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Periodontal Disease

Marielaina Perrone DDS Cosmetic DentistPeriodontal disease (or gum disease) is a very serious and chronic infection of the gum tissues in the mouth that can result in the destruction of the bone and soft tissues that surrounds and supports your teeth. This chronic infection process begins when bacteria and plaque form a sticky bio film on your teeth and causes the gum tissue to become inflamed and swollen.  Periodontal disease will continue to progress if this is not resolved by maintaining proper dental care and hygiene. Periodontal disease is the leading cause of tooth loss in adults. Various studies have shown that somewhere between 75% and 90% of all adults in the world are suffering from some form of periodontal disease.

Periodontal disease and tooth decay are caused by different types of bacteria, and are considered to be two separate dental conditions, however, you can suffer from both issues. Poor oral hygiene maintenance increases the risk of both tooth decay and development of periodontal disease. Swollen and receding gums open up the more vulnerable areas of the tooth…The root areas, which, are not protected by enamel and can break down quickly to form root cavities.  On the flip side, In patients with significant decay, the broken down teeth allow for food trap areas which keep gum tissue chronically inflamed.

Gingivitis

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The intial stage of periodontal disease is called gingivitis. This is the most mild form of periodontal disease. Symptoms include red, swollen (or puffy) and inflamed gums due to plaque-bacteria build-up. The gums may also bleed easily during brushing or eating of hard foods. During this earliest stage, the disease process can be reversed using proper brushing, flossing and professional dental care to remove the excess bacterial plaque. If the required oral hygiene does not occur, the periodontal disease then progresses  to the next stage. Most patients with this early form of periodontal disease, do not even know they have it. This is a critical time for the patient, as the condition can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been affected) at this stage if it is recognized and properly treated. Gingivitis is commonly seen during puberty, pregnancy, times of high stress, and menopause, as hormones can make you more prone to the inflammatory process. As for the rest of the population, maintaining poor dental hygiene is generally the most common cause, followed by medication and various medical conditions.

Periodontitis

As the periodontal disease progresses it becomes harder to treat and manage. The difference between gingivitis and periodontitis is that gingivitis only infects the gum tissue that surrounds the teeth while the periodontal disease process also invades the bone that provides support and stability for the teeth. The bacteria eventually invades past the  gum line area and destruction begins to the point that gums may begin to separate or pull away from the teeth (taking away support and connective fibers with it). What results are called periodontal pockets. These periodontal pockets allow for bacteria to invade below the gum line.  They eventually become loaded with toxic plaque and bacteria that moves and works its way deeper. It begins to erode the bone below the gum line. A patient’s bite will be affected (as the teeth shift or loosen) by the lost support which then affects chewing and other functions.

Advanced Periodontitis

As the periodontal disease process progresses further, the fibers and bone that provide support for the teeth are destroyed. About 50% of the bone support (if not more) will have broken down at this late stage of periodontal disease. It does not grow back naturally. You may notice your teeth begin to loosen. Deep root cleanings and surgical intervention are typical protocol at this stage. This may include cleaning with a periodontal microscope, (Perioscope), grafting of tissue, bone, placement of growth factors, (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), surgery, and, possibly tooth removal.

How To Tell If You Have Periodontal Disease?

Periodontal disease can occur to a person of any age. It is most common among adults. Remember, if periodontal disease is diagnosed in its earliest stages it can be reversed so it’s important to see your dentist if you notice any of the following symptoms:

-Gums that are red, puffy or inflamed, or tender.

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-Gums that bleed easily during routine brushing or flossing.

-Teeth that appear longer due to recession of gum tissue.

-Changes in the way your teeth fit together when you bite or chew.

-Pus coming from between your teeth and gums

-Bad breath odor or bad taste in your mouth.

Treatment of Periodontal Disease

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Arestin use in Periodontal Disease

The earliest stages of periodontal disease is reversible. This is accomplished thru proper brushing, flossing, and maintaining a regular schedule with your dentist. A professional cleaning by your dentist or hygienist is the only way to remove plaque and tartar. The hygienist will clean (also called scaling) your teeth to remove the tartar and plaque buildup from above and below the gum line. If the periodontal disease condition worsens, then a root planing procedure may be necessary. Root planing helps smooth irregularities on the roots to make it more difficult for plaque to deposit there. Also makes it easier for you to keep your teeth clean at home. , treatment can also include use of antibiotics.

If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene. In that case, your periodontitis treatment may require dental surgery. These may include:

-Pocket Reduction Surgery (also called Flap surgery). In this procedure, your periodontist makes tiny incisions in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. Because periodontitis often causes bone loss, the underlying bone may be recontoured before the gum tissue is sutured back in place. The procedure generally takes from one to three hours and is performed under local anesthesia.

-Soft tissue grafts. Gum tissue is often lost as part of the periodontal disease process making your teeth appear longer than normal. You may need to have damaged tissue replaced to return your cosmetic appearance back to normal. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.

-Bone graft. This procedure is needed when periodontitis has destroyed the bone surrounding your tooth. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone.

-Antibiotics and medicaments – A wide array of antibacterial rinses(Peridex), antibiotics taken in pill form, (Periostat) or localized placement directly into the affected pockets(Arestin), can aide in and promote healing of the affected gum tissue.Periodontitis

-Guided tissue regeneration. This allows the regrowth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.

-Enamel matrix derivative application. Another technique involves the application of a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue. An example of this is the use of emdogain.

To insure a successful result following periodontal therapy, patient cooperation in maintaining excellent oral hygiene is essential. More frequent professional cleanings can help reduce the likelihood of the periodontal disease ever returning.

By scheduling regular checkups, early stage periodontal disease can be treated before it leads to a much more serious condition. If your periodontal disease is more advanced, treatment in the dental office will be required.

 

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