WHAT IS PERIODONTAL DISEASE
Periodontal disease (also known as gum disease) occurs when plaque bacteria below the gum line irritate the gums and trigger an inflammatory response characterized by reddened tissue, swelling, and bleeding. In severe cases of periodontal disease, over time the inflammatory response and bacteria erode gum and supporting bone tissue, causing gum recession, spaces between the teeth and gums, loosening and shifting teeth, and eventually tooth loss.
Symptoms of Periodontal Disease
Periodontal disease can be hard to detect in its early stages. Signs of gingivitis include bleeding, redness and swollen or tender gums. Severe cases of periodontal disease may exhibit gums that appear to be pulling away from teeth, persistent bad breath, loose or separating teeth, pus between gums and teeth, or mouth sores.
Types of Periodontal Disease
Gingivitis: The mildest form of periodontal disease, gingivitis causes redness, swelling, and bleeding of the gums. It usually can be reversed by daily brushing, flossing, and regular cleanings by a dental professional. If left untreated, gingivitis can advance into periodontitis, which is more severe.
Periodontitis: As plaque accumulates below the gum line, gums can separate from teeth, creating gaps (known as pockets) that may become infected. These pockets can deepen, often resulting in destroyed gum tissue and bone as well as loosening teeth that may have to be removed.
Types of periodontitis include the following:
- Chronic periodontitis, which often progresses slowly is the most common form and is most prevalent in adults
- Aggressive periodontitis, which is characterized by rapid detachment of gums to teeth and rapid bone loss. This form is likely to appear in smokers and in those with a family history of periodontitis
- Necrotizing periodontal disease in which necrosis(the death of tissue) affects gums, bone tissue, and the fiber connecting teeth to the bone. This extremely rare form of periodontitis is prevalent in those who suffer from human immunodeficiency virus (HIV), immunosuppression, or malnutrition. In some cases, periodontitis is associated with systemic disease affecting other parts of the body. Conditions like diabetes are associated with this form of periodontal disease.
Prevention
There are a few things you can do at home to help reduce inflammation in your mouth and body.
Oral Hygiene: The first step to preventing periodontal disease is by brushing at least twice a day and flossing once a day to remove plaque and debris from between the teeth and below the gum line as a part of a daily oral health routine.
Diet: Foods rich in omega-3 fatty acids―including oily cold -water fish (salmon, tuna, herring, or sardines) and walnuts―have been found to reduce inflammation. The body does not produce these acids naturally, and they can come only from consuming certain foods. Additionally, antioxidant-rich green tea has been shown to reduce inflammation in the body.
Exercise: People who exercise regularly demonstrate fewer incidences of periodontal disease than those who do not exercise regularly. While moderate exercise may help reduce inflammation in your body, extreme exercise (such as marathon running) can actually increase systemic inflammation. Exercise also reduces stress, another risk factor for periodontal disease. Stress has a negative impact on the body’s ability to fight infection and inflammation.
The AAP also recommends that all adults receive a comprehensive periodontal evaluation annually.
Risk Factors
Poor Oral Health Habits: Without twice-daily brushing and regular flossing, there is an increased likelihood of plaque buildup.
Age: Adults age 65 and over have higher incidences of periodontal disease, according to data from the Centers for Disease Control and Prevention 65 percent of adults between the ages of 65 and 79 have some form of periodontal disease.
Medications: Some drugs (such as oral contraceptives, anti- depressants, and certain heart medicines) can affect your periodontal health. Certain drugs can reduce the flow of saliva. Without adequate saliva production, the mouth can become a breeding ground for bacteria.
Tobacco Use: Tobacco use is linked with many serious illnesses (including cancer, lung disease, and cardiovascular disease) as well as numerous other health problems. Users of cigarettes and chewing tobacco are at an increased risk of periodontal disease. Tobacco use is said to be one of the most significant risk factors in the development and progression of periodontal disease. The detection of periodontal disease is often more difficult in tobacco users. This is because the nicotine and other chemicals found in tobacco products can hide the symptoms commonly associated with periodontal disease, such as bleeding gums. As such, necessary treatment is often delayed, allowing the disease to advance in severity.
Genetic Predisposition: Research has found some individuals may be genetically susceptible to periodontal disease.
Stress: Research demonstrates that stress, which is linked to a number of health conditions, can make it more difficult for the body to fight off infection, including periodontal disease.
Clenching or grinding your teeth: Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.
Other systemic diseases: Other systemic diseases that interfere with the body’s inflammatory system, including cardiovascular disease, diabetes, and rheumatoid arthritis, may worsen the condition of the gums and be linked to periodontal disease.
Poor Nutrition and Obesity: A diet low in key nutrients can compromise the body’s immune system and make it harder for the body to fight off infection. Because periodontal disease begins as an infection, poor nutrition can worsen the condition of your gums. Additionally, research has found that obesity may increase the risk of periodontal disease.
THE PERIO-SYSTEMIC LINK
A growing body of research suggests that periodontal disease may share a link with other systemic conditions. Recent studies indicate that inflammation may be the culprit behind these links. Here are a few conditions that share a notable connection to periodontal disease.
Diabetes
People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those who do not have their diabetes under control are especially at risk.
Research has suggested that the relationship between diabetes and periodontal disease is bi-directional, and periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. The tooth loss seen as a result of severe untreated periodontal disease can make chewing and digesting food difficult, having a negative impact on a diabetic’s ability to maintain proper nutrition and control his or her blood sugar levels. Periodontal disease also raises a person’s systemic inflammatory signals, which increase blood sugar. It is important for people with diabetes to treat periodontal disease to eliminate the infection for optimal metabolic control.
Cardiovascular Disease
Several studies have shown that periodontal disease is associated with cardiovascular disease. While a cause- and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of cardiovascular disease.
Periodontal disease can also exacerbate existing cardiovascular conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.
Stroke
In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group. Both stroke and periodontal disease are associated with inflammation of the blood vessels.
Rheumatoid Arthritis
Researchers discovered that patients with rheumatoid arthritis (RA)―a chronic, inflammatory disease of the joints―are eight times more likely to have periodontal disease than those without RA. However, the research indicates that poor oral hygiene alone did not account for the connection between RA and gum disease, which means that other factors play a role as well.
Cancers
Research found that men with a history of periodontal disease are 14 percent more likely to develop cancer than men with healthy gums. In fact, researchers discovered that men with periodontal disease are 49 percent more likely to develop kidney cancer, 54 percent more likely to develop pancreatic cancer, and 30 percent more likely to develop blood cancers.
Kidney Disease
A study published in the Journal of Periodontology suggests that toothless adults may be more likely to have chronic kidney disease than adults with all of their teeth. Untreated periodontal disease, the leading cause of tooth loss in adults, can lead to bone loss around teeth, which can then cause teeth to loosen and fall out. In the study, missing teeth shared a significant association with chronic kidney disease, which is also an inflammatory condition.
THE COMPREHENSIVE PERIODONTAL EXAMINATION
With periodontal disease affecting nearly 64.7 million people in the United States (almost one in every two adults over the age of 30), the health of your gums should be monitored consistently to minimize your risk. Many patients don’t see a dental profession until after they’ve noticed pain, bleeding gums, or loosening teeth- all signs that periodontal disease in its advanced stages. . The American Academy of Periodontology recommends that all adults undergo a comprehensive periodontal evaluation (CPE) once a year, which can detect periodontal disease before it becomes severe. CPE is the first step to creating a suitable treatment and /or maintenance plan for your individual situation.
What is a Comprehensive Periodontal Evaluation? A CPE assesses your risk of periodontal disease and determines the right types of treatment if periodontal disease is diagnosed.
Teeth: Your dental professional will evaluate each tooth as well as dental fillings, implants, crowns, or other types of restoration. The position of the teeth and their closeness to each other will be noted.
Bite: The evaluation will include a check of the way your teeth come together when your mouth is closed, also known as occlusion or bite. Your dental professional will look for moving or loose teeth, which can be a sign of periodontal disease.
Plaque and Tartar Buildup: The amount and location of bacterial plaque and tartar will be assessed.
Gums: A dental probe will be inserted into the spaces between your teeth and gums to see how well your
gums attach to your teeth. Any inflammation or bleeding that occurs during the probing process is documented.
Bone Structure: X-rays may be taken to evaluate the quality of the bone in your upper and lower jaw and to determine if any bone loss has occurred.
Risk Factors: Your dental professional will ask about a number of periodontal disease risk factors, including age, tobacco use, family history of periodontal disease, or if you have another systemic condition that may be linked to periodontal disease, such as heart disease or diabetes.
TREATMENT OF PERIODONTITS
If you’ve recently been diagnosed with periodontal disease, you probably have some questions about your treatment. Be assured that periodontists believe that periodontal therapy, including non-surgical treatment, should be achieved in the least invasive and most cost-effective way possible.
Remember that the first step toward good periodontal health begins with proper oral hygiene, which can go a long way toward preventing certain forms of periodontal disease and reversing gingivitis, an early stage of periodontal disease. Good oral hygiene includes brushing your teeth at least twice each day, flossing at least once each day, and seeing a periodontist annually for a comprehensive periodontal evaluation.
If you are diagnosed with periodontal disease, common treatments include the following:
Deep Cleaning/Scaling and Root Planing
A deep cleaning, also known as scaling and root planing, is a non-invasive measure of preventing the progression of periodontal disease. A deep cleaning goes beneath the gum line to remove plaque, bacteria, and other toxins from areas that brushing and flossing cannot reach, reducing the risk of disease advancement. A routine cleaning does not require the dentist or hygienist to go below the gum line; therefore, the procedure does not eliminate the cause of disease if it is present.
Medication
Oral antibiotics as well as anti-microbial mouth rinses can be prescribed short-term to control bacteria and treat acute periodontal infection. Other medicinal treatments include antibiotic gels, slow-release antiseptic chips, microspheres, and enzyme suppressants used after scaling and root planing procedures.
Surgery
If inflammation and deep pockets are present after deep cleaning and medication, a periodontist may perform flap surgery to minimize the depth of the pocket. The surgery consists of plaque removal below the gum line and then closure of the gums so that they fit snugly against the tooth.
A bone and tissue graft procedure helps to regenerate any tissue or bone lost to periodontal disease through the placement of natural or synthetic bone material to promote bone growth.
A soft tissue graft uses synthetic material or tissue from the mouth to cover tooth roots that have been exposed.
After a period of healing, your periodontist will evaluate your condition to determine if further treatment is necessary. If additional treatment is required, your periodontist will develop a treatment plan to help restore your smile to a state of health. If you don’t require further treatment, you’ll enter a maintenance phase, and thorough checkups on your teeth and gums will occur every few months.
Periodontists are uniquely qualified to treat disease of the gum tissue and underlying bone in the mouth. With three additional years if specialized training after dental school, periodontists area masters of the treatment skills necessary for predictable and successful periodontal disease treatment.
Deep Cleaning/Scaling and Root Planing
Smoking and tobacco use reduce the delivery of oxygen and nutrients to the gum tissues, weakening the body’s defense mechanisms. This can slow down the healing process and make periodontal treatment results less predictable.
Because the treatment of periodontal disease can be more difficult in tobacco users, your periodontist will urge you to quit your tobacco use. Quitting seems to gradually erase the harmful effects of tobacco use on periodontal health and overall health.
PERIODONTAL PLASTIC SURGERY
A smile is one of the most universally recognizable expressions. Smiling can demonstrate a per- son’s happiness, confidence, attractiveness, sociability, and sincerity. However, the effects of gum disease or other oral tissue disorders cannot only be dangerous to your health and well-being, but can also have the potential to ruin your smile.
Luckily, periodontists are the experts in treating the tissues around the teeth. They have the know-how to treat the effects of gum disease or other oral tissue disorders and help improve your smile. There are a variety of periodontal cosmetic procedures that can improve and enhance the overall artwork of your smile.
Root Coverage
Gum recession as a result of gum disease causes the tooth root to become exposed, which can make teeth look long and can prematurely age a person. In fact, the phrase “long in the tooth”, used to describe the elderly, is derived from this very reason. A periodontist can fix this problem with a procedure called root coverage. During this procedure, tissue from the mouth’s palate, or other synthetic materials, are used to facilitate coverage of the exposed root.
Gummy Smile
Periodontists also have the ability to fix a “gummy smile” when a person’s teeth appear too short. The teeth may actually be the proper length, but they’re covered with too much gum tissue. Your periodontist can correct this by performing a procedure called crown lengthening. During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. Think of it like pushing back the cuticles on a fingernail. The outcome is longer looking teeth and a winning smile.
Your gums are an important part of your smile. They frame the teeth and play an integral role in the overall aesthetics of your everyday appearance. While taking care of them by brushing and flossing daily is the best way to maintain a healthy mouth, talk to your periodontist about the procedures available to maximize the potential of your smile.
Combination Procedures
Sometimes, you may need a few of these procedures to build the framework for your perfect smile. Often, periodontal plastic surgery is used to lay the foundation for further cosmetic enhancements, such as orthodontic devices and veneers. A combination of periodontal procedures can result in a beautiful new smile and improved periodontal health.
PROTECTING YOUR ORAL HEALTH: MAINTENANCE
You’ve already taken the first step towards good oral health by pursuing active periodontal therapy. You’re already beginning to enjoy some of the benefits of treatment- a healthy mouth and a happy smile. Now that you’ve made the commitment to good oral health, it’s important for you to protect it. Without careful, ongoing monitoring and treatment, periodontal disease can recur. Left untreated, periodontal disease can lead to bone and tooth loss. With help from periodontists, dentists who specialize in the prevention, diagnosis and treatment of periodontal disease, you have an excellent chance of keeping your teeth for a lifetime!
How do I protect my oral health?
Once you’ve been diagnosed with and treated for periodontal disease, regular periodontal maintenance enables you to gain control of the disease and increases your chances of keeping your natural teeth. Periodontal maintenance is a specialized treatment to protect your gums and the bone that supports your teeth. This treatment is different from traditional six-month dental cleanings from your general dentist, which also help to protect the health of your teeth.
During a periodontal maintenance visit, your periodontist updates your dental and medical histories to note any factors that may influence your periodontal health. In addition to a dental examination, a thorough periodontal evaluation is performed, which may include an assessment of your probing depths, oral cancer screening, and x-rays to evaluate the bone supporting your teeth. Plaque and calculus are then removed from above and below the gum line, and your periodontist will review your at-home oral hygiene routine. If new or recurrent periodontal disease is identified, additional treatment may be recommended.
How often do I need periodontal maintenance?
The answer to this question varies from person to person. Your periodontist will work with you to create a schedule that best protects your oral health. The intervals between periodontal maintenance visits may range from every few weeks to a few times a year, and the frequency may be influenced by:
- Risk factors such as genetics or tobacco use
- Severity of periodontal disease
- Severity of bone loss
- Overall general health
- At-home oral hygiene
At each periodontal maintenance visit, your periodontist will monitor your disease progression and treatment effectiveness, and may increase or decrease the frequency of your visits accordingly.
How will I benefit from periodontal maintenance?
Periodontal disease is similar to other chronic diseases, such as diabetes; the key to control is early diagnosis and prompt treatment. Periodontal maintenance is a way for you to protect your oral health by helping to prevent or minimize the recurrence and progression of periodontal disease. If the disease returns, careful monitoring increases the likelihood of locating and treating it in a timely manner before tooth-threatening bone loss becomes uncontrollable.
Protecting your periodontal health brings a lifetime of benefits. You keep dental costs down by preventing future visits. You smile, speak, and eat with comfort and confidence. More importantly, research has linked periodontal disease to other health problems such as cardiovascular disease and diabetes. As research continues to define how periodontal disease is linked to these and other health problems, oral maintenance is essential. As you can see, gum disease is more than just gums; a commitment to oral maintenance is a commitment to better health!
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