What is Periodontal Disease?

Periodontal disease (or commonly known as gum disease) is an inflammatory disease of the support structures of teeth. These structures include gingiva (gum), periodontal ligament, and alveolar bone (part of the jaw bone). The gingiva, being the most superficial tissue, provides most of the signs and symptoms of periodontal diseases, such as swelling, redness, bleeding, recession, etc. When inflammation is confined ONLY to the superficial layer (the gingiva), the condition is known as Gingivitis. This is a very common condition affecting adults and children alike. When inflammation is spread to and involves deeper structures (such as bone) the condition is known as Periodontitis (or Periodontal Disease). It is usually characterized by the irreversible loss of jawbone. This bone loss feature can be seen on radiographs (x-rays). About 30% of the adult population can have limited Periodontitis during their lifetime. Generalized and severe Periodontitis only affects 10-15% of the adult population.

What Causes Periodontal Disease?

Bacteria in the mouth are usually responsible for causing Gingivitis and Periodontitis. Inadequate personal oral hygiene (tooth cleaning) allows bacteria to accumulate around the neck of teeth and gum margins. This build-up of bacterial moss is known as dental plaque. The prolonged retention of plaque at these locations will cause gum inflammation (gingivitis). If gingivitis is allowed to go on for a long time, some gingivitis progress to the next stage of disease – Periodontitis, where there is a progressive loss of bone and tooth attachment to bone. The reason (and mechanism) for the transformation from gingivitis to Periodontitis is not clearly understood at present.

In advanced cases, the excessive loss of tooth support structure can result in the loss of this tooth. Therefore, segmental and progressive tooth loss is a common feature of advanced periodontal disease.

Can Periodontal Disease Be Cured?

Gingivitis, being a reversible condition, will restore quickly once the dental plaque is removed and prevented from returning (by regular tooth brushing and flossing). Periodontitis, unfortunately, is NOT reversible. The loss of support structures (including bone) around teeth is usually a permanent feature. At best it can only be halted by appropriate treatment and satisfactory personal oral hygiene. In severe cases, a permanent disfigurement (such as gum recession and elongation of teeth) remains and the patient has to accept these limitations. Plastic and reconstructive surgery can correct some of these disfigurements, but not in all cases.

What is a Periodontist?

A Periodontist is a specialist dentist, who completed a 2-3 year residency after dental school, specializes in and limits practice to the management of periodontal disease. These days, Periodontists also involve themselves in the correction and rebuilding of dentition after the destructive effects of periodontal disease. They provide services in plastic and reconstructive periodontal surgery and implant surgery. This provides the foundation for restorative dentists to replace missing teeth or restore broken down teeth.

How Does a Periodontist Treat Periodontal Disease?

The first step is to eliminate gum inflammation through a series of debridement procedures as well as enlisting the patient’s cooperation in self-care (daily oral hygiene) to ensure a satisfactory healing outcome.

The second step is to make changes around and between teeth to allow access for oral hygiene. This may involve surgery to the gum and bone structure, and replacing or modifying restorations on teeth.

Finally, if the patient can achieve a stable condition he/she will be placed on a maintenance routine where professional checks and treatment are given at regular intervals.

Are Lasers Useful in the Treatment of Periodontal Disease?

Unfortunately at this time, despite Laser Manufacturer’s claims, there is just no evidence AT THIS TIME to support the use of Lasers in treating PD. Lasers ARE used in minor surgical procedures; this results in less bleeding, but with a slight increase in healing time. Once Lasers are shown to really do what they claim, you can bet that every Periodontist will have one!

Do I Need a Referral to Get a Periodontal Exam?

In most cases, no. The only exception is if you have an HMO or PPO that requires a referral from your dentist to have insurance coverage. If you do not have a dentist, you most likely have not had regular cleanings, and are thus at increased risk for periodontal disease. Many patients self refer to a means of getting another opinion for the proposed treatment. We encourage our patients to get a second opinion, as this gives patients confidence in their treatment choices.

Why Did My Cardiologist Refer Me to a Periodontist?

Your Cardiologist is aware of the growing evidence that Periodontal Disease can increase your risk of heart disease and can cause inflammation on the lining of your blood vessels. Periodontal bacteria and their inflammatory products travel from the mouth via the bloodstream and cause damage to the heart and coronary arteries. If gum inflammation is elevated, the risk of a cardiac event is also elevated.

Why Did My OB/GYN Insist I See a Periodontist?

Having Periodontal Disease (PD) can have several adverse effects on your pregnancy. These include being at seven times greater risk of having a low birth weight or a pre-term delivery. Also, there is an increased risk of preeclampsia (Toxemia). In addition, increased hormone levels during pregnancy can make existing PD worsen dramatically. Conservative PD treatment in the second and third trimester can greatly reduce these risks to both you and your unborn child.

What is the Connection Between Diabetes and Periodontal Disease (PD)?

Each disease makes the other disease worse. Diabetes is always harder to control when the body has an infection. PD is a somewhat contagious infection in the gum and bone surrounding the teeth, and there is no question that poorly controlled diabetes greatly accelerates the destruction of the jawbone that holds the teeth in the mouth. PD can be easily treated to help control diabetes, and after treatment, frequent periodontal cleanings will go a long way to keep diabetes in check!

My Dentist/Hygienist Has Told Me That I Have Deep Pockets. What Does This Mean?

First, let me say that every tooth has a pocket. A normal, healthy pocket measures 2-3mm without bleeding or inflammation. Hardened, calcified bacteria on roots of the teeth called “calculus” cause deep pockets. The bacteria cause the loss of bone surrounding the teeth and other major health problems. The goal of the periodontist is to free you from the disease so you can return to your general dentist for regular 3-4 month cleanings. This is done with various procedures to reduce the pockets, creating a cleanable, disease-free mouth.

I Have Had a Deep Cleaning; Do I Need Additional Treatment to Control My Periodontal Disease (PD)?

Cleaning the roots of the teeth to remove all bacterial products (tartar or calculus) is the cornerstone of treating PD. After a deep cleaning, the inflammation that was present will subside. If the “pockets” shrink down to 2-4 mm, then there is no need for additional active PD treatment; only routine periodontal cleanings, usually every 3-4 months will maintain your mouth in a healthy state. If after a deep cleaning there are some pockets left that measure more than 4 mm, then additional treatment will be required (on these sites only) to further reduce these pockets to a healthy, maintainable depth.

I Have Had Localized Antibiotics Placed in My Deep Pockets; Do I Need to Have This Repeated?

Localized antibiotics (Arrestin ™, among others) are injected into the space between the teeth and gums after a thorough deep cleaning to release a high concentration of antibiotics right where needed most for up to 10 days. This greatly decreases the number of harmful bacteria present for some time. Usually, after 3-6 months harmful bacteria start to increase to the same levels as before, requiring re-treatment with more localized antibiotics, or a more lasting treatment may be used to control the disease.

My Gums Got Worse Since I Started Taking a Heart Medication. What’s This About?

Calcium channel blockers (used to treat high blood pressure) can cause dry mouth and gum overgrowth. Meticulous oral hygiene usually will stop the enlargement, but the lessened salivary flow can predispose you to tooth decay. Once oral hygiene is has improved, any remaining gum overgrowth is usually permanent; if this is impairing your hygiene, a simple, quick reshaping of your gums should be done. Other drugs that can cause dry mouth/gum enlargement include those used to treat seizures, tissue rejection, allergies, chronic pain, spastic bladder, and anxiety. Make sure to avoid sugars as much as possible and get frequent dental cleanings.

What are the Warning Signs of Periodontal Disease?

The warning signs of Periodontal Disease (PD) may include bad breath; bleeding of the gums when brushing, flossing or tooth picking; gums that are slightly red and appear swollen and/or tender; receding gums; teeth that are shifting and/or appearing longer; spaces developing between your teeth; pus appearing at the interface between the tooth and gum when pressing on the gums; and sores in the mouth. It is interesting to note that not all people with PD will have all of these signs and that in particular, bleeding gums may only be present in the early stages of PD progression.

What Can I Do at Home to Prevent Periodontal Disease?

Keeping your teeth clean above and most importantly, below your gum line is the key to keeping Periodontal Disease (PD) from stealing your teeth! After brushing your teeth, remove the bacterial plaque from between your teeth and as far below your gum line as possible. A good way to get beneath the gums is by placing a rubber tip in the space between the gum and teeth and dragging it back and forth. As a rule, mouth rinses don’t help with PD, and ones with alcohol may make matters worse by decreasing salivary flow! Be sure to see your dentist for cleanings at least twice a year!

Is Periodontal Disease Linked to Other Disease?

There is a large and constantly growing body of research that links Periodontal Disease (PD) with a number of other diseases. These include suspected causal relationships to Cardiovascular Disease, which can lead to heart attacks and strokes; Poorly controlled Diabetes; Chronic Obstructive Pulmonary Disease; Osteoporosis; and in women, Low birth weight and/or Pre-Term Babies. If you suffer from or have any of these conditions, it would be wise to have an exam by your Dentist or Periodontist. Like high blood pressure, PD may be present without your knowledge.

Can My Gummy Smile Be Fixed?

A “Gummy Smile” can be caused by excess gum tissue, known as gingival overgrowth, or you may just have a really big smile coupled with a high lip line. If your gummy smile is the result of gingival tissue overgrowth, correction can be as simple as reshaping the gums to their most natural and pleasing contour using either a laser or an electronic scalpel. Both methods are quick, painless, and have minimal if any post-op bleeding or pain. If your gummy smile is the result of a high lip line, major improvements are still possible but may require that some bone in addition to gum be recontoured.

What is Periodontal Microsurgery?

Periodontal Microsurgery is any periodontal surgical procedure that is done in such a way as to minimize tissue disruption and achieve the finest result possible; this is accomplished by using eye magnification, ultra-small incisions using tiny blades, and by utilizing ultra-fine sutures that in many cases are hard to see with the naked eye. By keeping the surgical site tiny, it is possible to repair both bone and gum defects. This drastically reduces any post-op discomfort and can make the gun repair virtually invisible. Periodontists are specially trained to provide this treatment and use it wherever possible.

What Causes Gum Recession and How is It Treated?

Periodontal disease, crooked teeth, or aggressive tooth brushing can cause gum recession. Recession is treated by replacing the lost gingival tissue. This procedure is called a “soft tissue graft”. Microsurgery makes grafting much less traumatic and often undetectable. No more “patch on an inner tube” look. There are two main ways to replace gingival tissue. Patients decide whether tissue is taken from the roof of your mouth through a tiny incision or, preferably, your periodontist can use an allograft from a tissue bank. In addition to avoiding a second surgical site, an allograft enables long/multiple grafts to be placed in one visit with very little discomfort!

Does It Cost More to Have a Periodontist Treat My Periodontal Disease?

In most cases no. While most general dentists provide basic periodontal treatment, few cover the whole spectrum of available treatment choices. When treatment options overlap, you may be surprised that Periodontists may actually charge the same or less for the exact same procedure. This is due in large part to the reduced time required by a specialist, who does the same procedures every day. Advanced procedures like gum grafts, bone grafts, and implants are likewise more cost-effectively treated, especially when the alternative is an extracted tooth; replacements are almost always more expensive! As with any service, getting more than one estimate is always a wise decision.

What is Halitosis?

Halitosis is a clinical term used to describe oral malodor or bad breath, as it is commonly known.

What are the Causes of Halitosis?

There are many causes of halitosis. However, over 80% of cases are caused by oral bacteria giving out sulfur-containing gases (volatile compounds). Typically these bacteria reside on the upper surface of the tongue and in periodontal pockets (the separation between gum and teeth).

The second most common source of bad breath comes from decaying food debris in the mouth and around teeth.

How is Halitosis Treated?

The Periodontist will take a detailed history and carry out a thorough examination and assessment. Depending on the findings of the examinations, appropriate treatment will be given. In most cases, oral malodor will not be detectable if the patient follows instructions closely and adhere to a strict regimen of oral hygiene.

What are Dental Implants?

Dental implants are made of Titanium metal of various sizes and shapes and are placed in the jawbone following tooth/teeth loss. After successful healing (osseointegration) dental restorations (crowns and/or bridges) are then placed on these implant supports.

How Successful are Dental Implants?

Provided thorough criteria of case selection and clinical protocols are adhered to, dental implants can have a success rate of 97% or more. In some cases, such as in the anterior mandible, the success rate is close to 99%. Your periodontist will assess you and advise you if you are a suitable candidate for dental implants. To improve implant success, a CT scan is made of your jaw, generating a data file. This data allows a 3-Dimensional view of your bone; it’s true height, width, and most importantly, your actual jaw bone density exactly where each implant will be placed. Using sophisticated 3-D implant planning software, we plan the exact location of the implants. This enables us to do “virtual surgery” on the computer, vastly simplifying treatment planning, and reduces surgical time and discomfort.

Are There Any Undesirable Side-Affects of Dental Implants?

Yes, complications for dental implants can occur. With proper CT Scan treatment planning, however, these are very, very rare.

I Have a very Loose Lower Denture. Is There a Way to Make It Tighter?

Yes! The insertion of 2 small implants can be placed in the lower jaw in most cases. The lower denture is then modified with retainers that snap onto these implants, effectively locking your denture in place. The denture can still be removed for cleaning. This is a great way to improve a tough situation, without the expense of 6-8 implants and a fixed bridge.

I Had a Tooth Extracted; Can I Get an Implant to Replace This Tooth?

Yes! However, a bone or gum graft may be required either first or during the implant placement. The only way to measure your bone density and the best way to measure bone width is by CT Scan. After your scan is processed, it is possible to view the final result, determine if a graft will be needed, and have a computer drill guide to place the implant very precisely. If you have the proper bone, it is possible to place the implant, but the crown tooth on it, and leave the office in less than an hour! The CT Scan/Planning software is truly a revolution in implant dentistry!

I Had a Tooth Extracted; Can I Get an Implant to Replace This Tooth?

Successful dental implants are based on the creation and maintenance of integration between the implant and the surrounding bone. This is called Osseointegration. Osseointegration is a dynamic state of the union between bone and titanium surface. As such, it relies on healthy bony metabolism throughout life. Within certain limits, osseointegration should last for the duration of the natural life span of the individual.

Risk factors known to destroy osseointegration are:

  • Infection (bacterial or deep gingival infection)
  • ‘Overloading’ (such as to-and-fro movements on implants generated by teeth clenching or grinding habits).

On the other hand, restorations (crowns and other connection components (screws) are subject to wear and tear processes in the mouth. They will also be subject to accidental breakage. Therefore, replacement or repair is expected infrequently.

How Natural Looking Will Implant Crowns Be?

They will depend on a large number of factors. The most important factors are the amount of tissue loss after extractions and the feasibility of replacing the lost tissue by plastic and reconstructive surgery. If the lost tissue can be successfully restored, then it is usually a simple matter of fabricating a crown with pleasing esthetics.

Is the Implant Procedure Painful?

Not at all. Local anesthetics are used in most cases. In complex and extensive cases, light sedation can be used. The amount of post-operative discomfort varies from case to case according to your situation. For simple cases such as a simple implant, the post-operative discomfort is usually minimal. Most patients can return to normal activity the following day.

Periodontal Disease

Tobacco

You are probably familiar with the links between tobacco use and lung disease, cancer, and heart disease.

Numerous studies have linked periodontal disease with tobacco usage. These cases are usually more severe than those of non-smokers. There is a greater incidence of calculus formation on teeth, deeper pockets between gums and teeth as well as a greater and faster loss of the bone and fibers that hold teeth in your mouth. In addition, your chance of developing oral cancer increases with the use of smokeless tobacco.

Chemicals in tobacco such as nicotine and tar slow down healing and the predictability of success following periodontal treatment.

Problems caused by tobacco include Lung disease, heart disease, cancer, mouth sores, gum recession, loss of bone and teeth, bad breath, tooth staining, and less success with periodontal treatment and with dental implants.

Quitting tobacco will reduce the chance of developing the above problems.

Diabetes and Oral Health

Individuals suffering from diabetes, especially uncontrolled diabetics, have a higher risk of developing bacterial infections of the mouth. These infections may impair your ability to process insulin, resulting in greater difficulty with controlling your diabetes. Periodontal diseases will be more severe than those of a non-diabetic and treatment somewhat more difficult.

Steps to prevent periodontal disease include daily brushing and flossing to remove plaque from your teeth and gums; regular dental visits for professional cleaning and regular periodontal evaluation. Your health professional must also be told of your history and the current status of your diabetes. And finally, you can help resist periodontal infection by maintaining good control of your blood sugar levels.

Women and Periodontal Health

Throughout a woman’s life, hormonal changes affect tissue throughout the body. Fluctuations in levels occur during puberty, pregnancy, and menopause. At these times, the chance of periodontal disease may increase, requiring special care of your oral health.

Puberty

During puberty, there is increased production of sex hormones. These higher levels increase gum sensitivity and lead to greater irritations from plaque and food particles. The gums can become swollen, turn red, and feel tender.

Menstruation

Similar symptoms occasionally appear several days before menstruation. There can be bleeding of the gums, bright red swelling between the teeth and gum, or sores on the inside of the cheek. The symptoms clear up once the period has started. As the number of sex hormones decreases, so do these symptoms.

Pregnancy

Your gums and teeth are also affected during pregnancy. Between the second and eighth months, your gums may also swell, bleed, and become red or tender. Large red to purple lumps may appear as a reaction to local irritants. However, these growths are generally painless and not cancerous. They may require professional removal but usually disappear after pregnancy.

Periodontal health should be part of your prenatal care. Any infections during pregnancy, including periodontal infections, can place a baby’s health at risk.

The best way to prevent periodontal infections is, to begin with, healthy gums and continue to maintain your oral health with proper home care and careful periodontal monitoring.

Oral contraceptives

Swelling, bleeding, and tenderness of the gums may also occur when you are taking oral contraceptives, which are synthetic hormones.

You must mention any prescriptions you are taking, including oral contraceptives, prior to medical or dental treatment. This will help eliminate the risk of drug interactions, such as antibiotics with oral contraceptives – where the effectiveness of the contraceptive can be lessened.

Menopause

Changes in the look and feel of your mouth may occur if you are menopausal or post-menopausal. They include feeling pain and burning in your gum tissue and salty, peppery or sour tastes.

Careful oral hygiene at home and professional cleaning may relieve these symptoms. There are also saliva substitutes to treat the effects of “dry mouth.”