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 is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.
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.
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.
What is Periodontal (Gum) Disease?
The term “periodontal” means “around the tooth.” Periodontal disease (also known as periodontitis and gum disease) is a common inflammatory condition that affects the supporting and surrounding soft tissues of the tooth, eventually affecting the jawbone itself in the disease’s 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 cause 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.
Please contact our office if you have questions or concerns about periodontal disease, periodontal treatment, or dental implants.
Periodontal Disease Self-Evaluation
Periodontal disease is the leading cause of tooth loss in adult dental patients and should be taken seriously. Many patients with this condition do not know it until symptoms progress to advanced stages of disease.
Before you begin the following self-test, it’s important to know that, in general, women are at greater risk for developing periodontal disease because of hormone changes during puberty, pregnancy and menopause. The chances of developing periodontal disease also increase with age. If you smoke, you should be aware that you may experience slower healing, deeper gum pockets, faster bone loss and more calculus (tartar) deposits on the teeth than non-smokers.
This self-test is not intended as a substitute for dental advice or a comprehensive periodontal assessment. Instead, being able to identify common risk factors related to gum disease helps individuals understand the importance of seeking an evaluation by their dental health professional.
Do your teeth and gums bleed during brushing and flossing?
Bleeding is one of the most common general symptoms of periodontal disease. Unexplained bleeding while brushing and flossing teeth is a sure sign something is amiss and needs prompt attention by a health professional.
Do you have loose or wobbly teeth?
Periodontal disease is caused by bacteria that infect soft tissue and damage supporting structures around teeth over time. As bone and soft tissue are compromised due to infection, the teeth become less firmly attached and may wobble, shift or fall out completely.
Are your teeth suddenly looking longer?
Gum recession is a highly visible warning sign of periodontal disease. If teeth appear longer than before, gums may be receding as bacteria and debris deepen periodontal pockets around teeth. While some gum recession is expected as we age, soft tissue problems resulting from periodontal disease cause significant and quick recession.
Do you suffer from other health conditions?
Heart disease, high stress, diabetes, osteoporosis and osteopenia are all linked to periodontal disease. Medications taken for these illnesses can also render the gums more sensitive to bacteria commonly found in the mouth.
Does anyone in your family have periodontal disease?
Despite a rigorous oral hygiene routine, 30% of the population may be genetically predisposed to developing gum disease. Periodontal disease can also be spread through bacteria found in saliva. When saliva is passed through common contact, couples and children are at additional risk for gum disease.
Have you had previous gum problems?
A personal history of gum problems, such as general soft tissue irritation and inflammation, increases the risk of advanced periodontal disease six fold.
Daily brushing and flossing reduces amounts of harmful oral bacteria and keeps calculus formation to a minimum. However, periodontal disease can progress without any noticeable symptoms, so it is essential to get a dental check-up and professional cleaning twice a year. This professional cleaning removes tartar and assists in maintaining better gum health over time.
If you have completed the self-test and found yourself to be at risk or have more questions regarding periodontal disease, please ask your oral health professional about treatment for soft tissue infection and how to prevent additional gum problems.
Causes of Periodontal Disease
Periodontal disease, which is also known as gum disease and periodontitis, is a progressive disease which, if left untreated, may result in tooth loss. Gum disease begins with the inflammation and irritation of the gingival tissues which surround and support the teeth. The cause of this inflammation is the toxins found in plaque which cause an ongoing bacterial infection.
The bacterial infection colonizes in the gingival tissue, and deep pockets form between the teeth and the gums. If treated promptly by a periodontist, the effects of mild inflammation (known as gingivitis) are completely reversible. However, if the bacterial infection is allowed to progress, periodontal disease begins to destroy the gums and the underlying jawbone, promoting tooth loss. In some cases, the bacteria from this infection can travel to other areas of the body via the bloodstream.
Common Causes of Gum Disease
There are genetic and environmental factors involved in the onset of gum disease, and in many cases, the risk of developing periodontitis can be significantly lowered by taking preventative measures.
Here are some of the most common causes of gum disease:
- Poor dental hygiene– Preventing dental disease starts at home with good oral hygiene and a balanced diet. Prevention also includes regular dental visits which include exams, cleanings, and x-rays. A combination of excellent home care and professional dental care will preserve the natural dentition and support of bony structures. When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacterial toxins and can cause gingivitis or periodontitis, which ultimately lead to tooth loss.
- Tobacco use– Research has indicated that smoking and tobacco use are some of the most significant factors in the development and progression of gum disease. In addition to smokers experiencing a slower recovery and healing rate, smokers are far more likely to suffer from calculus (tartar) build-up on teeth, deep pockets in the gingival tissue, and significant bone loss.
- Genetic predisposition– Despite practicing rigorous oral hygiene routines, as much as 30% of the population may have a strong genetic predisposition to gum disease. These individuals are six times more likely to develop periodontal disease than individuals with no genetic predisposition. Genetic tests can be used to determine susceptibility and early intervention can be performed to keep the oral cavity healthy.
- Pregnancy and menopause– During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.
- Chronic stress and poor diet– Stress lowers the ability of the immune system to fight off disease which means bacterial infection can beat the body’s defense system. Poor diet or malnutrition can also lower the body’s ability to fight periodontal infections, as well as negatively affecting the health of the gums.
- Diabetes and underlying medical issues– Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis and osteoporosis. Diabetes hinders the body’s ability to utilize insulin which makes the bacterial infection in the gums more difficult to control and cure.
- Grinding teeth– The clenching or grinding of teeth can significantly damage the supporting tissue surrounding the teeth. Grinding one’s teeth is usually associated with a “bad bite” or the misalignment of the teeth. When an individual is suffering from gum disease, the additional destruction of gingival tissue due to grinding can accelerate the progression of the disease.
- Medication– Many drugs including oral contraceptive pills, heart medicines, anti-depressants, and steroids affect the overall condition of teeth and gums, making them more susceptible to gum disease. Steroid use promotes gingival overgrowth, which makes swelling more commonplace and allows bacteria to colonize more readily in the gum tissue.
Treatment of Gum Disease
Periodontists specialize in the treatment of gum disease and the placement of dental implants. A periodontist can perform effective cleaning procedures in deep pockets such as scaling and root planing; they can also prescribe antibiotic and antifungal medications to treat infection and halt the progression of the disease.
In the case of tooth loss, the periodontist is able to perform tissue grafts to promote natural tissue regeneration, and insert dental implants if a tooth or several teeth are missing. Where gum recession causes a “toothy” looking smile, the periodontist can recontour the gingival tissue to create an even and aesthetically pleasing appearance.
Preventing periodontal disease is critical in preserving the natural dentition. Addressing the causes of gum disease and discussing them with your dentist will help prevent the onset, progression, and recurrence of periodontal disease.
If you have any questions or concerns about the causes or treatments pertaining to gum disease, please ask your dentist.
Gingival recession (receding gums) refers to the progressive loss of gum tissue, which can eventually result in tooth root exposure if left untreated. Gum recession is most common in adults over the age of 40, but the process can begin in the teenage years.
Gum recession can be difficult to self-diagnose in its earlier stages because the changes often occur asymptomatically and gradually. Regular dental check ups will help to prevent gum recession and assess risk factors.
The following symptoms may be indicative of gum recession:
- Sensitive teeth – When the gums recede enough to expose the cementum protecting the tooth root, the dentin tubules beneath will become more susceptible to external stimuli.
Visible roots – This is one of the main characteristics of a more severe case of gum recession.
- Longer-looking teeth – Individuals experiencing gingival recession often have a “toothy” smile. The length of the teeth is perfectly normal, but the gum tissue has been lost, making the teeth appear longer.
- Halitosis, inflammation, and bleeding – These symptoms are characteristic of gingivitis or periodontal disease. A bacterial infection causes the gums to recede from the teeth and may cause tooth loss if not treated promptly.
Causes of Gum Recession
Gum recession is an incredibly widespread problem that dentists diagnose and treat on a daily basis. It is important to thoroughly examine the affected areas and make an accurate diagnosis of the actual underlying problem. Once the cause of the gum recession has been determined, surgical and non-surgical procedures can be performed to halt the progress of the recession and prevent it from occurring in the future.
The most common causes of gingival recession are:
- Overaggressive brushing – Over-brushing can almost be as dangerous to the gums as too little. Brushing too hard or brushing with a hard-bristled toothbrush can erode the tooth enamel at the gum line and irritate/inflame gum tissue.
- Poor oral hygiene – When brushing and flossing are performed improperly or not at all, a plaque build up can begin to affect the teeth. The plaque contains various bacterial toxins which can promote infection and erode the underlying jawbone.
- Chewing tobacco – Any kind of tobacco use has devastating effects on the entire oral cavity, chewing tobacco in particular. It aggravates the gingival lining of the mouth and causes gum recession when used continuously.
- Periodontal disease – Periodontal disease can be a result of improper oral hygiene or caused by systemic diseases such as diabetes. The excess sugars in the mouth and narrowed blood vessels experienced by diabetics create a perfect environment for oral bacteria. The bacterium causes an infection which progresses deeper and deeper into the gum and bone tissue, eventually resulting in tooth loss.
Treatment of Gum Recession
Every case of gum recession is slightly different, therefore many treatments are available. The nature of the problem which caused the recession to begin with needs to be addressed first.
If overly aggressive brushing techniques are eroding the gums, a softer toothbrush and a gentler brushing technique should be used. If poor oral hygiene is a problem, prophylaxis (professional dental cleaning) may be recommended to rid the gum pockets of debris and bacteria. In the case of a severe calculus (tartar) build-up, scaling and root planing will be performed to heal gingival inflammation and clean the teeth.
Once the cause of the gingival recession has been addressed, surgery of a more cosmetic or restorative nature might be recommended. Gum tissue regeneration and gum grafting are two excellent ways to restore natural symmetry to the gums and make the smile look more aesthetically pleasing.
If you have any questions or concerns about periodontal disease, periodontal treatments, or gum recession, please contact our office.
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:
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.
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.
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.
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 contact our office. We care about your overall health and your smile!
Periodontal Disease, Heart Disease, and Stroke
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 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 contact our office.
Periodontal Disease and Diabetes
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 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 contact our office.
Periodontal Disease and Pregnancy
Researchers have shown that periodontal disease in expectant mothers actually exposes their unborn child to many different risks, particularly if they also happen to be diabetes sufferers.
Periodontal disease generally begins with a bacterial infection in the gum (gingival) tissue, which progressively destroys the tissue and the underlying bone. If left untreated, the bacterial infection causes an inflammatory reaction in the body, which can significantly deepen the gum pockets (space between the teeth and gums), and forces the gum and jawbone to recede. Eventually, the progressive nature of periodontal disease causes the teeth to become loose and unstable, and eventually fall out.
Pregnancy causes many hormonal changes which increase the risk of the expectant mother to develop gingivitis (inflammation of the gum tissue) and periodontal disease. These oral problems have been linked in many research studies to preeclampsia, low birth weight of the baby and premature birth. Expectant women should seek immediate treatment for periodontal disease in order to reduce the risk of pre-natal and post-natal complications.
Reasons for the Connection
There are many different reasons why periodontal disease may affect the health of the mother and her unborn child:
- Prostaglandin– Periodontal disease appears to elevate levels of prostaglandin in mothers who are suffering from the more advanced forms of the condition. Prostaglandin is a labor-inducing compound found in one of the oral bacteria strains associated with periodontitis. Elevated levels of prostaglandin can cause the mother to give birth prematurely and deliver a baby with a low birth weight.
- C – reactive protein (CRP)– This protein, which has been previously linked to heart disease, has now been associated with adverse pregnancy outcomes including preeclampsia and premature birth. Periodontal infections elevate C-reactive protein levels and amplify the body’s natural inflammatory response. Periodontal bacteria may enter the bloodstream causing the liver to produce CRP which leads to inflamed arteries as well as possible blood clots. These inflammatory effects can then lead to blocked arteries causing strokes or heart attacks.
- Bacteria spread– The bacteria which colonize in the gum pockets can readily travel through the bloodstream and affect other parts of the body. In pregnant women, research has found that oral bacteria and associated pathogens have colonized in the internal mammary glands and coronary arteries.
Diagnosis and Treatment
There are many safe, non surgical treatment options available for pregnant women. It is of paramount importance to halt the progress of periodontal disease in order to increase the chances of a safe and healthy delivery.
Initially, the dentist will assess the exact condition of the gums and jawbone in order to make a precise diagnosis. Scaling and root planing are two common non-surgical procedures used to rid the tooth-root surfaces of calculus (tartar) and remove the bacterial toxins from the gum pockets.
With treatment, the risks of pregnancy complications caused by periodontal disease are reduced by as much as 50%, and these treatments will alleviate many unpleasant and harmful effects associated with gingivitis and periodontal infection.
Dentists can provide education and recommendations to pregnant women about effective home care which can reduce risks that may affect her and/or her child’s health. Risks of periodontal disease can be vastly reduced by proper home care, smoking cessation, dietary changes, and the ingestion of supplementary vitamins.
If you have any questions or concerns about periodontal disease and its affect on pregnancy, please contact our practice.
Periodontal Disease and Osteoporosis
Periodontal disease is characterized by a progressive loss of supportive gingival tissue in the gums and jawbone. It is the number one cause of tooth loss among adults in the developed world. Periodontal disease occurs when toxins found in oral plaque inflame and irritate the soft tissues surrounding the teeth. If left untreated, bacteria colonies initially cause the systematic destruction of gum tissue, and then proceed to destroy the underlying bone tissue.
Osteoporosis is a common metabolic bone disease which frequently occurs in postmenopausal women, and occurs less frequently in men. Osteoporosis is characterized by bone fragility, low bone mass and a decrease in bone mineral density. Many studies have explored and identified a connection between periodontal disease and osteoporosis.
A study conducted at the University of New York at Buffalo in 1995 concluded that post-menopausal women who suffered from osteoporosis were 86% more likely to also develop periodontal disease.
Reasons for the Connection
Though studies are still being conducted in order to further assess the extent of the relationship between osteoporosis and periodontal disease, the researchers have thus far made the following connections:
- Estrogen deficiency– Estrogen deficiency accompanies menopause and also speeds up the progression of oral bone loss. The lack of estrogen accelerates the rate of attachment loss (fibers and tissues which keep the teeth stable are destroyed).
- Low mineral bone density– This is thought to be one of several causes of osteoporosis, and the inflammation from periodontal disease makes weakened bones more prone to break down. This is why periodontitis can be more progressive in patients with osteoporosis.
Diagnosis and Treatment
Osteoporosis and periodontal disease are much less dangerous if they are diagnosed in the early stages. Once a diagnosis has been made, the dentist will generally work with the patient’s doctor to ensure that both diseases are effectively controlled.
Here are some methods commonly used to diagnose and treat the diseases:
- Routine dental X-rays– X-rays can be effectively used to screen for bone loss in the upper and lower jaw, and the dentist can provide interventions for preventing and treating periodontal disease. It is believed that minimizing periodontal disease will help treat osteoporosis.
- Estrogen supplements– Providing post-menopausal women with estrogen supplements lowers the rate of attachment loss and also lowers gingival inflammation, which in turn protects the teeth from periodontal disease.
- Assessment of risk factors– Dentists and doctors are able to closely monitor the patients that are at an increased risk of developing both diseases by assessing family history, medical history, X-ray results, current medications and modifiable risk factors. Tobacco use, obesity, poor diet and estrogen deficiency can all be managed using a combination of education, support and prescription medications.
If you have any questions about periodontal disease and its connection with osteoporosis, please contact our practice.
Periodontal Disease and Respiratory Disease
Periodontal disease (also called periodontitis and gum disease) has been linked to respiratory disease through recent research studies. Researchers have concluded that periodontal disease can worsen conditions such as chronic obstructive pulmonary disease (COPD) and may actually play a causal role in the contraction of pneumonia, bronchitis and emphysema.
Periodontal disease is a progressive condition which generally begins with a bacterial infection. The bacteria found in plaque begin to colonize in gingival tissue, causing an inflammatory response in which the body destroys both gum and bone tissue. The sufferer may notice the teeth “lengthening” as the gums recede while the disease progresses. If left untreated, erosion of the bone tissue brings about a less stable base for the teeth, meaning loose, shifting or complete tooth loss.
There are a number of different respiratory diseases linked to periodontal disease. Pneumonia, COPD, and bronchitis are among the most common. Generally, bacterial respiratory infections occur due to the inhalation of fine droplets from the mouth into the lungs. COPD is a leading cause of death and should be taken very seriously.
Reasons for the Connection
The fact that respiratory disease and periodontal disease are linked may seem far-fetched, but there is plenty of evidence to support it.
Here are some of the reasons for the link between periodontal disease and respiratory disease:
- Bacterial spread– The specific type of oral bacterium that causes periodontal disease can easily be drawn into the lower respiratory tract. Once the bacteria colonize in the lungs, it can cause pneumonia and exacerbate serious conditions such as COPD.
- Low immunity– It has been well-documented that most people who experience chronic or persistent respiratory problems suffer from low immunity. This low immunity allows oral bacteria to embed itself above and below the gum line without being challenged by the body’s immune system. Not only does this accelerate the progression of periodontal disease, it also puts the sufferer at increased risk of developing emphysema, pneumonia and COPD.
- Modifiable factors– Smoking is thought to be the leading cause of COPD and other chronic respiratory conditions. Tobacco use also damages the gingiva and compromises the good health of the oral cavity in its entirety. Tobacco use slows the healing process, causes gum pockets to grow deeper and also accelerates attachment loss. Smoking is not the sole cause of periodontal disease, but it is certainly a cofactor to avoid.
- Inflammation– Periodontal disease causes the inflammation and irritation of oral tissue. It is possible that the oral bacteria causing the irritation could contribute to inflammation of the lung lining, thus limiting the amount of air that can freely pass to and from the lungs.
Diagnosis and Treatment
When respiratory disease and periodontal disease are both diagnosed in one individual, it is important for the dentist and doctor to function as a team to control both conditions. There are many non-surgical and surgical options available, depending on the specific condition of the teeth, gums and jaw.
The dentist is able to assess the extent of the inflammation and tissue loss and can treat the bacterial infection easily. Scaling procedures cleanse the pockets of debris and root planing smoothes the tooth root to eliminate any remaining bacteria. The dentist generally places antibiotics into the pockets after cleaning to promote good healing and reduce the risk of the infection returning.
Whichever treatment is deemed the most suitable, the benefits of controlling periodontal disease are two-fold. Firstly, any discomfort in the oral region will be reduced and the gums will be much healthier. Secondly, the frequent, unpleasant respiratory infections associated with COPD and other common respiratory problems will reduce in number.
If you have questions or concerns about respiratory disease or periodontal disease, please ask your dentist.
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).
Periodontal Scaling and Root Planing
The objective of scaling and root planing 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 planing 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 planing 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.
Pocket Reduction Surgery
Pocket reduction surgery (also known as gingivectomy, osseous surgery and flap surgery) is a collective term for a series of several different surgeries aimed at gaining access to the roots of the teeth in order to remove bacteria and tartar (calculus).
The human mouth contains dozens of different bacteria at any given time. The bacteria found in plaque (the sticky substance on teeth) produce acids that lead to demineralization of the tooth surface, and ultimately contribute to periodontal disease.
Periodontal infections cause a chronic inflammatory response in the body that literally destroys bone and gum tissues once they invade the subgingival area (below the gum line). Gum pockets form and deepen between the gums and teeth as the tissue continues to be destroyed.
Periodontal disease is a progressive condition which, if left untreated, causes massive bacteria colonization in gum pockets and can eventually cause teeth to fall out. Pocket reduction surgery is an attempt to alleviate this destructive cycle, and reduce the depth of the bacteria-harboring pockets.
Reasons for the pocket reduction surgery
Pocket reduction surgery is a common periodontal procedure which has been proven effective at eliminating bacteria, reducing inflammation and saving teeth. The goals of pocket reduction surgery are:
- Reducing bacterial spread– Oral bacteria has been connected to many other serious conditions such as diabetes, heart disease and stroke. Oral bacteria can travel to various parts of the body from inside the bloodstream and begin to colonize. It is important to decrease bacteria in the mouth in order to reduce the risk of secondary infection.
- Halting bone loss– The chronic inflammatory response induced by oral bacteria leads the body to destroy bone tissue. As the jawbone becomes affected by periodontal disease, the teeth lose their rigid anchor. When the teeth become too loose, they may require extraction.
- Facilitate home care– As the gum pockets become progressively deeper, they become incredibly difficult for the patient to clean. The toothbrush and dental floss cannot reach the bottom of the pockets, increasing the risk of further periodontal infections.
- Enhancing the smile– An oral cavity that is affected by periodontal disease is not attractive to the eye. In fact, smiles may be marred by brown gums, rotting teeth and ridge indentations. Pocket reduction surgery halts the progression of gum disease and improves the aesthetics of the smile.
What does pocket reduction surgery involve?
Before recommending treatment or performing any procedure, the dentist will perform thorough visual and X-ray examinations in order to assess the condition of the teeth, gums, and underlying bone. Pocket reduction surgery can be performed under local or general anesthetic depending on patient preferences.
The gums will be gently pulled back from the teeth and bacteria and calculus (tartar) will be eliminated. Scaling and root planing will generally be required to fully remove the ossification (tartar) from the surface of the tooth root. If the root is not completely smooth, a planing procedure will be performed to ensure that when the gums do heal, they will not reattach to rough or uneven surfaces.
The final part of the surgery is usually the administration of an antimicrobial liquid to eliminate any remaining bacteria and promote healing. The gum is then sutured with tiny stitches that are left in place for 5-10 days.
Though the gums will be more sensitive immediately following the procedure, there will be a significant reduction in pocket depth and a vast improvement in the condition of the teeth and gums.
If you have any questions about pocket reduction surgery or treatment for periodontal disease, please contact our practice.
Crown lengthening is generally performed to improve the health of the gum tissue or to prepare the mouth for restorative or cosmetic procedures. In addition, crown lengthening procedures can also be used to correct a “gummy” smile, where teeth are covered with excess gum tissue. Crown lengthening exposes more of the natural tooth by reshaping or recontouring bone and gum tissue. This treatment can be performed on a single tooth, many teeth, or the entire gum line, exposing an aesthetically pleasing smile.
Reasons for crown lengthening
Crown lengthening is a versatile and common procedure that has many effective uses and benefits. The vast majority of patients who have undergone this type of surgery are highly delighted with the results.
Here are some of the most common reasons for crown lengthening:
- Restoration of damaged teeth– Periodontal disease can cause severe damage to the teeth, as can trauma and decay. Where teeth have been broken beneath the gum line, crown lengthening can be used to prepare the area for a new restoration to correct the damaged teeth.
- Cosmetic uses– Extra gum tissue can make teeth look unnaturally short and can also increase susceptibility to periodontal infections. Removing excess gum tissue can restore a balanced, healthy look and improve the aesthetic appearance of the smile.
- Dental crowns– Crown lengthening provides more space between the supporting jawbone and dental crown. This prevents the new crown from damaging gum tissues and bone once it is in place.
What does crown lengthening involve?
Crown lengthening is normally performed under local anesthetic. The amount of time this procedure takes will largely depend on how many teeth are involved and whether a small amount of bone needs to be removed along with the soft tissue. Any existing dental crowns will be removed prior to the procedure and replaced immediately afterwards.
Your dentist will make a series of small incisions around the soft tissue in order to separate the gums away from the teeth. Even if only one tooth requires the re-contour, neighboring teeth are usually treated to provide a more even reshaping. Separating the gums provides your dentist with access to the roots of the teeth and the underlying bone.
In some cases, the removal of a small amount of tissue will provide enough tooth exposure to place a crown. In other cases, your dentist will also need to remove a small amount of bone from around the teeth. The bone is usually removed using a combination of special hand instruments, and rotary instruments. The rotary instruments roughly resemble the drill that is used in cavity treatment.
The teeth will look noticeably longer immediately after surgery because the gums will have been repositioned. The teeth will look noticeably longer immediately after surgery because the gums have now been repositioned.
Your dentist will secure the surgical site using an intraoral (periodontal) bandage which serves to prevent infection. Prescriptions may be provided for pain medication, and a chlorhexidine (antimicrobial) mouth rinse may be given to help reduce any bacteria attempting to re-colonize. The surgical site will be completely healed in approximately two to three months.
If you have any questions about crown lengthening, please contact our office.
A dental implant is essentially an artificial tooth root which is attached to the jaw bone. Eventually, a replacement tooth or bridge will be firmly fixed to this root, restoring complete function to the tooth. The key to a successful and long-lasting implant is the quality and quantity of jawbone to which the implant will be attached. If bone has been lost due to injury or periodontal disease, a sinus augmentation can raise the sinus floor to allow for new bone formation.
In the most common sinus augmentation technique, a tiny incision is made near the upper premolar or molar region to expose the jawbone. A small opening is cut into the bone and the membrane lining the sinus on the other side of the opening is gently pushed upward. The underlying space is filled with bone graft material and the incision is closed. The bone which is used for this procedure may be from your own body or from a cadaver. Sometimes the dentist might use synthetic materials which can also stimulate bone formation. The implants are placed after healing has occurred; this will depend on the individual case. Sinus augmentation has been shown to increase the success of dental implant procedures.
A gum graft (also known as a gingival graft or periodontal plastic surgery), is a collective name for surgical periodontal procedures that aim to cover an exposed tooth root surface with grafted oral tissue.
Exposed tooth roots are usually the result of gingival recession due to periodontal disease. There are other common causes, including overly aggressive brushing and trauma.
Here are some of the most common types of gum grafting:
- Free gingival graft– This procedure is often used to thicken gum tissue. A layer of tissue is removed from the palate and relocated to the area affected by gum recession. Both sites will quickly heal without permanent damage.
- Subepithelial connective tissue graft– This procedure is commonly used to cover exposed roots. Tissue is removed fairly painlessly from the outer layer of the palate and relocated to the site of gum recession.
- Acellular dermal matrix allograft– This procedure uses medically processed, donated human tissue as a tissue source for the graft. The advantage of this is procedure is that there is no need for a donor site from the patient’s palate (and thus, less pain).
Reasons for gum grafting
Gum grafting is a common periodontal procedure. Though the name might sound frightening, the procedure is commonly performed with excellent results.
Here are some of the major benefits associated with gum grafting:
- Reduced sensitivity– When the tooth root becomes exposed, eating or drinking hot or cold foods can cause extreme sensitivity to the teeth. Gum grafting surgery permanently covers the exposed root, helps reduce discomfort, and restores the good health of the gums.
- Improved appearance– Periodontal disease is characterized by gum recession and inflammation. Gum recession and root exposure can make the teeth look longer than normal and the smile to appear “toothy.” Gum grafting can make the teeth look shorter, more symmetrical and generally more pleasing to look at. In addition, adjacent tissue can be enhanced and augmented during the procedure for aesthetic purposes.
- Improved gum health– Periodontal disease can progress and destroy gum tissue very rapidly. If left untreated, a large amount of gum tissue can be lost in a short period of time. Gum grafting can help halt tissue and bone loss; preventing further problems and protecting exposed roots from further decay.
What does gum grafting treatment involve?
Once the need for gum grafting surgery has been determined, there are several treatments the dentist will want perform before gum grafting takes place. First, the teeth must be thoroughly cleaned supra and subgingivally to remove calculus (tartar) and bacteria. The dentist can also provide literature, advice and educational tools to increase the effectiveness of homecare and help reduce the susceptibility of periodontal disease in the future.
The gum grafting procedure is usually performed under local anesthetic. The exact procedure will depend much on whether tissue is coming from the patient’s palate or a tissue bank.
Initially, small incisions will be made at the recipient site to create a small pocket to accommodate the graft. Then a split thickness incision is made and the connective tissue graft is inserted into the space between the two sections of tissue. The graft is usually slightly larger than the recession area, so some excess will be apparent.
Sutures are often placed to further stabilize the graft and to prevent any shifting from the designated site. Surgical material is used to protect the surgical area during the first week of healing. Uniformity and healing of the gums will be achieved in approximately six weeks.
If you have any questions about gum grafting, 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!