| Gum disease or periodontal disease, a chronic
inflammation and infection of the gums and surrounding tissue, is the
major cause of about 70 percent of adult tooth loss, affecting three
out of four persons at some point in their life.
What causes gum
disease?
Bacterial plaque - a sticky, colorless film that constantly forms on
the teeth - is recognized as the primary cause of gum disease.
Specific periodontal diseases may be associated with specific
bacterial types. If plaque isn't removed each day by brushing and
flossing, it hardens into a rough, porous substance called calculus
(also known as tartar).Toxins (poisons) produced and released by
bacteria in plaque irritate the gums. These toxins cause the breakdown
of the fibers that hold the gums tightly to the teeth, creating
periodontal pockets which fill with even more toxins and bacteria. As
the disease progresses, pockets extend deeper and the bacteria moves
down until the bone that holds the tooth in place is destroyed. The
tooth eventually will fall out or require extraction.
Are there other factors?
Yes. Genetics is also a factor, as are lifestyle choices. A diet low
in nutrients can diminish the body's ability to fight infection.
Smokers and spit tobacco users have more irritation to gum tissues
than non-tobacco users, while stress can also affect the ability to
ward off disease. Diseases that interfere with the body's immune
system, such as leukemia and AIDS, may worsen the condition of the
gums. In patients with uncontrolled diabetes, where the body is more
prone to infection, gum disease is more severe or harder to control.
What are the warning signs of gum disease?
Signs include red, swollen or tender gums, bleeding while brushing or
flossing, gums that pull away from teeth, loose or separating teeth,
puss between the gum and tooth, persistent bad breath, change in the
way teeth fit together when the patient bites, and a change in the fit
of partial dentures. While patients are advised to check for the
warning signs, there might not be any discomfort until the disease has
spread to a point where the tooth is unsalvageable. That's why
patients are advised to get frequent dental exams.
What does periodontal treatment involve?
In the early stages, most treatment involves scaling and root planning-removing
plaque and calculus around the tooth and smoothing the root surfaces.
Antibiotics or antimicrobials may be used to supplement the effects of
scaling and root planning. In most cases of early gum disease, called
gingivitis, scaling and root planning and proper daily cleaning achieve
a satisfactory result. More advanced cases may require surgical
treatment, which involves cutting the gums, and removing the hardened
plaque build-up and recontouring the damaged bone. The procedure is
also designed to smooth root surfaces and reposition the gum tissue so
it will be easier to keep clean.
How do you prevent gum disease?
Removing plaque through daily brushing, flossing and professional
cleaning is the best way to minimize your risk. Your dentist can
design a personalized program of home oral care to meet your needs. If
a dentist doesn't do a periodontal exam during a regular visit, the
patient should request it. Children also should be examined.
What is the role of the general dentist?
The general dentist usually detects gum disease and treats it in the
early stages. Some general dentists have acquired additional expertise
to treat more advanced conditions of the disease. If the general
dentist believes that the gum disease requires treatment by a
specialist, the patient will be referred to a periodontist. The
dentist and periodontist will work together to formulate a treatment
plan for the patient.
Is maintenance important?
Sticking to a regular oral hygiene regimen is crucial for patients who
want to sustain the results of therapy. Patients should visit the
dentist every 3-4 months (or more, depending on the patient) for spot
scaling and root planning and an overall exam. In between visits, they
should brush at least twice a day, floss daily, and brush their
tongue. Manual soft nylon bristle brushes are the most dependable and
least expensive. Electric brushes are also a good option, but don't
reach any further into the pocket than manual brushes. Proxy brushes
(small, narrow brushes) are the best way to clean in between the
recesses in the teeth, and should be used once a day. Wooden tooth
picks and rubber tips should only be used if recommended by your
dentist.
Periodontal Procedures
Following are some of the procedures that
periodontists use to treat patients diagnosed with a periodontal (gum)
disease. The main cause of periodontal disease is bacteria in the form
of a sticky, colorless plaque that constantly forms on your teeth;
however, many other factors can cause periodontal (gum) disease or
influence its progression.
Non-Surgical Treatments
AAP treatment guidelines stress that periodontal
health should be achieved in the least invasive and most
cost-effective manner. This is often accomplished through non-surgical
periodontal treatment, including scaling and root planning (a careful
cleaning of the root surfaces to remove plaque and calculus [tartar]
from deep periodontal pockets and to smooth the tooth root to remove
bacterial toxins), followed by adjunctive therapy such as local
delivery antimicrobials and host modulation, as needed on a
case-by-case basis.
Most periodontists would agree that after
scaling and root planning, many patients do not require any further
active treatment, including surgical therapy. However, the majority of
patients will require ongoing maintenance therapy to sustain health.
Non-surgical therapy does have its limitations, however, and when it
does not achieve periodontal health, surgery may be indicated to
restore periodontal anatomy damaged by periodontal diseases and to
facilitate oral hygiene practices.
Periodontal Surgery
If you're diagnosed with periodontal disease,
your periodontist may recommend periodontal surgery. Periodontal
surgery is necessary when your periodontist determines that the tissue
around your teeth is unhealthy and cannot be repaired with
non-surgical treatment. Following are the four types of surgical
treatments most commonly prescribed:
Dental Implants
If you've already lost a tooth to periodontal
disease or other reasons, you may be interested in
dental implants –
the permanent tooth replacement option.
Cosmetic Procedures
In addition to procedures to treat periodontal
disease, many periodontists also perform cosmetic procedures to
enhance your smile. Oftentimes, patients who pursue cosmetic
procedures notice improved function as well. Cosmetic procedures
include:
Crown Lengthening
Soft Tissue
Grafts
Ridge Augmentation
Ask a periodontist near you for a smile
consultation. He or she can evaluate your smile and provide a range of
treatments available to help achieve the look you want.
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