Periodontitis, or “gum disease,” is a chronic inflammatory disease that if left untreated can lead to tooth loss and other health problems. Typically the disease is painless and most patients are unaware that they have an issue until they are examined by a dentist.
To determine the health of your gums, your dental professional will perform a periodontal exam. A measuring tool is gently placed into the collar of gum tissue that surrounds the tooth, called a pocket. Normal, healthy pockets are typically between 1-3 mm in depth with no bleeding. If bacteria are allowed to accumulate below the gum line for extended periods of time, they harden on to the root structure and creates an inflammatory response that signals your body to destroy the bone and ligament supporting your teeth. The bacteria can also enter the bloodstream and contribute to systemic health conditions.
The main cause of periodontitis is bacteria in an immune susceptible host, but other factors also affect the health of your gums and can increase the likelihood of you developing periodontitis.
When periodontal disease occurs, the bacteria accumulate below the gum line. If allowed to sit for long periods of time, the bacteria become embedded in the tissue and hardened on to the root structures, creating deeper pockets that are no longer accessible with regular tooth brushing. Part of your treatment includes the removal of the calculus from the root structure by using a combination of specially designed ultrasonic and hand instruments. Once the debris is removed, the gum tissue should reattach to the clean root structure.
Research has demonstrated that some people are genetically susceptible to gum disease and periodontitis does run in families. For these people, despite excellent oral hygiene, they are more likely to develop periodontitis. While to date there is no valid test that can predict if you are at an increased risk of developing periodontal problems, ongoing research is dedicated to this area with a goal of determining what genes contribute to periodontitis susceptibility.
Tobacco users are at an increased risk of developing periodontitis. Studies have shown that tobacco use is one of the most significant risk factors in the development and progression of periodontitis. In fact, smoking increases your chance of losing teeth by 700%! Smoking has a myriad of negative affects throughout your body and in your mouth, but paramount of these is delayed wound healing. Luckily, research points out that if you are able to quit, you can restore your healing capabilities and increase your chance of success of all types of oral surgery, including dental implants.
The link between periodontitis and a myriad of systemic diseases has been a hot research topic as of late. While no causal links have been established, we do know that several systemic diseases that interfere with the body’s inflammatory system (such as cardiovascular disease, rheumatoid arthritis, and diabetes) worsen the condition of the gums. In particular, diabetes has been closely linked with periodontal disease progression. Diabetic patients are more susceptible to periodontitis, although level of susceptibility is correlated with the stability of blood sugar. Thus, if blood sugar levels remain well-controlled and stable the effect is negligible.
Research has shown that obesity may increase the risk of periodontitis. Additionally, diets low in important nutrients can compromise the body’s immune system, making it more difficult to fight off infection. As periodontitis begins as an infection, malnutrition can worsen the condition of your gums.
Research has shown the stress impairs the body’s ability to fight of infections, including periodontal diseases.
While growing older doesn’t cause one to develop periodontitis, data support that older people have the highest rates of gum disease. Specifically, recent data from the Centers for Disease Control and Prevention indicate that over 70% of Americans age 65 and older have periodontitis.
Treatment of periodontitis typically begins with a “deep cleaning,” called scaling and root planing, to remove plaque and tartar deposits beneath the gum line.
The roots of the teeth may also be planed to smooth the root surface, allowing the affected gum tissue to heal and reattach to the root surface. Despite what you may have heard, scaling and root planing is painless! This treatment is completed with the use of local anesthetic in affected areas. Typically, when full mouth scaling and root planing is necessary, it is scheduled in two, one and a half hour appointments. Following this procedure, your at home oral hygiene is of key importance to helping your body heal and your pockets shrink. Six weeks after scaling and root planing, a re-evaluation appointment is critical to determine how you responded to this treatment. If at this appointment it is determined that your gums are healthy, a long term periodontal maintenance program will be recommended, typically requiring you to come in for a cleaning every 3 months. If at the re-evaluation your gums still have not reached a healthy state, other treatment options will be discussed with you aimed to continue to improve your oral health.
65 year-old female presents with chief concern: “I don’t like the way my front teeth look and I would like new crowns. Also my last dentist told me I have gum problems.”
To discuss this case, we will focus on the upper front teeth, although all teeth were affected. You will see photos taken prior to any periodontal treatment. Note the heavy calculus and plaque accumulation, bleeding sites, and deep pockets. By just looking at this patient, you may not guess she had gum disease, as the majority of her disease is occurring on the backside of her teeth.
This illustrates the importance of scheduling regular check-ups at both your dentist’s and periodontist’s offices so together, they will be able to catch problems early on.
Just 6 weeks after scaling and root planing was completed, the patient’s tissue health improved dramatically and her pockets shrunk considerably. At this point, the patient was placed on 3 month periodontal maintenance and no surgical therapy was recommended.
The patient was thrilled with the improved health of her gums!
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21055 12 Mile Road, Roseville MI 48066