Periodontal Care (Around the Tooth)
A. What is gum disease?
D. Causes of Gum Disease
E. Periodontal Treatment
For people in their thirties and beyond, the threat of gum disease is a very serious and potentially dangerous condition. Gum disease is particularly dangerous because the progression of the disease is often painless, going undetected until it creates serious problems. Although, genetics may play a small role in its development, doctors agree that gum disease is most often related to how well people care for their teeth and gums.
A. Periodontal (gum) disease, including gingivitis and periodontitis, is a combination of 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. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.
B. Gingivitis is the early stage of gum disease, which can be treated and reversed if diagnosed early. The signs and symptoms are red, swollen and puffy gums that bleed easily. There is usually little or no discomfort at this stage. If treatment is not received, gingivitis could progress into periodontitis, an advanced and more serious stage of gum disease which includes bone loss and is not reversible. Gum disease is one of the main causes of tooth loss in adults and has also been linked to heart attacks and strokes. Gingivitis is often caused by insufficient oral hygiene. Gingivitis is reversible with professional treatment and good oral home care. Brushing twice a day, flossing daily, regular dental exams and cleanings are the best preventions against gum disease.
C. Periodontitis is advanced gum disease or inflammation of gum tissue which causes bone loss resulting in tooth loss if untreated. With time, plaque 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, forming pockets (spaces between the teeth and gums). As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. As time progresses, the bacterial plaque will calcify into calculus (tartar) which can cause the pockets to become deeper as plaque will accumulate on the calculus deposits and harbor bacteria that causes the tissues to become inflamed and detach from the tooth. As the tissue continue to detach and the pockets get deeper, the bone will start to recede and the teeth will start to become mobile. Eventually, teeth can become loose and may have to be removed. The disease process can be rapid or slow, it is different from case to case. If addressed early, it can be maintained with a higher chance of keeping the teeth. There are many forms of periodontitis. The most common ones include the following :
•Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
•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, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
•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.
D. Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. Periodontal disease can affect one tooth or many teeth. 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.
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 inventive treatment may help them keep their teeth for a lifetime.
Puberty, Pregnancy and Menopause in Women
A woman's health needs are unique. Though brushing and flossing daily, a healthy diet, and regular exercise are important for oral health throughout life, there are certain times in a woman's life when extra care is needed—times when you mature and change such as puberty or menopause, and times when you have special health needs, such as menstruation or pregnancy. During these particular times, a woman's body experiences hormonal changes that can affect many of the tissues in your body, including the 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.
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.
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 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.
Other Systemic Diseases
Diseases that interfere with the body's immune system may worsen the condition of the gums.
Poor Nutrition and Obesity
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.
E. Periodontal Treatment - Non-Surgical Treatments:
AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment, including scaling and root planing (a careful cleaning of the root surfaces to remove plaque and calculus [tartar] from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins), followed by adjunctive therapy such as local delivery antibiotics, as needed on a case by case basis.
Most periodontists would agree that after scaling and root planing, many patients do not require any further active treatment, including surgical therapy. However, the majority of patients will require ongoing maintenance therapy to sustain health.
Non-surgical therapy does have its limitations. When it does not achieve improved periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices. If a patient needs scaling and root planning, this procedure is normally done in two visits (one side at a time). If , after your comprehensive examination including radiographs, the doctor feels that your condition is too advanced, we will refer you to a periodontist (gum specialist) because you may need gum surgery.
If you're diagnosed with periodontal disease, your dentist may recommend periodontal surgery. Periodontal surgery is necessary when your dentist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment.
After completing the scaling and root planning, patients will need to come in for periodontal maintenance appointments. These maintenance cleanings should be every 3-4 months depending on your condition. Periodontal maintenance in conjunction with good oral homecare is essential for maintaining good oral health and preventing the disease from progressing and/or becoming worse.
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