What is Gingivitis?
Gingivitis simply means inflammation of the gums (gingiva), caused
by plaque (food and bacteria) and tartar (calcified plaque) adhering
to the teeth. This inflammation results in swelling, redness
(erythema), and bleeding on probing of the gum tissue surrounding
the teeth. The key point in its definition is that this inflammation
has not led to the destruction of the cellular attachment of
the gum tissue to the tooth.
What is periodontal disease?
Periodontal disease, gum disease, periodontitis is a severe inflammatory
reaction of the gum tissue resulting in cellular attachment loss
of the gum tissue to the tooth. It usually develops from a preexisting
gingivitis condition, however not every case of gingivitis develops
into periodontitis. The attachment region compromised is known
as the junctional epithelium. When this attachment is lost, plaque
(food and bacteria) and tartar (calcified plaque) can adhere
to the tooth and root structure below the gums. This foreign
matter results in an inflammatory response by the body in an
attempt to kill the bacteria. It is this immune response that
leads to bone loss of the supporting bone surrounding the tooth (alveolar
bone). This bone loss can be so severe that the teeth themselves
can become loose (mobile), and may eventually be lost.
Signs and Symptoms of Periodontal disease:
-Bleeding gums while brushing or flossing.
-Puffy, red gums, that may be tender or painful.
-Teeth that appear longer because the gums have moved down the
tooth (recession).
-Bad breath or bad taste in your mouth.
-Pus coming from around your teeth
-Teeth that have become loose or shifted.
How is periodontal disease evaluated?
Probing:
The dentist or dental hygienist measures the gum tissue around
the tooth. A dental instrument called a periodontal probe is
used. The region known as the sulcus is a space much like a
trench all the way around the tooth. The periodontal probe
measures the depth of this space between your tooth and gum.
In health this space measures around 1 to 2 mm. When gum disease
is present the measurement increases getting deeper and deeper
forming "pockets" where
food and bacteria can collect. In severe cases pocket depths
of up to 8mm or greater are possible.
X-rays:
X- rays are a valuable tool to study the supporting bone of the
teeth. X-rays show the level of bone height relative to the tooth
structure. X-rays are an excellent way of documenting bone levels
over time. By comparing current films with films of the previous
year etc., one can see if changes in the bone level have occurred.
For this reason I strongly recommend the use dental x-rays when
periodontal disease is suspected.
How common is Periodontal Disease?
There are several forms of periodontal disease. The most common
form is Adult onset (AP). Periodontal disease can occur in the
first two decades of life, but generally by the third and four
decade prevalence increases dramatically. In a recent U.S. study
it was found that over 75% of the adult population had a periodontal
pocket of 4mm or greater. Of this population, 8% had severe periodontal
disease defined as one or more pockets of 7mm or greater.
What can I do to prevent Periodontal Disease?
The best way to prevent gum disease is through good oral hygiene.
(1) Brush your teeth twice a day, morning and night,
with a soft bristle brush and ADA approved toothpaste.
(2) Flossing and using interdental cleaners such as proxy brushes
for large gaps daily will help reduce plaque build up between
and below the gum line.
(3) Bridges must be flossed underneath to prevent gum disease
around the supporting teeth.
(4) Dental checkup and cleanings on a 6 month bases so that dentist
and hygienist can detect early signs of gum disease and remove
any plaque and or tartar on the teeth.
(5) Do not smoke or use any form of tobacco products. These are
not only known to cause oral cancer, but irritate the gum tissue.
(6) Eat a well balanced diet
(7) Take nutritional supplements, such as, CoQ-10 (Click
here to find out more about nutritional supplements)
(8) Avoid sugary foods that will lead to increased plaque formation.
How is Periodontal Disease treated?
Scaling:
Scaling is the process of removing calculus and other debris
above the gum level. This is generally what is done during
routine cleanings with your dentist or hygienist.
Root Planing:
Root planing is the removal of calculus and other debris below
the gum level on the root structure itself, resulting in a smooth,
hard, clean root surface. The gum tissue is then allowed to heal.
The goal of root planing is to gain reattachment of the gum tissue
to the tooth/root surface, resulting in decreased pocket depth
and possible pocket elimination. This procedure may take several
appointments and can require the use of dental anesthesia (numbing).
Surgery:
Periodontal surgery is used for difficult or extreme cases of
periodontal disease. This is a procedure generally performed
by a gum specialist known as a periodontist. There are several
types of surgery options depending on the type of periodontal
defect at hand. The general idea involves the following. The
patient is given anesthesia; the gum tissue is surgically lifted
from the tooth and bone so the region can be effectively debrided
(cleaned). At this time the bone surrounding the teeth involved
may be recontoured for a more favorable shape. The gum tissue
is then repositioned around the teeth as desired, sutured and
allowed to heal. This is the most effective way of treating periodontal
disease, especially severe cases, which will not respond to root
planing alone.
Regeneration:
With today's technology it is possible to graft bone between
and around teeth. This process works only for specific types
of bony defects, and is difficult and very technique sensitive.
Again a periodontist generally performs this procedure. In cases
where bone is lost between teeth or roots of molars (furcations)
bone can be partially regenerated. Generally once the damaged
area is surgically prepared bone is grafted, a special membrane
is placed over the grafted bone, and the gum is sutured in place
and allowed to heal.
