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Gum disease is also known as periodontal disease. The word "periodontal" means around the tooth. Periodontal disease attacks the gums and the bone that support the teeth. Periodontal disease is characterized by red, swollen and bleeding gums.
Periodontal disease is the number one reason for tooth loss. Most people are not aware that they have it because it is virtually pain free in the early stages. Research suggests that there may be a link between periodontal disease and other diseases such as stroke, bacterial pneumonia, diabetes, cardiovascular disease and increased risk during pregnancy. Researchers are evaluating if inflammation and bacteria associated with periodontal disease affects these systemic diseases and conditions. Smoking also increases the risk of periodontal disease.
What Causes Periodontal (Gum) Disease?
Periodontal disease is caused 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 calculcus are not removed (by flossing, brushing, and regular dental cleanings), they will continue to build up and create toxins that can damage the gums and bone surrounding the teeth. Periodontal disease forms just below the gum line, and creates small pockets that separate the gums from the teeth.
Periodontal disease is diagnosed by your dentist during a periodontal examination. This type of exam is a 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 depths of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if the pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper. Deepening pockets are a sign that soft tissue and bone is being destroyed by periodontal disease. Your dentist will perform a thorough examination using x-rays, pocket depths, amount of bleeding, inflammation, tooth mobility and amount of bone loss to make a periodontal diagosis.
- Gingivitis - This is the first stage of periodontal disease, Plaque and its toxin by-products irritate the gums, making them tender, inflamed and likely to bleed. At this early stage, if 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.
- Periodontitis - If left untreated, gingivitis will advance into periodontitis, and the gums and bone that support the teeth will become seriously and irreversibly damaged. 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. 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 ligaments continue to deteriorate. Unless treated, the affected teeth will become loose and may be lost. Generalized oderate to severe bone may be present.
Certain factors can increase a patient's risk of developing periodontal disease, including:
- Smoking or using chewing tobacco
- Certain types of medication such as steroids, anti-epilepsy drugs, cancer therapy drugs, calcium channel blockers, and oral contraceptives
- Bridges that no longer fit properly
- Crooked teeth
- Old fillings
While it is possible to have periodontal disease and not know it, some symptoms can include:
- Bleeding gums - Gums should never bleed, even when you brush vigorously or use dental floss.
- Red, swollen, tender gums - Gums should never be red or swollen.
- Gums that have pulled away from the teeth or receding gums - Loss of bone around a tooth.
- Persistent bad breath or bad taste - Caused by bacteria in the mouth.
- Pus between your teeth and gums - Signs that there is an infection present.
- Permanent teeth that are loose or separating - Caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
- Any change in the way your teeth fit together when you bite
- Any change in the fit of partial dentures
Treating Periodontal (Gum) Disease
Treatments for periodontal disease can vary depending on the severity of each individual case. Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment. Typical treatments include:
Daily home care helps to control this build-up of plaque and calculus. However, those areas of bone loss and hard to reach places 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 maintenance). These will take place three to four times a year. At these cleanings, 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 gumline.
Preventing Periodontal (Gum) Disease
Regular dental checkups and periodontal examinations are important for maintaining your health and the health of your smile. You do not have to lose teeth to periodontal disease, and by practicing good oral hygiene at home, you can significantly reduce your chances of ever getting gum disease. Remember to brush regularly, floss between your teeth, eat a balanced diet, and schedule regular dental visits to help keep your smile healthy.
Special periodontal cleaning called scaling and root planing (deep cleaning). During this type of cleaning, the mouth is divided into four quadrants. Typically, one or two quadrants are completed at a time while the area is numb.
Scaling: This procedure is performed with special dental instruments and may include an ultrasonic scaler. The scaling instrument removes calculus and plaque from the crown and root surfaces.
Root Planing: The root of the tooth is literally smoothed in order to remove unwanted microorganisms, toxins and calculus in order to promote good healing. Having smooth, clean root surfaces deter bacteria from colonizing in the future. This procedure helps gums to heal and pockets to shrink.
Prescription mouth rinses and an electric toothbrush may be recommended to help control infection and healing.
Periodontal surgery and laser gum surgery:
If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth more cleansible. Your dentist may refer you to a Periodontist (gum and bone specialist)for more comprehensive periodontal care.
When teeth have been lost due to periodontal disease, the esthetics and functionality of the mouth can be restored by using dental implants into the jawbone.