Understanding Your Periodontal Condition
A smile is one of the most universally recognizable expressions. Smiling can demonstrate a person’s happiness, confidence, attractiveness, sociability, and sincerity. However, the effects of gum disease or other oral health disorders can not only be dangerous to your health and well-being, but can also have the potential to alter your smile.
Periodontal (“gum”) disease is one of the leading causes of tooth loss in adults. The most recent information from the Centers for Disease Control (CDC) notes that almost half of all Americans (47.2%) have periodontal disease. That means that one of every two American adults over the age of 30 has periodontal disease, with approximately 8.7% having a mild form, 30% a moderate form, and 8.5% having severe periodontitis. Research also notes that the prevalence of periodontitis in adults over the age of 65 jumps to 70.1%.
Luckily, periodontists are experts in treating the bone and gum tissues that surround and support the teeth. They have the know-how to treat the effects of gum disease or other oral tissue disorders and help to improve your smile. There are a variety of periodontal treatments that can improve your oral health and improve your smile.
Periodontal (“gum”) disease is one of the leading causes of tooth loss in adults. In the past, the only options for disguising tooth loss were dentures and bridges. Today, dental implants are a more natural-looking option because implants look and feel just like real teeth. They also allow a patient to speak and eat with comfort and confidence.
During this procedure, a dental implant is placed in the root area and after a healing period, an artificial tooth is attached. The result is a permanent replacement tooth that blends right in with the rest of your smile. Periodontists are experts at the placement of dental implants, with advanced training, techniques, and treatments to achieve health and an improved smile.
PERIODONTIC SPECIALISTS – What 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 are also experts in the treatment of oral inflammation.
Periodontists receive extensive training in these areas, including three additional years of residency education beyond the completion of dental school. They are familiar with the latest techniques for diagnosing and treating periodontal disease, and are also trained in performing cosmetic periodontal procedures.
Periodontists often treat more problematic periodontal cases, such as those with moderate-severe gum disease or a complex medical history. Periodontists offer a wide range of treatments, such as non-surgical scaling and root planing (“Tissue Conditioning”) (in which the infected surface of the root is cleaned) or root surface debridement (in which damaged tissue is removed).
They also specialize in the treatment of patients with severe gum problems using a range of surgical procedures, in which both gum (“Soft Tissue or Gum Grafting”) and bone (“Pocket Reduction Therapy” with “Regenerative Therapy”) can be grown around teeth. In addition, should teeth require removal, periodontists are specially trained in the placement and repair of “Dental Implants.”
During the first visit, Dr. Tom or Dr. Fred will review the patient’s complete medical and dental histories. It is extremely important for the periodontist to know if any medications are being taken or the patient is being treated for any condition that can affect periodontal care, such as heart disease, diabetes, or pregnancy.
The periodontist examines the gums, evaluates for any gum line recession, assesses how the teeth fit together when biting, and checks the teeth to see if any are loose. The periodontist will also take a small measuring instrument called a probe and place it between the teeth and gums to determine the depth of those spaces, known as periodontal pockets (“probing depths”); this helps him or her to assess the health of the gums and underlying bone. Dental X-rays are also taken in order to observe the health of the bone below the gum line.
WHO SHOULD SEE A PERIODONTIST?
Some patients’ periodontal needs can be managed by the general dentist. However, as more and more patients are exhibiting signs of periodontal disease, coupled with research that suggests a relationship between periodontal disease and other chronic diseases, periodontal treatment may necessitate a greater understanding and increased level of expertise by a trained specialist.
Patients who present with moderate or severe levels of periodontal disease, patients with more complex cases, or patients requiring dental implants will be best managed by a partnership between the dentist and periodontist. The goal is a more comprehensive or team-type of approach between patient, general dentist, and periodontist; that is truly how a patient receives the highest quality of care.
TYPES OF Periodontal (“GUM”) DISEASE
*Untreated periodontal disease can eventually lead to tooth loss and other health problems*
is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. It is reversible with professional treatment and good oral home care.
Factors that may contribute to gingivitis include diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medication use.
Untreated gingivitis can advance to periodontitis. Periodontal disease represents a bacterial infection of your gum tissue, the bone supporting your tooth, and the jaw bone itself, as well as an inflammatory/immune response to these bacteria.
With time, plaque bacterial infection can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed.
Gums separate from the teeth, and form pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.
There are many forms of periodontitis. The most common forms include the following:
- Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment, and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults greater than the age of 35 years, but can occur at any age. Progression of attachment loss usually occurs more slowly over time, but periods of rapid progression can occur.
- Aggressive periodontitis occurs in patients who are otherwise clinically healthy, and typically occurs in patients less than the age of 35 years. Common features include rapid attachment loss, rapid bone destruction, and familial/genetic aggregation.
- Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
- Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.
GUM DISEASE RISK FACTORS
*The main cause of periodontal (“gum”) disease is infection by plaque bacteria, but other factors affect the health of your gums*
Studies indicate that older people may have the highest rates of periodontal disease. The most recent information from the Centers for Disease Control (CDC) indicates that more than 70% of Americans 65 and older have periodontitis. Although periodontal disease is common among older patients, it is not exclusively a disease of the elderly, and occurs frequently in a large portion of America’s population.
Additional information from the CDC notes that almost half of all Americans (47.2%) have periodontal disease. That means that one of every two American adults over the age of 30 has periodontal disease, with approximately 8.7% having a mild form, 30% a moderate form, and 8.5% facing severe periodontitis.
Tobacco use is linked with many serious illnesses such as cancer, lung disease, and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for 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.
Research has indicated that some people may be genetically susceptible to gum disease. Despite diligent and aggressive oral care habits, these people may be more likely to develop periodontal disease.
Do you have a family history of periodontal disease, a father or mother, or a sister or brother with previous periodontal issues? Persons with a family member with periodontal (“gum”) disease and early tooth loss may be at an increased chance of having their own periodontal concerns.
Stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. Stress also is a risk factor for periodontal disease. Research demonstrates that stress and “high oxidative stress” can make it more difficult for the body to fight off infection, including periodontal diseases.
Some drugs, such as oral contraceptives, anti-depressants, and certain heart and blood pressure 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
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. Often times a night-guard or bite-guard may be helpful in conjunction with periodontal treatments to lessen excessive forces on your teeth and supporting structures.
OTHER SYSTEMIC DISEASES
Other systemic diseases that interfere with the body's inflammatory system may worsen the condition of the periodontal tissues (gum and bone). These include cardiovascular disease, diabetes, and rheumatoid arthritis.
POOR NUTRITION AND OBESITY
A diet low in essential nutrients can compromise the body’s immune system and make it harder for the body to fight off infection. Because periodontal disease begins as an infection, poor nutrition can worsen the condition of your gums. In addition, research has shown that obesity may increase the risk of periodontal disease.
GUM DISEASE SYMPTOMS
Periodontal (“gum”) disease is often silent, which means symptoms may not appear until an advanced stage of the disease. However, warning signs of gum disease include the following:
Red, swollen, or tender gums or other pain in your mouth
Bleeding while brushing, flossing, or eating hard food
Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before, and exposing the underlying root surface.
Loose or separating teeth
Pus between your gums and teeth
Sores in your mouth
Persistent bad breath
A change in the way your teeth fit together when you bite
A change in the fit of partial dentures
*Millions of people don’t know they have this serious infection that can lead to tooth loss if not treated*
PERIODONTAL DISEASE AND SYSTEMIC HEALTH
DIABETES AND PERIODONTAL DISEASE
*Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications*
People with diabetes are more likely to have periodontal disease than people without diabetes. In fact, periodontal disease is often considered a complication of diabetes. Persons with poor diabetic control are especially at risk. Your periodontist may ask you about your diabetic control, your blood sugar levels, and specific diabetic tests (“HbA1c”) performed with your medical doctor that help to understand your diabetic control.
Research has suggested that the relationship between diabetes and periodontal disease goes both ways: periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.
Severe periodontal disease can increase blood sugar, and contribute to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications.
GUM DISEASE AND HEART DISEASE
Gum disease and cardiovascular disease are both major public health issues that impact a large number of Americans every day. While these two diseases impact separate areas of the body, research indicates that periodontal disease and cardiovascular disease are connected; having one disease may actually increase your risk of developing the other.
While a cause-and-effect relationship has not yet been sustained, research has indicated that periodontal disease increases the risk of heart disease. Scientists believe that inflammation caused by periodontal disease may be responsible for the association. Periodontal disease and cardiovascular disease are both considered chronic inflammatory conditions. Inflammation is the body’s instinctive reaction to fight off infection. Inflammation is initially good for your body because it helps in the healing process.
However, chronic and prolonged inflammation can lead to severe health complications. Researchers believe that inflammation provides the basis for the connection between gum disease and heart disease. And now, periodontists and those who treat cardiovascular disease are working together to provide the best care to patients.
Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Dr. Tom or Dr. Fred and your cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.
Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.
GUM DISEASE AND OTHER SYSTEMIC DISEASES
Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease.
Researchers found that men with gum disease were 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers.
Men with periodontal disease, especially those younger than 30 or older than 70, are at increased risk of developing impotence, according to research. Researchers believe that inflammation may be the link between the two conditions; prolonged chronic inflammation (the same type of inflammation that is associated with periodontal disease) can damage blood vessels leading to impotence.
Researchers have suggested that a potential link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation.