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Periodontics

Periodontal disease (also known as gum disease) is a chronic inflammatory disease that affects the gum tissue and bone supporting the teeth, and is usually brought on by a buildup of plaque. Plaque is a sticky film of food debris, bacteria, and saliva. If plaque is not removed, it turns into calculus (tartar). When plaque and calculus are not removed, they begin to destroy the gums and bone. Periodontal disease is characterized by red, swollen, and bleeding gums.

It is estimated that approximately 50% of American adults have periodontal disease.  Most periodontal sufferers are not aware of their condition because the disease is usually painless in the early stages.  If left untreated, periodontal disease can lead to tooth loss. Research has also shown that periodontal disease is associated with other chronic inflammatory diseases, such as diabetes and cardiovascular disease.

The good news is that periodontal disease can often be treated with a deep cleaning called scaling and root planning.  This treatment has a huge benefit: you’ll increase the chances of keeping your natural teeth.

Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.

 

Periodontics - help with gum disease

 

Signs and symptoms of periodontal disease:

Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss
Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone)
New spacing between teeth – Caused by bone loss
Persistent bad breath – Caused by bacteria in the mouth
Pus around the teeth and gums – Sign that there is an infection present
Receding gums – Loss of gum around a tooth
Red and puffy gums – Gums should never be red or swollen
Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth

Common Concerns About Periodontal Disease

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 which affects the supporting and surrounding soft tissues of the tooth; also the jawbone itself when in its 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 lead to 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 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.

Periodontal Disease & 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 prenatal 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 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.

Mouth - Body Connection

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 the 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 co-factors associated with periodontal disease include:

Diabetes

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.

Heart 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.

Pregnancy Complications

In general, women 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.

Respiratory Disease

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 the 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!

Gum Recession

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 – and chewing tobacco in particular – has devastating effects on the entire oral cavity. 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.

Bruxism – Clenching and grinding of the teeth can be a cause of eroding gum tissue.  This mostly happens at night while sleeping, but can also be a problem for some during their day to day activities.

 

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.

If clenching and grinding is found to be the cause of the loss of gum tissue, then a night guard maybe be suggested as a treatment.  A night guard is a custom fabricated device to wear during the times when the most clenching occurs.  It will lessen the force placed on the teeth and jaws.  Another viable option for treatment is Botox injections to help atrophy any overactive muscles.

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.

Diagnosis

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 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

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.

Periodontitis

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.

Advanced Periodontitis

The teeth lose more support as the gums, bone, and periodontal ligament continues 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.

Treatment for Periodontal Disease

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, specially medicated mouth rinses, an electric toothbrush, periodontal aids, and a water flosser may be recommended to help control infection and healing.

There are many surgical and nonsurgical treatments your dentist 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.  In some cases, you may be referred to a specialist, called a Periodontist.  We have established referral patterns with highly qualified specialists in our area.

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.

Maintenance

It only takes twenty-four hours for the 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!

Causes Of Periodontal Disease

Periodontal (gum) disease, which is also known as periodontal 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, 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 ensure and preserve the natural dentition and supporting bony structures. When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacteria toxins and can cause gingivitis or periodontitis, which can lead to tooth loss.

Tobacco use – Research has indicated that smoking and tobacco use is one 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 towards 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 infections may possibly 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 the 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 common and allows bacteria to colonize more readily in the gum tissue.

 

Treatment of Gum Disease

Preventing periodontal disease is critical in preserving 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.

Better Dental Care is Our Mission

So you can smile with confidence

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LDA@LaramieDental.com

352 North 4th Street
Laramie, WY 82072