Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth.

It is a progressive inflammatory disease of the gums and the surrounding tissue around the teeth. It is commonly known as gum disease and was referred to as pyorrhea in the old days. It is estimated that up to 80% of the population above the age of 40 may suffer from this disease with the severity varying drastically from one person to another. Periodontitis is the number one cause of tooth loss after the age of 40.

If you notice any of the following signs of gum disease, schedule an appointment immediately:

Click here to learn more about Gingival recessions

Causes of Periodontal Disease
The main cause of periodontal disease is bacterial plaque, a sticky, colorless film that constantly forms on your teeth. However, factors like the following also affect the health of your gums.

Smoking/Tobacco Use
As you probably already know, tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. What you may not know is that tobacco users also are at increased risk for periodontal disease. In fact, recent studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

Genetics
Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interceptive treatment may help them keep their teeth for a lifetime.

Pregnancy and Puberty
As a woman, you know that your health needs are unique. You know that brushing and flossing daily, a healthy diet, and regular exercise are all important to help you stay in shape. You also know that at specific times in your life, you need to take extra care of yourself. Times when you mature and change, for example, puberty or menopause, and times when you have special health needs, such as menstruation or pregnancy. During these particular times, your body experiences hormonal changes. These changes can affect many of the tissues in your body, including your gums. Your gums can become sensitive, and at times react strongly to the hormonal fluctuations. This may make you more susceptible to gum disease. Additionally, recent studies suggest that pregnant women with gum disease are seven times more likely to deliver preterm, low birth weight babies.

Stress
As you probably already know, stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. What you may not know is that stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

Medications
Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

Clenching or Grinding Your Teeth
Has anyone ever told you that you grind your teeth at night? Is your jaw sore from clenching your teeth when you're taking a test or solving a problem at work? Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

Diabetes
Diabetes is a disease that causes altered levels of sugar in the blood. Diabetes develops from either a deficiency in insulin production (a hormone that is the key component in the body's ability to use blood sugars) or the body's inability to use insulin correctly. According to the American Diabetes Association, approximately 16 million Americans have diabetes; however, more than half have not been diagnosed with this disease. If you are diabetic, you are at higher risk for developing infections, including periodontal diseases. These infections can impair the ability to process and/or utilize insulin, which may cause your diabetes to be more difficult to control and your infection to be more severe than a non-diabetic.

Poor Nutrition
As you may already know, a diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Because periodontal disease is a serious infection, poor nutrition can worsen the condition of your gums.

Other Systemic Diseases
Diseases that interfere with the body's immune system may worsen the condition of the gums.

Treatment Options

Scaling and Root Planing: Manually removing the plaque and tarter from the root surfaces of your teeth below the gum line.

Antibiotics: Because bacteria cause periodontitis antibiotics may be prescribed as pills or as an Antibiotic fiber. The fibers are used in conjunction with scaling and root planing. They are placed directly into the pockets and are removed within 7-10 days later. Antibacterial mouth rinses may also be recommended to help plaque control.

Antibiotic Therapy

Systemic Antibiotic Therapy
Low Dose Antibiotics
Local Antibiotic Therapy

Systemic Antibiotic Therapy

Systemic antibiotics are drugs that, when given, affect the whole body. Normally they are administered in pill form when used in periodontal treatment. Periodontists use systemic antibiotics to treat acute infections, such as a gum abscess (gum boil), and also before treatment when patients have certain medical conditions, such as mitral valve prolapse (See Prophylactic Antibiotics). Systemic antibiotics are also recommended for two weeks after regeneration procedures and when implants are placed. This is done to make sure there is no infection during the early healing stages, which are critical with these two techniques.

Recently there has been interest in the use of low dose antibiotics. The dose is so low the drug does not act to kill bacteria, but rather to change the way the body responds to infection.

Actisite, a string embedded with tetracycline, a drug known to kill many of the bacteria that cause periodontal disease. The Actisite fiber is placed in the pocket and left for ten days, and during this time high concentrations of tetracycline are released. At the end of 10 days the string is removed from the pocket. Over the next few days the inflammation will subside, and the pocket will ideally shrink as the tissues tighten around the tooth.

PerioChip
PerioChip is a thin wafer that contains chlorhexidine. While chlorhexidine is not an antibiotic, it is a powerful antiseptic and kills most pathogens. The wafer slides under the edge of the gum into the pocket, a simple procedure that does not require anesthesia. The wafer dissolves over several days, and does not have to be removed.

The most recent local antibiotic therapy introduced consists of small spheres of minocycline, a derivative of tetracycline. This drug, similar to the ingredients in Actisite and Atridox, is very effective in killing the bacteria that are thought to cause periodontal disease. The primary advantage of this new product is the ease of use.

Bite correction: An imbalanced bite may accelerate bone destruction. Your teeth may be adjusted for proper and better function. A Bite-guard (removable retainer fitting over teeth) may be required to protect teeth surfaces and relax tense muscles.

Splinting: This technique attaches weak teeth together, combining them into a stronger single unit, making them more stable and offering more comfortable chewing.

_________________________________________________________________________________

Who is a periodontist?
A periodontist is a dentist who specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. Periodontists are familiar with the latest techniques for diagnosing and treating periodontal disease. In addition, they can perform cosmetic periodontal procedures to help you achieve the smile you desire. Often, dentists refer their patients to a periodontist when their periodontal disease is advanced. However, you don't need a referral to see a periodontist. In fact, there are occasions when you may choose to go directly to a periodontist or to refer a family member or friend to your own periodontist.

Is there a relationship between tobacco use and periodontal disease?
Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Smokers are much more likely than non-smokers to have calculus form on their teeth, have deeper pockets between the teeth and gums and lose more of the bone and tissue that support the teeth.

Is it normal for my gums to bleed when I brush my teeth?
Bleeding gums are one of the signs of gum disease. Think of gum tissue as the skin on your hand. If your hands bled every time you washed them, you would know something was wrong. There are a number of other warning signs of gum disease.

What are pockets?
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth. Over time, these pockets become deeper, providing a larger space in which bacteria can live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.

Could my periodontal disease be genetic?
Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be six times more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early interventive treatment may help them keep their teeth for a lifetime.

Can I pass my periodontal disease to others?
Periodontal disease may be passed from parents to children and between couples, according to an article in the September 1997 issue of the Journal of the American Dental Association. Researchers suggest that bacteria causing periodontal disease are passed though saliva. This means that when a family or couple come into contact with each other's saliva, they're at risk for contracting the periodontal disease of another family member. Based on this research, the American Academy of Periodontology recognizes that treatment of gum disease may involve entire families. If one family member has periodontal disease, the AAP recommends that all family members see a dental professional for a periodontal disease screening.

To keep your teeth for a lifetime, you must remove the plaque from your teeth and gums every day with proper brushing and flossing. Regular dental visits are also important. Daily cleaning will help keep calculus formation to a minimum, but it won't completely prevent it. A professional cleaning at least twice a year is necessary to remove calculus from places your toothbrush and floss may have missed.
Other factors can affect the health of your gums.

Your chances of developing periodontal disease increase considerably as you get older. More than half of people aged 55 and older have periodontitis. The good news is that research suggests that these higher rates may be related to risk factors other than age. So, periodontal disease is not an inevitable part of aging. Risk factors that may make older people more susceptible include general health status, diminished immune status, medications, depression, worsening memory, diminished salivary flow, functional impairments and change in financial status.

When should I see a periodontist?
If you value your oral as well as overall health, anytime is a good time to see a periodontist for a periodontal evaluation.

Sometimes the only way to detect periodontal disease is through a periodontal evaluation. A periodontal evaluation may be especially important in the following situations:

What can I expect the first time I visit a periodontist?
During your first visit, your periodontist will review your complete medical and dental history with you. It's extremely important for your periodontist to know if you are taking any medications or being treated for any condition that can affect your periodontal care. You will be given a complete oral and periodontal exam. Your periodontist will examine your gums, check to see if there is any gum line recession, assess how your teeth fit together when you bite and check your teeth to see if any are loose. Your periodontist will also take a small measuring instrument and place it between your teeth and gums to determine the depth of those spaces, known as periodontal pockets. This helps your periodontist assess the health of your gums. Radiographs (x-rays) may be used to show the bone levels between your teeth to check for possible bone loss.

When gum is inflamed severely (periodontitis), alveolar bone will be absorbed, and defected. Periodontal ligaments which connect between the alveolar bone and the teeth will disappear. Sever bone lose will cause tooth moving and missing. Flap and bone surgery is order to contour the bone, deeply clean the tooth to reduce the inflammation, and promote bone re-growing and connections firm.

There are two types of gum tissue in the mouth, one of which surrounds the necks of the teeth and is thick and protective in nature (keratinized gingiva). The other of which lines our cheeks and floor of the mouth whose purpose is to be elastic and mobile in nature (mucosa).

Soft tissue grafts are used to replace missing thick tissue (keratinized gingiva), which has worn away from the necks of the teeth for a variety of reasons. The purpose of gum grafting is to minimize and/or arrest the progression of recession.

Unfortunately associated with every type of recession, there is bone loss, because the bone resides just beneath the gums. Therefore, if the gums have receded, then the bone too has receded. The purpose of gum grafting is to arrest the progression of recession and thereby halt the bone loss as well, by restoring a thick zone of protective tissue around the neck of the tooth / teeth which exhibits an absence of this thick keratinized gum tissue.

In certain instances it is not only possible to restore the missing keratinized (thick / protective) gum tissue, but also to cover the exposed root surface of the tooth / teeth in question. Other issues must be addressed as well, such as the biting forces being placed on the teeth.

Unbalanced forces placed on the teeth in the presence of clenching or grinding can predispose an individual to recession. Being a candidate for this root coverage procedure, which is achieved by a connective tissue graft, is to be determined by the individual practitioner.

Cosmetic Gum Grafts:
Esthetic gum grafting can be used to "plump up" the gum tissue in an area that is deficient and would result an unaesthetic cosmetic make-over. Remember the teeth and gums should exhibit symmetry, yet sometimes one side is deficient, therefore, gum grafting may be essential to achieve symmetry prior to a cosmetic make-over.

When treating recession by gum grafting, the causative factor must also be addressed in order for the grafting procedure to be successful.

1. Soft tissue graft: There are many types of soft tissue grafts. This type of graft involves taking a small piece of tissue from the surface skin on the roof of the mouth and transplanting it to areas in the mouth that are lacking. This type of graft restores and augments the missing thick keratinized gingiva, but does not result in covering of the exposed root.

2. Connective Tissue Graft: In this procedure tissue is taken from the undersurface of the palatal tissue (roof of the mouth) via tiny incisions, and is used to not only restore missing thick keratinized gum tissue, but also used to cover exposed roots of the teeth.

What is a bone graft?
Bone grafting is the replacement or augmentation of the bone around the teeth.

Why is a bone graft needed?
Bone grafting is performed to reverse the bone loss / destruction caused by periodontal disease, trauma, or ill fitting removable dentures. It is also used to augment bone to permit implant placement, such as augmenting bone in the sinus area for implant placement, or augmenting bone to enhance the fit and comfort of removable prostheses, or to enhance esthetics of a missing tooth site in the smile zone. When one loses a tooth, as in an extraction, the surrounding bone collapses. To preserve this bone for future implant placement or for esthetics, a bone graft is used.

1. autogenous - bone taken from one area of the patient and transplanted to another area requiring such grafting
2. allograft - either synthetic bone or bone from a bone bank (cadaver bone)
3. xenograft - bovine /cow bone

Which graft is used and when and why?
Autogenous bone is the "gold standard" and oftentimes has the most predictable results. This is described as the best type of graft because such bone is live bone with live active cellular elements that enhance bone growth, whereas other types of grafts are devoid of any active cellular material.

Allografts and Xenografts both do not require a second surgical site as does the autogenous bone. Ample amounts can be easily obtained.

Barrier membranes
In conjunction with bone grafting, membranes are often used to help stabilize the bone graft as well as displace the gum tissue from invading the healing bone graft. Gum tissue grows at a much faster rate than bone, therefore, membranes are used to prevent gum tissue from growing in and displacing the bone graft before it matures.

Here are some guidelines for choosing dental care products – what works for most patients most of the time. To find out what is best for your particular needs, talk to your periodontist.

How should I choose oral care products?
Choose products that carry the American Dental Association Seal of Acceptance – an important symbol of a dental product's safety and effectiveness.

What is gum disease?
Gum disease refers to inflammation of the soft tissue (gingiva) and abnormal loss of bone that surrounds the teeth and holds them in place. Gum disease is the second most common cause of toothache.

What causes gum disease?
Gum disease is caused by toxins secreted by bacteria in "plaque" that accumulate over time along the gum line. This plaque is a mixture of food, saliva, and bacteria.

What are symptoms of gum disease?
Early symptoms of gum disease include gum bleeding without pain. Pain is a symptom of more advanced gum disease as the loss of bone around the teeth leads to the formation of gum pockets. Bacteria in these pockets cause gum infection, swelling, pain, and further bone destruction. Advanced gum disease can cause loss of otherwise healthy teeth.

How is gum disease treated?
Treatment of early gum disease involves oral hygiene and removal of bacterial plaque. Moderate to advanced gum disease usually requires a thorough cleaning of the teeth and teeth roots called "root planing" and "subgingival curettage." Root planing is the removal of plaque and tartar (hardened plaque) from exposed teeth roots while subgingival curettage refers to the removal of the surface of the inflamed layer of gum tissue. Both of these procedures are usually performed under local anesthesia and may be accompanied by the use of oral antibiotics to overcome gum infection or abscess. Follow-up treatment may include various types of gum surgeries. In advanced gum disease with significant bone destruction and loosening of teeth, teeth splinting or teeth extractions may be necessary.

You may not realize that persistent swollen, red or bleeding gums, tooth sensitivity, and bad breath are warning signs of periodontal (gum) disease -- a serious infection that, left untreated, can lead to tooth loss.

Jot down your answers to the following questions to find out if you have the symptoms of periodontal disease.