Q: How common is periodontal disease?
A: Periodontal disease affects three out of four adults at some time in their lives.

Q: Is tooth loss a natural part of aging?
A: With good oral hygiene and regular professional care, your teeth are meant to last a lifetime. However, if left untreated, periodontal disease can lead to tooth loss.

Q: What are some of the signs of periodontal disease?
A: Bleeding gums are one of the signs of gum disease. Other signs include: red, swollen or tender gums; gums that have pulled away from the teeth; persistent bad breath; pus between the teeth and gums; loose or separating teeth; a change in the way the teeth fit together; and a change in the fit of partial dentures.

Q: Does oral health affect overall health?
A: Recent research links periodontal disease to cardiovascular disease; preterm, low birth weight babies; osteoporosis, and diabetes.

Q: Does overall health affect oral health?
A: Yes. Diet, stress level, and general resistance level will manifest in the oral tissues.

Q: Are some people more susceptible to periodontal disease than others?
A: Research proves that up to 30% of the population may be genetically susceptible to gum disease. Despite aggressive oral care, these people may be six times more likely to develop periodontal disease. People who smoke and people with diabetes are also more susceptible to periodontal disease.

Q: What are some of the ways to treat gum disease?
A: The first step is to remove plaque and tartar deposits beneath the gumline. The tooth roots may also be smoothed. Antibiotics or irrigation with antimicrobial (chemical) agents may be recommended. Surgery may be needed to reduce the depth of deeper pockets and rebuild or reshape bone that has been destroyed.

What is Periodontal Disease?
A: Generally, periodontal disease involves the inflammation and destruction of tissues that surround and support the teeth, including the gums (gingiva) and supporting bone and fibers. It is a major cause of tooth loss in adults. In fact, after age 35, about three out of four adults are affected by some form of periodontal disease. Oral health professionals make an important distinction between the two most common forms of periodontal disease: gingivitis and periodontitis. Gingivitis is an inflammation of the gums. It is the mildest form of periodontal disease and does not cause destruction of the tissues that support the teeth. However, if gingivitis is left untreated, it can advance to periodontitis. Periodontitis involves inflammation of the gums and destruction of connective tissue and bone that is largely irreversible. In the mild stage, periodontitis begins to destroy the bone and tissue that support the teeth. Moderate to advanced periodontitis results in extensive bone and tissue loss.

Causes of Periodontal Disease
Periodontal disease is triggered by bacterial plaque - a sticky film of bacteria - that builds up on the teeth. Ironically, your immune systems response to the bacteria plays the primary role in destructive periodontal disease. The presence of bacterial plaque around the teeth cause your body to try to eliminate these "invaders" from the gum tissues. This reaction to the bacteria is known as the host immune response. The host immune response is an amazing and complicated cascade of actions and reactions involving many different biochemicals and the cells that produce them. In periodontal disease, one of the end results of the immune response is the production of enzymes called matrix metalloproteinases, or MMPs. These MMPs are produced by the body's own cells with the intention to help rid it of the bacteria. In doing so, these MMPs also happen to destroy collagen and other connective tissue fibers around the infected area. Without collagen, the gum tissues and bone supporting the teeth quietly dissolve away, causing the tell-tale signs of periodontal disease-bleeding gums, pocketing and recession of the gums, and loosening of the teeth. So it is the MMP enzymes, produced by the body in response to the presence of bacteria, that are responsible for the actual breakdown of the gums and bone supporting the teeth.

Symptoms of Periodontal Disease
Because periodontal disease is usually painless, you may not know you have it. The symptoms range from those that are nearly undetectable to the patient, to mildly bleeding gums, to chronically red, swollen and abscessing gums and loose or shifting teeth. In the early stage of periodontal disease (gingivitis) the gums can become red, swollen and bleed easily. In the more advanced stages of periodontal disease, the teeth can become loose, fall out or have to be removed by a dentist. If you notice any of the following signs of periodontal disease, see your dentist immediately:

• Gums that bleed when you brush your teeth
• Red, swollen or tender gums
• Gums that have pulled away from the teeth
• Bad breath that doesn't go away
• Pus between your teeth and gums
• Loose teeth 
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

Risk Factors for Periodontal Disease
Although the immune system's response to bacteria seems to play the primary role in destructive periodontal disease, other factors can also affect your periodontal health. For example, poor oral hygiene and diet are risk factors for periodontal disease. So is the use of tobacco. We know that smoking is linked to many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Smokers also are at increased risk for periodontal disease. In fact, recent studies have shown that smoking may be one of the most significant risk factors in the development and progression of periodontal disease, making smokers two- to seven-times more likely to develop the disease. If you smoke, you probably will develop periodontal disease, if you haven't already. If you are diabetic, you are also at higher risk for developing periodontal diseases, especially if your have poor control of your sugar levels. Patients with diabetes mellitus should also be aware that periodontal infections can impair their ability to process and/or utilize insulin, which may cause the diabetes to be even more difficult to control. While controlling these risk factors is important, a person's genetic make-up also appears to determine their likelihood of developing periodontal disease. Individuals with a specific gene make-up are more likely to progress rapidly towards a severe form of periodontal disease. Up to 30% of the population may be genetically susceptible to developing an aggressive form of periodontal disease, according to a recently published study.

Factors That Put You at Risk for Periodontitis 

• Smoking n Diabetes Mellitus (Type I and II)
• Genetic Markers (Family History)
• Poor Dental Hygiene
• Poor Diet
• Stress
• Existing Periodontitis
• Immune Compromise
• Crooked or Crowded Teeth

Consequences of Periodontal Disease
If not properly treated, periodontitis can lead to tooth loss and require expensive and involved restorative procedures. In addition, loose and missing teeth can place limitations on the ability to eat certain foods and, in some cases, even to speak properly. Tooth loss also creates aesthetic concerns - highly visible ones - in the minds of many people. In addition to tooth loss, uncontrolled periodontal disease may increase the risk of heart disease, diabetes and even low-birth-weight babies and premature births.

Preventing Periodontal Disease
Periodontal disease is a quietly progressive disease, usually doing a lot of its damage before it is diagnosed. Often, there is no pain and gums and bones may be silently and seriously damaged. Although patients with advanced periodontal disease can be effectively treated, it is certainly better to take early precautions, before the damage is done. The good news is that you can help prevent periodontal disease by taking good care of your teeth every day and having regular dental checkups. Here's how to keep your teeth and gums healthy:

Home Care Instruction - Daily Oral Care
Patients should keep their teeth clean by brushing and flossing carefully each day and by asking your dentist or periodontist about prevention.

• Brush your teeth well twice a day. Brushing removes the film of bacteria from the teeth. Be sure to use a soft-bristled toothbrush in good condition.
• Toothpastes and mouth rinses containing fluoride strengthen the teeth and help prevent decay.

Brushing Tips:

• Place your toothbrush at a 45-degree angle against the gums.
• Move the brush back and forth gently in short strokes.
• Brush all tooth surfaces the outer tooth surfaces, the inner tooth surfaces, and the chewing surfaces of the teeth.
• Use the "toe" of the brush to clean the inside surfaces of the front teeth, using a gentle up and down stroke.
• Brush your tongue to remove bacteria and freshen your breath.
• Clean between your teeth every day. Cleaning between your teeth with floss or interdental cleaners removes bacteria and food particles from between the teeth, where a toothbrush can't reach. Early gum disease can often be reversed by daily brushing and flossing.

Flossing Tips: 

• Break off about 18 inches of floss and wind most of it around one of your middle fingers.
  
• Wind the remaining floss around the same finger of the opposite hand.
  
• Hold the floss tightly between your thumbs and forefingers. Guide the floss between your teeth using a gentle rubbing motion. Never snap the floss into the gums.
  
• When the floss reaches the gumline, curve it into a "C" shape against one tooth. Gently slide it into the space between the gum and the tooth.
• Gently rub the side of the tooth, moving the floss away from the gum with up and down motions.
• Repeat this method on the rest of your teeth. Don't forget the back side of your last tooth.

Reducing Risk Factors
Some risk factors for periodontal disease can be controlled, such as giving up smoking and controlling diabetes mellitus. For those patients who suspect that periodontal disease runs in their family, a new test - called "PST" - is now available. The "PST" test is the first genetic susceptibility test for periodontal disease. It allows early identification for the tendency to develop a more aggressive form of the disease. This test is now available to the general dental market.

Eat a Balanced Diet
One way to prevent tooth decay and periodontal disease is by eating a balanced diet and limiting the number of between-meal snacks. Choose foods from the basic food groups, such as breads, cereals and other grain products; fruits; vegetables; meat, poultry and fish; and dairy products, such as milk, cheese and yogurt.
Visit Your Dentist Regularly
It is important to have regular dental checkups. Your dentist can diagnose periodontal disease and can provide a professional cleaning (prophylaxis) to help prevent it in the future. By taking care of your teeth, eating a balanced diet, controlling risk factors for periodontal disease, and visiting your dentist regularly, you can have healthy teeth and an attractive smile your entire life.

 Do You Think You May Have Periodontal Disease?
If you think you have periodontal disease, you should visit your dentist or periodontist for a thorough examination. As part of the examination your dentist will measure the pockets around every tooth, and check for bleeding and tooth mobility. Other tests such as Periocheck® may be performed as well. Once your periodontal health has been evaluated, your periodontist or dentist will work with you to determine the best course of action to take. Your treatment plan will be customized for you based on the type of disease you have, how far the condition has progressed, and a variety of other factors. The most important factor in the success of any periodontal therapy is the patient's desire and motivation to save their teeth, and to comply with home care instructions. You, the patient, must take responsibility for the success of your treatment by closely following the doctor's home care recommendations.

Treatments for Periodontal Disease
There are many different types of treatment used to combat periodontal disease and help return you to good oral health. These treatments can range from simple cleanings to involved surgical procedures, and are primarily focused on reducing the amount of bacteria in the mouth that are responsible for starting the disease process. In this section we'll mention but a few of the many treatment options your dentist or periodontist may determine appropriate for you. The first step is often to remove plaque and tartar deposits beneath the gumline. The tooth roots may also be planed to smooth the root surface, allowing the gum tissue to heal and reattach to the tooth. Antibiotics or irrigation with antimicrobial (chemical) agents may be recommended to help control the growth of bacteria. In some cases, your dentist may place antibiotic fibers in the periodontal pockets after scaling and planing. When deep pockets between teeth and gums (4 to 6 mm or greater) are present, surgery may be needed to reduce the depth of the pockets. If your teeth's bony support is damaged, bone surgery may be used to rebuild or reshape the bone. Grafts of the patient's bone or artificial bone may be used. The dentist may use splints or other appliances to stabilize loose teeth and to guide the regeneration of tissue during healing. This has been a small sample of the many treatment options available today. Your dentist or periodontist will determine the most appropriate treatments for you.

New Treatment Approaches
Recently, researchers have begun investigating treatments that address the direct cause of tissue breakdown - the host response and the tissue-destroying enzymes that are produced. This new approach attempts to reduce the amount of tissue breakdown by modulating the host response; that is, by acting on the destructive cascade of events that occur in response to the presence of oral bacteria. Researchers hope that by adding host response modulation to the traditional anti-bacterial treatment strategy, oral health care professionals can provide a more effective dual approach to treating periodontal disease.

The information on this page has been provided by Collagenex, Inc and the American Dental Association. The information is intended for educational purposes only, and should not be used for self-diagnosis or as a substitute for a professional dental examination and consultation. Each case will vary and results may differ between patients depending on a number of different factors. We hope this information has answered any questions you might have had regarding periodontal problems and their treatment. 

To evaluate your periodontal condition, and to determine what your next
course of treatment should be, call or email our office today to schedule an
appointment for an evaluation and consultation.