So, Are You Wondering if You Have Periodontal Disease?
What Is It?
So, what exactly is periodontal disease? Well, a recent publication form Columbia University's College of Medicine probably described it best this way.
"Peri" means around, and "odontal" refers to teeth. Periodontal diseases are infections of the structures around the teeth. These include the gums, the cementum that covers the root, the periodontal ligament and the alveolar bone. In the earliest stage of periodontal disease, gingivitis, the infection affects only the gums. In more severe forms of the disease, all of the supporting tissues are involved.
Gingivitis and Periodontitis
Gingivitis is that unpleasant swelling that many of us find around our teeth, at what dentists call the "neck" of the tooth, that can bleed or have significant swelling when we brush. You can really diagnose this for yourself. Do your gums bleed when you brush or floss? Are your gums constantly red and swollen? Do you have bad breath that won't go away? Does your mouth hurt when you chew food? Or are your gums receding?
If you answered even one of those questions with a "YES," then you probably have the early stage of periodontal disease, or what we commonly call gingivitis. The good news is that you're likely still early enough in the stages of gingivitis to stop things for getting worse. But more on that below.
Let's talk about the second level of periodontal disease and the one that means things have gotten quite serious. Periodontitis is when you not only have swollen and bleeding gums, you've also probably progressed to the supporting structure around the teeth and have developed pockets around or spaces between the teeth and gums.
Now if you take only one thing away from reading this today, remember this
Periodontal Disease is the Leading Cause of Tooth Loss!
If the progress of periodontal inflammation is not halted, the supporting structures of the teeth, including the surrounding bone, are destroyed. The teeth eventually loosen and are lost, or require extraction. Other problems patients may experience include painful abscesses, drifting of the teeth that may interfere with eating, and unsightly lengthening of the teeth with exposure of the roots, as a result of gum recession.
How Did This Happen?!
So now you're probably wondering, "How did this happen?" Well, at the end of the day it can come down to a lot of factors. But before you go blaming any one issue, you need to know that periodontal disease is caused by bacteria in your mouth. And we all have bacteria in our mouth, over 700 different species of them in fact!
Now these bacteria do have purposes that we won't get into here, suffice it to say that their purpose is NOT to cause periodontal disease! They are really actually pretty harmless until we let them build up on our teeth. When we do, we get what is commonly called "plaque." Plaque starts as a sticky film and then builds up on the teeth and hardens to form "tartar."
Tatar then encourages growth of the bacteria at the tooth root. As the inflammation progresses deeper, the attachment of the gum to the root is disrupted and a gap or periodontal pocket is formed between them. This pocket is an ideal place for harmful bacteria to colonize and in which to multiply, therefore driving the disease process forward. In their new habitat, the bacteria release toxins as products of their metabolism, which further trigger the body’s defense mechanisms. The severity and speed of progression of periodontitis depends upon the balance of a number of factors: the number and type of bacteria present, how strong the individual’s defense mechanisms are, and the presence or absence of certain risk factors.
The risk factor that takes most of the blame is the failure to properly brush and floss your teeth. But there are other factors that may cause some individuals to be more susceptible to the sticky plaque build-up.
For example, smokers have a higher rate of periodontal disease. People with immuno-compromised systems can also be more easily affected by plaque. You see, the body's natural response to the buildup of dental bacteria is what causes the swelling in your mouth to start.
Recent studies have even suggested that there may be environmental and genetic factors that can increase a person's propensity toward getting gum disease. Other factors linked to higher incidence of gum disease include:
- Medications that reduce the flow of saliva
- Fluctuating hormone levels, and even
- Poor nutrition.
- Atherosclerosis and heart disease — Gum disease may increase the risk of clogged arteries and heart disease. It also is believed to worsen existing heart disease.
- Stroke — Gum disease may increase the risk of the type of stroke that is caused by blocked arteries.
- Premature births — A woman who has gum disease during pregnancy may be more likely to deliver her baby too early. The infant may be more likely to be of low birth weight.
- Diabetes — Diabetic patients with periodontal disease may have more trouble controlling their blood sugar than diabetic patients with healthy gums.
- Respiratory disease — Bacteria involved in gum disease may cause lung infections or worsen existing lung conditions. This is particularly important for elderly adults in institutions such as nursing homes. In this group, bacteria from the mouth may reach the lungs and may cause severe pneumonia.
What Are the Treatment Choices for Advanced Periodontal Disease?
With careful assessment and treatment, it is usually possible to completely halt the progress of periodontitis. The key to success is to eliminate the bacterial plaque that is triggering the disease process and to establish excellent oral hygiene practices.
In some cases, with or without microbiological evaluation, antibiotics are prescribed to deal with active or persistent gum infections, which have not responded to oral hygiene measures.
Sometimes, a surgical procedure is carried out to clean away plaque bacteria and deposits that are under the gum within periodontal pockets and on the root surfaces at the furcations (where the roots diverge). These areas are inaccessible to brushes and floss and inflammation will persist in these sites as long as bacteria are allowed to colonize them. Under local anesthesia, the gum is lifted away and the root surfaces are cleaned to ensure that all bacteria are removed.
Occasionally, it is possible to treat bone loss at the same time using a special regenerative treatment. At the end of the procedure, the gums are sutured back into place around the teeth.
So, How do I Prevent Gum Disease?
The best way to reduce your risk of getting gingivitis or periodontitis is to improve your oral cleaning regimen. Stop the bacteria buildup, stop the plaque. Stop the plaque, stop the tartar. Stop the tartar, decrease the likelihood and inflammation and gum disease in general!
A regular regimen of brushing and flossing, along with regular dental cleanings to scrape away tartar build-up in usually the number one prescription for prevention of gum disease.
In fact it is now known that even periodontitis can be reversed by effective personal oral hygiene practices.
Though the majority of adults are affected by gingivitis, gingivitis fortunately does not always develop into periodontal disease. One of the challenges for early detection of periodontal disease is its “silent” nature – the disease does not cause pain and can progress unnoticed. In most cases, periodontal disease responds to treatment and although the destruction is largely irreversible its progression can be halted.
Recently, a new type of oral care has shown great success in the prevention AND treatment of gingivitis (and therefore the chance of developing periodontal disease.
Periodontal trays are customized oral mouth-pieces that are designed to hold a dental solution of hydrogen peroxide against the teeth and gums for a specified period. This treatment, twice a day, has been shown to almost completely prevent the buildup of oral bacteria. Some recent studies have even suggested that they may be useful is rebuilding receding gum lines. More studies are underway to see if this effective treatment for gingivitis can also be useful is reversing some of the damage of periodontitis.
Unlike mass-marketed dental trays used for teeth bleaching, periodontal trays are made from patient-specific molds, and are designed with an internal seal to hold the hydrogen peroxide solution directly against the affected areas of the gums.
This is critical to ensuring that the bacteria that reside at the gum line are not allowed to grow and to begin the plaque forming process.