Periodontal Disease

What is Gingivitis?

Gingivitis simply means inflammation of the gums (gingiva), caused by plaque (food and bacteria) and tartar (calcified plaque) adhering to the teeth. This inflammation results in swelling, redness (erythema), and bleeding on probing of the gum tissue surrounding the teeth. The key point in its definition is that this inflammation has not led to the destruction of the cellular attachment of the gum tissue to the tooth.

What is periodontal disease?

Periodontal disease, gum disease, periodontitis is a severe inflammatory reaction of the gum tissue resulting in cellular attachment loss of the gum tissue to the tooth. It usually develops from a preexisting gingivitis condition, however not every case of gingivitis develops into periodontitis. The attachment region compromised is known as the junctional epithelium. When this attachment is lost, plaque (food and bacteria) and tartar (calcified plaque) can adhere to the tooth and root structure below the gums. This foreign matter results in an inflammatory response by the body in an attempt to kill the bacteria. It is this immune response that leads to bone loss of the supporting bone surrounding the tooth (alveolar bone). This bone loss can be so severe that the teeth themselves can become loose (mobile), and may eventually be lost.

Signs and Symptoms of Periodontal disease:

• Bleeding gums while brushing or flossing.
• Puffy, red gums, that may be tender or painful.
• Teeth that appear longer because the gums have moved down the tooth (recession).
• Bad breath or bad taste in your mouth.
• Pus coming from around your teeth.
• Teeth that have become loose or shifted.
  

How is periodontal disease evaluated?

Probing: The dentist or dental hygienist measures the gum tissue around the tooth. A dental instrument called a periodontal probe is used. The region known as the sulcus is a space much like a trench all the way around the tooth. The periodontal probe measures the depth of this space between your tooth and gum. In health this space measures around 1 to 2 mm. When gum disease is present the measurement increases getting deeper and deeper forming "pockets" where food and bacteria can collect. In severe cases pocket depths of up to 8mm or greater are possible.

X-rays: X- rays are a valuable tool to study the supporting bone of the teeth. X-rays show the level of bone height relative to the tooth structure. X-rays are an excellent way of documenting bone levels over time. By comparing current films with films of the previous year etc., one can see if changes in the bone level have occurred. For this reason I strongly recommend the use dental x-rays when periodontal disease is suspected.

How common is Periodontal Disease?

There are several forms of periodontal disease. The most common form is Adult onset (AP). Periodontal disease can occur in the first two decades of life, but generally by the third and four decade prevalence increases dramatically. In a recent U.S. study it was found that over 75% of the adult population had a periodontal pocket of 4mm or greater. Of this population, 8% had severe periodontal disease defined as one or more pockets of 7mm or greater.

What can I do to prevent Periodontal Disease?

The best way to prevent gum disease is through good oral hygiene.

• Brush your teeth twice a day, morning and night, with a soft bristle brush and ADA approved toothpaste.
• Flossing and using interdental cleaners such as proxy brushes for large gaps daily will help reduce plaque build up between and below the gum line.
• Bridges must be flossed underneath to prevent gum disease around the supporting teeth.
• Dental checkup and cleanings on a 6 month bases so that dentist and hygienist can detect early signs of gum disease and remove any plaque and or tartar on the teeth.
• Do not smoke or use any form of tobacco products. These are not only known to cause oral cancer, but irritate the gum tissue.
• Eat a well balanced diet
• Avoid sugary foods that will lead to increased plaque formation.

How is Periodontal Disease treated?

Scaling: Scaling is the process of removing calculus and other debris above the gum level. This is generally what is done during routine cleanings with your dentist or hygienist.

Root Planing: Root planing is the removal of calculus and other debris below the gum level on the root structure itself, resulting in a smooth, hard, clean root surface. The gum tissue is then allowed to heal. The goal of root planing is to gain reattachment of the gum tissue to the tooth/root surface, resulting in decreased pocket depth and possible pocket elimination. This procedure may take several appointments and can require the use of dental anesthesia (numbing).

Surgery: Periodontal surgery is used for difficult or extreme cases of periodontal disease. This is a procedure generally performed by a gum specialist known as a periodontist. There are several types of surgery options depending on the type of periodontal defect at hand. Surgery is the most effective way of treating severe cases of periodontal disease which don't respond to root planing alone.

Regeneration:
With today's technology it is possible to graft bone between and around teeth. This process works only for specific types of bony defects, and is difficult and very technique sensitive. Again a periodontist generally performs this procedure. In cases where bone is lost between teeth or roots of molars (furcations) bone can be partially regenerated. Generally once the damaged area is surgically prepared bone is grafted, a special membrane is placed over the grafted bone, and the gum is sutured in place and allowed to heal.