Peridontal disease (patient information)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost. Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.

Causes

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.

What is Gingivitis?

The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.

Periodontitis

When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.

Risk Factors

   Smoking.  Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.
   Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.
   Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.
   Other illnesses and their treatments. Diseases such as AIDS and its treatments can also negatively affect the health of gums, as can treatments for cancer.
   Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.
   Genetic susceptibility. Some people are more prone to severe gum disease than others.

Epidemiology and Demographics

People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.

Symptoms

   Bad breath that won’t go away
   Red or swollen gums
   Tender or bleeding gums
   Painful chewing
   Loose teeth
   Sensitive teeth
   Receding gums or longer appearing teeth

Physical Examination

   Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.
   Examine your gums and note any signs of inflammation.
   Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.

Diagnostic Studies

The dentist or hygienist may take an x-ray to see whether there is any bone loss.

Treatment

Refer you to a periodontist. Periodontists are experts in the diagnosis and treatment of gum disease and may provide you with treatment options that are not offered by your dentist.

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome. Deep Cleaning (Scaling and Root Planing)

The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. In some cases a laser may be used to remove plaque and tartar. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods. Medications

Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used. Medications Medications What is it? Why is it used? How is it used? Prescription antimicrobial mouthrinse A prescription mouthrinse containing an antimicrobial called chlorhexidine To control bacteria when treating gingivitis and after gum surgery It's used like a regular mouthwash. Antiseptic chip A tiny piece of gelatin filled with the medicine chlorhexidine To control bacteria and reduce the size of periodontal pockets After root planing, it's placed in the pockets where the medicine is slowly released over time. Antibiotic gel A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days. Antibiotic microspheres Tiny, round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline slowly over time. Enzyme suppressant A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body's enzyme response -- If not controlled, certain enzymes can break down gum tissue This medication is in tablet form. It is used in combination with scaling and root planing. Oral antibiotics Antibiotic tablets or capsules For short term treatment of an acute or locally persistent periodontal infection These come as tablets or capsules and are taken by mouth. Surgical Treatments

Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.

Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.

Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your periodontist what the level of success might be in your particular case. Second Opinion

When considering any extensive dental or medical treatment options, you should think about getting a second opinion. To find a dentist or periodontist for a second opinion, call your local dental society. They can provide you with names of practitioners in your area. Additionally, dental schools may sometimes be able to offer a second opinion. Call the dental school in your area to find out whether it offers this service.

Prevention

   Brush your teeth twice a day (with a fluoride toothpaste).
   Floss regularly to remove plaque from between teeth. Or use a device such as a special brush or wooden or plastic pick recommended by a dental professional.
   Visit the dentist routinely for a check-up and professional cleaning.
   Don’t smoke

Complications

In some studies, researchers have observed that people with gum disease (when compared to people without gum disease) were more likely to develop heart disease or have difficulty controlling blood sugar. Other studies showed that women with gum disease were more likely than those with healthy gums to deliver preterm, low birth weight babies. But so far, it has not been determined whether gum disease is the cause of these conditions.

There may be other reasons people with gum disease sometimes develop additional health problems.

For example, something else may be causing both the gum disease and the other condition, or it could be a coincidence that gum disease and other health problems are present together.

More research is needed to clarify whether gum disease actually causes health problems beyond the mouth, and whether treating gum disease can keep other health conditions from developing.

In the meantime, it’s a fact that controlling gum disease can save your teeth – a very good reason to take care of your teeth and gums.