Below you will find links to information on Periodontal Disease. If you don't have the time to read the information you may download and print them to read later.
Periodontal disease or gum disease is an infection around the teeth
caused by bacteria or germs. Periodontal disease is the most common disease in the world. Seventy-five to ninety percent of adults will experience some form of periodontal disease in their lifetime. Periodontal
disease is found mostly in adults. Children can have periodontal disease but it is not common. The bacteria or germs that cause this infection live in every adults mouth. These germs collect on our teeth every
day. If they are not removed thoroughly by brushing and flossing, they start to grow and migrate under the gum line. These germs that grow below the gum line produce toxins or poisons. The toxins start a
destructive process which causes the bone surrounding and supporting the teeth to be destroyed. Once under the gum line, the germs attach to the roots of the teeth. At this stage, the germs are now right next to the bone
and the toxins or poisons produced by these germs cause the bone to be gradually destroyed. As the bone is destroyed, the bacteria continue to migrate dissolving the bone toward the tip of the root. Eventually, enough
bone is destroyed that the teeth begin to loosen and ultimately are lost due to the loss of bone support. Although this infection is often called gum disease, it is the bone that experiences this destructive process.
Periodontal disease is preventable and treatable. Every year, new information, new techniques and new products are becoming available to help stop this infection. My advice is to educate yourself, discuss this with your
dentist, and don't let this infection rob you of your smile. Prevention
Everyone should understand that periodontal disease is preventable. Years ago it was commonly thought that losing teeth, as you got older was a natural course of living.
Of course, this is incorrect.
Periodontal disease is caused by bacteria that collect on our teeth every day. If the bacteria is removed once every 24
hours, there is no possible way this disease process can begin.
In my opinion, there are four critical parts to preventing periodontal disease. First, you have to remove the plaque from your teeth every day so you need to be consistent and remain motivated
. Second, you need to practice good technique. If you miss certain areas you consistently, you leave bacteria behind and this has the same results as not cleaning. Third, understand that certain teeth and
areas of the mouth are high-risk areas
that need additional attention and cleaning time. The molar teeth are an example. Because they are so far in the back of the mouth, the molars are easier to miss and less time is often spent cleaning. Everyone's mouth has its own high-risk areas and people need to have these areas identified and focus on them. Fourth,
professional maintenance or regular check-ups and cleanings. The time between professional cleanings should be quarterly or every three months. The old standard of six-month check-ups has
never been accurate or based on scientific data. This is especially true for a person with a history of periodontal disease. I recommend four specific techniques to remove plaque daily. Flossing, brushing, use of a
rubber tip stimulator and a proxy brush (a small brush to clean between the teeth) are all most people need to practice successful prevention. There are many new mechanical cleaning devices now on the market. Some are good
and some are over rated. This is also true for claims made about toothpastes, mouthwashes and other topical oral hygiene products. I will be happy to discuss the pros and cons of these products at your first
visit. Always remember, you can prevent a periodontal problem from beginning. If one already exists, get the proper treatment to remove the infection and then prevent future problems with a good maintenance plan.
Symptoms of Periodontal Disease There are many classic signs or symptoms of periodontal disease. They have been listed below. Please keep in mind that
very often there are no signs or symptoms that are obvious. Many of the people that are referred to me had no idea they had gum disease until their dentist found the problem. Periodontal disease is a slow,
chronic, low-grade infection that usually doesn't hurt until it's too late. Know the following symptoms but have yourself checked regularly so this infection doesn't sneak up on you. Bleeding gums-
If your gums bleed you have a periodontal problem. Find some help. Bleeding gums will not go away by themselves. Red or Swollen Gums- This is often the first sign of gum disease but can and usually is
present throughout all the stages of gum disease. Pus at the gum line- Pus is a large concentration of bacteria usually indicating an abscess. A very active and destructive process is occurring.
Bad breath or a bad taste- The bad odor is the byproduct of bacteria accumulating around the teeth and under the gum line. This indicates an active infection. Drifting teeth or loose teeth- If your teeth have
changed in position it is likely that the bone support is being lost due to periodontal disease. Gum Recession- Receding gums often are associated with periodontal disease. As the bone dissolves away due
to the infection, the gum line often follows. Sometimes the gum line recedes due to over brushing (tooth brush abrasion). Often times, the gum line will need to be reinforced by gum grafting to block further recession.
Contributing Factors to Periodontal Disease Periodontal disease cannot occur without the presence of bacteria. Inadequate oral hygiene and the lack of professional dental cleanings are the single most common reasons for periodontal disease.
Unfortunately, many people make themselves more susceptible and experience accelerated gum and bone damage due to factors other than bacteria. Contributing Factors Smoking- Smokers
are more susceptible to periodontal disease for a variety of reasons. Most important is that chronic tobacco use is known to lower your immune systems ability to fight off infection. Smoking causes stain to develop on
teeth making the accumulation of plaque easier. Smoking also drys out the mouth reducing saliva flow and makes the mouth less self cleansing. Diabetes- Uncontrolled diabetics are more susceptible to
periodontal disease and experience more damage when gum disease is present. Diabetes inhibits the function of the smaller blood vessels in the gum tissue, reducing the ability of our white blood cells (immune system) to fight
against this infection. Uncontrolled diabetics find it more difficult to control their diabetes if they are suffering from periodontal disease. Stress- Stress contributes to a multitude of medical problems. With regard to gum disease,
stress can cause chemicals that naturally occur in our body to increase, resulting in an environment more likely to encourage the development of periodontal disease. Stress also lowers our immune systems ability to fight
infection. Clenching and Grinding- Stress is often the cause behind clenching and grinding. If periodontal disease is present, clenching or grinding will accelerate the normal rate of bone damage. Medications
-There are a number of commonly used medications that can cause side effects that show-up in the mouth. These can often further complicate a periodontal problem. Make sure to include all medicines you are taking
or have recently taken on your health history so the doctor can know how best to treat you. Hormonal Changes- Pregnancy, puberty and chronic stress can cause changes to the normal hormone levels. Pregnant women are
more susceptible to periodontal infection due to hormone changes. If a preexisting periodontal infection exists and then a woman gets pregnant the infection is likely to accelerate. This is often times the starting
point for many women to develop periodontal disease. Systemic Diseases- Any disease or medical condition that limits your immune system from functioning normally will make you more susceptible to periodontal disease or
cause an existing problem to accelerate. Health Risks Associated with Periodontal Disease Until recently periodontal disease was thought to affect only the gum tissue, teeth and jaw bone. It was thought that the germs that collected below the gum line and caused the infection known as periodontal disease remained on the roots of the teeth and did not spread to other areas of the body. We now know this is incorrect. Recent research has shown that the germs that cause gum disease do spread through the blood stream to other parts of the body and cause the potential for serious health risks like heart disease, stroke and pulmonary infection.
Health Risks
Remember You can protect your teeth and your health by being evaluated for periodontal disease. It's treatable and preventable! There are many forms of periodontal therapy. The method chosen for treatment will be decided after a comprehensive examination, x-ray evaluation, and discussion of the treatment options with the patient. I
believe that it is very important to have the patient fully involved in the treatment planning. Educated patients have more successful results. Periodontal therapy ranges from conservative non-surgical treatment to
surgical therapy. A majority of the periodontal treatment methods are designed to eliminate a bacterial infection around the teeth. The cause of this infection is the accumulation of bacteria (plaque) on the
root surfaces below the gum line. This bacteria needs to be removed to stop the infection that causes damage to the connective tissue (gums), and bone. Non Surgical Therapy Non-surgical therapy is usually the starting point to remove the germs and associated infection. Root planing is the proper term for this non-surgical
treatment. Terms like deep cleaning, and deep scaling are often used to describe the same technique. A local anesthetic is administered prior to the root planing. Once anesthetized, the patient is
totally comfortable during the procedure. The idea of root planning is to slide different instruments below the gum line into the areas of infection (pockets) and remove the bacteria on the root surface. We are also
removing the outer layer of the root surface which has soaked up some of the toxins the bacteria have produced. When the bacteria and the contaminated outer layer of the root have been removed, the root surface grows back and
new fibers in the root join with fibers in the gum tissue to form a new connection or attachment. This shrinks the pocket. In addition to this, the swelling and inflammation associated with the infection resolves and
further shrinking of the pockets occurs. When the anesthetic wears off, the patient is free to eat what they want and return to a normal routine the same day. If needed, Tylenol or ibuprofen are
recommended following the treatment.
Surgical Therapy Surgical Pocket Elimination If the infection is advanced and the pocket is deep, the only way to get deep enough to remove the bacteria is to open the gum tissue and gain access to the infection.
In my office, we generally do these procedures with a local anesthetic like you would get to have a filling done. Our patients are comfortable throughout the
treatment. Once the gum line has been folded back, the deep infection is removed and the root surfaces are thoroughly cleaned. Often, the bone around the teeth has changed in shape due to the infection. The bone
doesn't dissolve away in a nice horizontal pattern and irregularities often exist. One option is to smooth and reshape the changes in the bone to a better contour. Sometimes it's possible to build back the bone through
bone grafting and fill in the irregularities. The surgical area is then closed with sutures and a protective putty-like bandage is applied to the sides of the teeth to protect the area during healing. Post operatively;
we prescribe a pain medicine, an antibiotic and an antibacterial rinse to help in the healing. When our patients take their pain medicine before the anesthetic wears off, they have very little, discomfort after
treatment.
Another surgical technique commonly used by a periodontist is soft tissue grafting. These types of grafts are usually chosen to correct areas of severe recession. Recession is most often caused by either (1) over aggressive back and forth brushing or (2 ) periodontal disease. In either case, the gum line has receded and the underlying bone has also receded. When too much gum tissue has been lost through recession, its necessary to build back a new protective level of gum tissue through soft tissue grafting. The source of the graft is most often the soft tissue of the palate next to the back teeth. This tissue has the same make-up of the tissue lost through recession and grows back completely after a few weeks. Stitches are used to connect the graft to the area of recession. A putty-like bandage is used to cover and protect the donor and graft site. The same postoperative medications are used as with the other surgical techniques.
This is a very predictable technique to stop further recession, build-back lost tissue and cover exposed root surfaces. An additional benefit that soft tissue grafting can provide is improved cosmetics. If the recession is in the upper front teeth and the teeth have started to look longer, soft tissue grafting can return the gum line to a normal healthy appearance.
Summary Periodontal treatment can be non-surgical or surgical. Often times a combination of these two methods is used. Medication is often a helpful supplement to treatment. Bone grafting, soft tissue grafting and regeneration of new bone are all every day techniques. Never before, have we had so many weapons to fight against tooth loss and the future is even brighter. The idea of a dental implant is
nothing new. Back in the time of Cleopatra, the Egyptians would carve seashells to look like teeth and insert them in the socket of a recently lost tooth. Fortunately we've come a long way since then. In fact, in
the last 20 years major advancements have been made in dental implants, making them an everyday dental procedure. Today, implants are most often titanium cylinders with threads. In simple terms, they are
very sophisticated dental screws that go into the jawbone. These titanium screws act as the root of a tooth and are usually about as big around and as long as the root of a natural tooth. The success rate is 95%
or higher. Dental implants can be used to replace a single tooth or any number that is needed. The placement of implants is a relatively simple surgical procedure done with only a local anesthetic (Novacaine) and
the healing period is usually only a few days. The planning stage is the most critical part for implant success. Special X-rays are needed to evaluate the jawbone and identify all the important
biological landmarks. A clinical examination of the mouth is needed to further understand the individual needs of each patient. Once this is done, the periodontist and general dentist consult with one another to
finalize the plans from implant placement to final restoration. Implant placement starts with a small incision which creates a window through the gum line to the jaw bone below. Then, the bone is gently removed creating a
cylindrical space where the implant is to be placed. The implant is then carefully screwed into the space until the implant is level with the bone. A few stitches close the window in the gum tissue and the procedure is completed.
The implant is now secure in the bone under the gum tissue. Now, the healing phase begins. It takes about 3 months for lower jaw implants to fuse with the bone and 4 to 6 months in the upper. The time difference is due to
the density of the bone, which is greater in the lower jaw. Once the bone and implant have integrated together, the top of the implant is exposed in a five minute procedure. The general dentist will finish the procedure by
making a tooth or teeth that attach to the implants. Taking care of an implant with the attached tooth is no more difficult than cleaning a natural tooth with a crown. An added bonus is that it's impossible to have a
cavity on a tooth supported by an implant. Implants have come a long way in a short period of time. With the easy placement techniques and high success rates, dental implants are an option that should be explored
when missing teeth need replacement. Periodontal disease is an infection around the teeth that damages and destroys the bone. In recent years, periodontists have found ways to grow
the bone around the teeth. These advancements result in saving teeth that were once thought to be hopeless. The idea of bone grafting is not new but the success that can now be achieved is dramatically better. Bone
grafts can also be used to buildup a jaw bone that is too thin for implant placement. Bone grafting is also frequently used in an extraction socket to prevent shrinkage of the bone during healing, which can often times result
in a difficult area to restore cosmetically. The best bone graft material is the patient's own bone. The bone is harvested from the adjacent jaw bone during the periodontal surgery. This is a quick,
painless and convenient method to acquire the graft material. The bone graft is then packed around the tooth. Most of the time, the bone graft is then covered by a biocompatible membrane, which acts as a bandage to protect
the bone until it has a chance to heal. This membrane is usually made of a material that dissolves in 8 to 12 weeks. The gum tissue is then closed with sutures over the bone and membrane, back to its original position .
If there is not enough bone in a nearby area during surgery to serve as a graft, other sources of grafting material are available. The most common of these is human bone, that comes from a bone bank. We get it in a
freeze-dried form which is reconstituted with a sterile solution at the time of surgery. This is a good material and is often used with the patients bone when a large volume is needed. Synthetic bone graft materials are also
available but do not have the same abilities and success as human bone. Recent research is showing some exciting potential in bone regeneration. Certain proteins can now be produced through genetic engineering, that when added to
bone grafts, increase the quality and volume of bone that can be regenerated. These bone morphogenic proteins (BMP) are making bone grafting even more successful. Bone grafting and regeneration of new support for the teeth
is today an everyday common procedure in a periodontal office. These procedures cause no additional discomfort and are extremely well tolerated post operatively. These techniques offer another weapon against the destructive process
of periodontal disease. |
