aggressive periodontitis – This form of gum disease occurs in an otherwise clinically healthy individual.  It is characterized by rapid loss of gum attachment, chronic bone destruction and familial aggregation.
  • Necrotizing periodontitis – This form of periodontal disease most often occurs in individuals suffering from systemic conditions such as HIV, immunosuppression and malnutrition.  Necrosis (tissue death) occurs in the periodontal ligament, alveolar bone and gingival tissues.
  • Periodontitis caused by systemic disease – This form of gum disease often begins at an early age.  Medical condition such as respiratory disease, diabetes and heart disease are common cofactors.

Treatment for Periodontal Disease

There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone.  A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

Here are some of the more common treatments for periodontal disease:

  • Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed.  The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection.  A prescription mouthwash may be incorporated into daily cleaning routines.
  • Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures.  A membrane may be inserted into the affected areas to assist in the regeneration process.
  • Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums.  Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.
  • Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the bone.

Ask your dentist if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination.  This type of exam should always be part of your regular dental check-up.

A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums.  The depth of a healthy sulcus measures three millimeters or less and does not bleed.  The periodontal probe helps indicate if pockets are deeper than three millimeters.  As periodontal disease progresses, the pockets usually get deeper.

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

Gingivitis

Gingivitis is the first stage of periodontal disease.  Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.

Periodontitis

Plaque hardens into calculus (tartar).  As calculus and plaque continue to build up, the gums begin to recede from the teeth.  Deeper pockets form between the gums and teeth and become filled with bacteria and pus.  The gums become very irritated, inflamed, and bleed easily.  Slight to moderate bone loss may be present.

Advanced Periodontitis

The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed.  Unless treated, the affected teeth will become very loose and may be lost.  Generalized moderate to severe bone loss may be present.

Periodontal treatment methods depend upon the type and severity of the disease.  Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment.

Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues.  When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!

If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended.  You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended.  It is usually done one quadrant of the mouth at a time while the area is numb.  In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing).  This procedure helps gum tissue to heal and pockets to shrink.  Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.

If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean.  Your dentist may also recommend that you see a Periodontist (specialist of the gums and supporting bone).

The objective of scaling & root planning is to remove etiologic agents which cause inflammation to the gingival (gum) tissue and surrounding bone.  Common etiologic agents removed by this conventional periodontal therapy include dental plaque and tartar (calculus).

These non-surgical procedures which completely cleanse the periodontium, work very effectively for individuals suffering from gingivitis (mild gum inflammation) and moderate/severe periodontal disease.

Reasons for scaling and root planing

Scaling and root planning can be used both as a preventative measure and as a stand-alone treatment.  These procedures are performed as a preventative measure for a periodontitis sufferer.

Here are some reasons why these dental procedures may be necessary:

  • Disease prevention – The oral bacteria which cause periodontal infections can travel via the bloodstream to other parts of the body.  Research has shown that lung infections and heart disease have been linked to periodontal bacteria.  Scaling and root planing remove bacteria and halts periodontal disease from progressing, thus preventing the bacteria from traveling to other parts of the body.
  • Tooth protection – When gum pockets exceed 3mm in depth, there is a greater risk of periodontal disease.  As pockets deepen, they tend to house more colonies of dangerous bacteria.  Eventually, a chronic inflammatory response by the body begins to destroy gingival and bone tissue which may lead to tooth loss.  Periodontal disease is the number one cause of tooth loss in the developed world.
  • Aesthetic effects – Scaling and root planing help remove tartar and plaque from the teeth and below the gumline.  As an added bonus, if superficial stains are present on the teeth, they will be removed in the process of the scaling and root planning procedure.
  • Better breath – One of the most common signs of periodontal disease is halitosis (bad breath).  Food particles and bacteria can cause a persistent bad odor in the oral cavity which is alleviated with cleaning procedures such as scaling and root planing.

What do scaling and root planing treatments involve?

Scaling and root planing treatments are only performed after a thorough examination of the mouth.  The dentist will take X-rays, conduct visual examinations and make a diagnosis before recommending or beginning these procedures.

Depending on the current condition of the gums, the amount of calculus (tartar) present, the depth of the pockets and the progression of the periodontitis, local anesthetic may be used.

Scaling – This procedure is usually performed with special dental instruments and may include an ultrasonic scaling tool.  The scaling tool removes calculus and plaque from the surface of the crown and root surfaces.  In many cases, the scaling tool includes an irrigation process that can also be used to deliver an antimicrobial agent below the gums that can help reduce oral bacteria.

Root Planing – This procedure is a specific treatment which serves to remove cementum and surface dentin that is embedded with unwanted microorganisms, toxins and tartar.  The root of the tooth is literally smoothed in order to promote good healing. Having clean, smooth root surfaces helps bacteria from easily colonizing in future.

Following these deep cleaning procedures, the gum pockets may be treated with antibiotics.  This will soothe irritation and help the gum tissues to heal quickly.

During the next appointment, the dentist or hygienist will thoroughly examine the gums again to see how well the pockets have healed.  If the gum pockets still measure more than 3mm in depth, additional and more intensive treatments may be recommended.

If you have any concerns or questions about scaling and root planing, or periodontal disease, please ask your dentist.

It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)!  Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.

Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year.  At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy.  Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.

In addition to your periodontal cleaning and evaluation, your appointment will usually include:

  • Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.
  • Examination of existing restorations: Check current fillings, crowns, etc.
  • Examination of tooth decay: Check all tooth surfaces for decay.
  • Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
  • Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
  • Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

Research studies have shown that there is a strong association between periodontal disease and other chronic conditions such as diabetes, heart disease, pregnancy complications and respiratory disease.

Periodontal disease is characterized by chronic inflammation of the gum tissue, periodontal infection below the gum line and a presence of disease-causing bacteria in the oral region.  Halting the progression of periodontal disease and maintaining excellent standards of oral hygiene will not only reduce the risk of gum disease and bone loss, but also reduce the chances of developing other serious illnesses.

Common cofactors associated with periodontal disease:

Diabetes

A research study has shown that individuals with pre-existing diabetic conditions are more likely to either have, or be more susceptible to periodontal disease.  Periodontal disease can increase blood sugar levels which makes controlling the amount of glucose in the blood difficult.  This factor alone can increase the risk of serious diabetic complications.  Conversely, diabetes thickens blood vessels and therefore makes it harder for the mouth to rid itself of excess sugar.  Excess sugar in the mouth creates a breeding ground for the types of oral bacteria that cause gum disease.

Heart Disease

There are several theories which explain the link between heart disease and periodontitis.  One such theory is that the oral bacteria strains which exacerbate periodontal disease attach themselves to the coronary arteries when they enter the bloodstream.  This in turn contributes to both blood clot formation and the narrowing of the coronary arteries, possibly leading to a heart attack.

A second possibility is that the inflammation caused by periodontal disease causes a significant plaque build up.  This can swell the arteries and worsen pre-existing heart conditions.  An article published by the American Academy of Periodontology suggests that patients whose bodies react to periodontal bacteria have an increased risk of developing heart disease.

Pregnancy Complications

Women in general are at increased risk of developing periodontal disease because of hormone fluctuations that occur during puberty, pregnancy and menopause.  Research suggests that pregnant women suffering from periodontal disease are more at risk of preeclampsia and delivering underweight, premature babies.

Periodontitis increases levels of prostaglandin, which is one of the labor-inducing chemicals.  Elevated levels prostaglandin may trigger premature labor, and increase the chances of delivering an underweight baby.  Periodontal disease also elevates C-reactive proteins (which have previously been linked to heart disease).  Heightened levels of these proteins can amplify the inflammatory response of the body and increase the chances of preeclampsia and low birth weight babies.

Respiratory Disease

Oral bacterium linked with gum disease has been shown to possibly cause or worsen conditions such as emphysema, pneumonia and Chronic Obstructive Pulmonary Disease (COPD).  Oral bacteria can be drawn into the lower respiratory tract during the course of normal inhalation and colonize; causing bacterial infections.  Studies have shown that the repeated infections which characterize COPD may be linked with periodontitis.

In addition to the bacterial risk, inflammation in gum tissue can lead to severe inflammation in the lining of the lungs, which aggravates pneumonia.  Individuals who suffer from chronic or persistent respiratory issues generally have low immunity.  This means that bacteria can readily colonize beneath the gum line unchallenged by body’s immune system.

If you have questions or concerns about periodontal disease and the mouth-body connection, please ask your dentist. We care about your overall health and your smile!

Periodontal disease, heart disease and stroke may seem to be unlikely bedfellows, but researchers have found that gum disease sufferers are nearly twice as likely to also suffer from coronary heart disease.  In addition, research studies have discovered that oral infection is indeed a risk factor for stroke.  People diagnosed with acute cerebrovascular ischemia were more likely to also be experiencing some degree of periodontal disease.

Periodontal disease is a progressive condition in which the gingival tissue surrounding the teeth is infected by the colonization of bacteria.  Bacteria found in plaque colonize first above, then below the g gumline causing the tissue to pull away from the teeth.  If periodontal disease is left untreated, deep pockets form between the gums and the teeth and the tissue of the underlying jawbone is also destroyed.  The destruction of bone tissue causes the teeth to shift, wobble or completely detach from the bone.

Coronary heart disease occurs when the walls of the coronary arteries become progressively thicker due to the buildup of fatty proteins.  The heart then suffers from a lack of oxygen and must labor significantly harder to pump blood to the rest of the body.  Coronary heart disease sufferers sometimes experience blood clots which obstruct normal blood flow and reduce the amount of vital nutrients and oxygen the heart needs to function properly.  This phenomenon often leads to heart attacks.

Reasons for the Connection

There is little doubt that the presence of periodontal disease can exacerbate existing heart conditions.  The periodontist and cardiologist generally work as a team in order to treat individuals experiencing both conditions.

There are several theories which may explain the link between heart disease, stroke and periodontal disease, which include the following:

  • Oral bacteria affect the heart – There are many different strains of periodontal bacteria.  Researchers assert that some of these strains of bacteria enter the bloodstream and attach to the fatty plaques in the heart blood vessels (coronary arteries).  This attachment then contributes to clot formation causing grave danger to the individual.
  • Inflammation – Periodontal disease causes severe inflammation in the gum tissue which elevates the white blood cell count and also the high sensitivity C-reactive protein levels.  Research studies have shown that elevated levels of C-reactive proteins have been linked to heart disease.
  • Infectious susceptibility – Individuals who experience particularly high levels of oral bacteria may have weaker immune systems and an inadequate host inflammatory response.  These factors may induce specific vascular effects which have previously been shown to contribute in the onset of certain forms of heart disease.

Diagnosis and Treatment

Since periodontal disease appears to be a risk factor for both heart attack and stroke, it is extremely important to seek immediate treatment.  Initially, the periodontist will conduct thorough examinations to assess the exact condition of the teeth, gums and jawbone.  X-rays can be helpful in determining whether bone loss is prevalent in the upper and lower jaw.

The dentist is able to conduct deep cleaning treatments such as scaling and root planing to remove hardened calculus (tartar) deposits from the gum pockets.  An antibiotic may be prescribed to ensure that the bacterium is completely destroyed and the periodontal infection does not spread.  In most cases, periodontal disease can be prevented with regular cleanings and proper home care.

If you have questions or concerns about periodontal disease and its relation to heart disease and stroke, please ask your dentist.

It is well documented that people who suffer from diabetes are more susceptible to developing infections than non-diabetes sufferers.  It is not widely known that t periodontal disease is often considered the sixth complication of diabetes; particularly when the diabetes is not under proper control.

Periodontal disease (often called periodontitis and gum disease) is a progressive condition that often leads to tooth loss if treatment is not promptly sought.  Periodontal disease begins with a bacterial infection in the gingival tissue which surrounds the teeth.  As the bacteria colonize, the gum pockets become deeper, the gums recede as tissue is destroyed and the periodontitis eventually attacks the underlying bone tissue.

Diabetes is characterized by too much glucose (or sugar) in the blood.  Type II diabetics are unable to regulate insulin levels which means excess glucose stays in the blood.  Type I diabetics do not produce any insulin at all.  Diabetes is a serious condition which can lead to heart disease and stroke.

Reasons for the Connection

Experts suggest the relationship between diabetes and periodontal disease can worsen both conditions if either condition is not properly controlled.

Here are ways in which diabetes and periodontal disease are linked:

  • Increased blood sugar – Moderate and severe periodontal disease elevates sugar levels in the body, increasing the amount of time the body has to function with high blood sugar.  This is why diabetics with periodontitis have difficulty keeping control of their blood sugar.  In addition, the higher sugar levels found in the mouth of diabetics provide food for the very bacteria that worsen periodontal infections.
  • Blood vessel thickening – The thickening of the blood vessels is one of the other major concerns for diabetes sufferers.  The blood vessels normally serve a vital function for tissues by delivering nutrients and removing waste products.  With diabetes, the blood vessels become too thick for these exchanges to occur.  This means that harmful waste is left in the mouth and can weaken the resistance of gum tissue, which can lead to infection and gum disease.
  • Smoking – Tobacco use does a great deal of damage in the oral region.  Not only does tobacco use slow the healing process, it also vastly increases the chances of an individual developing periodontal disease.  For diabetics who smoke, the risk is exponentially greater.  In fact, diabetic smokers aged 45 and over are twenty times more likely to develop periodontal disease.
  • Poor oral hygiene – It is essential for diabetics to maintain excellent levels of oral health.  When daily brushing and flossing does not occur, the harmful oral bacteria can ingest the excess sugar between the teeth and colonize more freely below the gum line.  This exacerbates the metabolic problems that diabetes sufferers experience.

Diagnosis and Treatment

It is of paramount importance for people suffering from any type of diabetes to see the dentist at least twice yearly for checkups and professional cleanings.  Studies have shown that simple non-surgical periodontal treatments can lower the HbA1c (hemoglobin molecule blood test) count by as much as 20% in a six month period.

The dentist will use medical history, family history and dental X-rays to assess the risk factors for periodontal disease and determine the exact condition of the gums, teeth and underlying jawbone.  If necessary the dentist will work in conjunction with other doctors to ensure that both the diabetes and the gum disease are being managed and controlled as effectively as possible.

Non-surgical procedures performed by the dentist and dental hygienist include deep scaling, where calculus (tartar) will be removed from the teeth above and below the gumline, and root planing, where the root of the tooth is smoothed down to eliminate any remaining bacteria.  Antibiotics may be applied to the gum pockets to promote healing.

Before and after periodontal treatment, the dentist and hygienist will recommend proper home care and oral maintenance as well as prescribing prescription mouthwashes which serve to deter further bacteria colonization.

If you have questions or concerns about diabetes or periodontal disease, please ask your dentist.