Periodontal (Gum) Disease

What is Periodontal Disease?

Commonly known as gum disease, periodontal disease is a family of related chronic inflammatory diseases that are all bacterial infections. Both periodontal disease and decay are caused by bacterial plaque – a sticky colorless film composed primarily of food particles and various types of bacteria, which sticks to your teeth at and below the gum line.

Plaque constantly forms on your teeth beginning within minutes after cleaning. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar). As plaque accumulates and hardens into tartar on the surfaces of the teeth, bacteria releases toxins that irritate the gums, causing the gums to swell, turn red, and bleed easily.

This build-up of tartar worsens the condition, causing the gums to pull away from the teeth forming spaces called “pockets” around the teeth. Over time these pockets become deeper, providing a larger space for bacteria to live. These deeper pockets result in tissue and bone loss. If left untreated, eventually too much bone is lost and the tooth or teeth will need to be extracted.

Periodontitis is affected by bacteria that adhere to the tooth surfaces along with an overly aggressive immune response to these bacteria. Periodontal disease is often a silent and very serious condition in which redness, swelling, and bleeding do not have to be present until an advanced stage of the disease. Because pain is usually not associated with periodontal disease and it progresses slowly, it is often ignored. 80% of Americans will have periodontal disease by age 45 and 4 out of 5 patients with this disease are unaware they have it. It is important to get this disease under control for the long-term health of your teeth.

Risk Factors of Periodontal Disease

Risk factors that increase the susceptibility of developing periodontal disease include:

• Poor oral hygiene – The main cause of periodontal disease is bacterial plaque. Lack of brushing, flossing, and professional dental cleanings and exams increases the likelihood of periodontal disease occurring.
• Tobacco Use – Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. There is a greater incidence of calculus formation on teeth, deeper pockets between gums and teeth, as well as a greater loss of the bone and fibers that hold teeth in your mouth. Chemicals in tobacco such as nicotine and tar slow down healing and the predictability of success following periodontal treatment.
• Genetics (family history of periodontal disease) – Research has shown that some people may be genetically susceptible to gum disease. Despite diligent oral care habits, these people may be more likely to develop periodontal disease.
• Systemic Diseases – Systemic diseases such as diabetes, heart disease, and rheumatoid arthritis can interfere with the body’s inflammatory system and worsen the condition of the periodontal (gum) tissues.
• Stress – Research has shown that stress makes it more difficult for the body to fight against infection including periodontal disease.
• Clenching or grinding your teeth – Clenching or grinding your teeth can put excess force on the supporting tissues of your teeth and could accelerate the rate at which these periodontal tissues are destroyed.
• Medications – Certain drugs such as anti-depressants, steroids, anti-epilepsy drugs, cancer therapy drugs, and calcium channel blockers (heart medication) can affect your oral health. Please inform Dr. Hoffman of all medications that you are taking and any changes in your overall health.
• Poor nutrition and obesity – A diet with insufficient nutrients can compromise the body’s immune system making it more difficult for the body to fight against infection, including periodontal disease. Hence, poor nutrition can worsen the condition of your gum tissues. Also, research has shown that obesity may increase the risk of periodontal disease.
• Crooked teeth or ill-fitting dental restorations – Crooked teeth and dental restorations that have become defective or no longer fit properly can contribute to plaque retention and increase your risk of developing periodontal disease.
• Pregnancy or use of oral contraceptives – Either of these occurrences causes an increase in hormone levels that can cause gum tissues to become more sensitive to the toxins produced by plaque. This can accelerate the growth of some bacteria that will cause the gum tissues to become red, inflamed, tender, and bleed easily.

Periodontal Disease and Systemic Health

Research has linked the bacteria associated with gum disease with an increased risk in:

• Diabetes
• Heart disease
• Stroke
• Osteoporosis
• Respiratory disease
• Certain cancers (pancreatic cancer, kidney cancer, and blood cancers)
• Rheumatoid arthritis

Preventing Periodontal Disease

Recent studies show that more than half of adults over the age of 35 are already in the early stages of periodontal disease. Adults over 35 lose more teeth to gum disease (periodontal disease) than from cavities. Three out of four adults are affected at some time in their life. Additionally, most adults who have periodontal disease are not even aware of their condition.

The best way to prevent cavities and periodontal disease is by good tooth brushing and flossing techniques performed daily along with regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people can still develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.

Diagnosing Periodontal Disease

During a periodontal exam, or screening, we typically check for and record these findings:

• Firmness or any swelling of the gums
• Bleeding of the gums
• Any tooth sensitivity or mobility
• Jawbone levels to help detect the breakdown of bone surrounding your teeth
• Probing – An instrument called a periodontal probe is used for checking pocket depths between your gums and teeth. This probe is placed in several spaces between the gum and each tooth in order to measure the depth at which the gums and tooth meet. In healthy, well-maintained teeth, a typical pocket depth ranges from 1 to 3 millimeters. Pocket depths exceeding 4 millimeters will usually involve a deeper type of cleaning (below the gum line), known as scaling and root planing.

Periodontal Care and Maintenance

Periodontal treatment is necessary when various conditions affect the health of your gums and the regions of your jawbone that hold your teeth in place. Retaining your teeth is directly dependent on proper periodontal care and maintenance. Healthy gums enhance the appearance of your teeth. When your gums become unhealthy, they can either recede or become swollen and red. In later stages, the supporting bone is destroyed and your teeth will shift, loosen, or fall out.

If you have been diagnosed with periodontal disease, it is important to seek treatment. At Andrew Hoffman D.M.D. we provide scaling and root planing and periodontal maintenance cleaning services for the treatment of gum disease.

Despite our best efforts to treat and control periodontal disease, in some cases it may not be enough. Despite your best efforts and those of Dr. Hoffman, if the desired response to treatment is not obtained, you may need to be referred to a periodontist as the next course of treatment.

Links:

For more information concerning periodontal (gum) disease go to the https://www.perio.org/for-patients/ (American Academy of Periodontology)