TAKE A SELF EVALUATION QUIZ
You may not realize that persistent swollen, red or bleeding gums, tooth sensitivity, and bad breath are warning signs of periodontal (gum) disease - a serious infection that, left untreated, can lead to tooth loss.
Jot down your answers to the following questions to find out if you have the symptoms of periodontal disease.
- Do you ever have pain in your mouth?
- Do your gums ever bleed when you brush your teeth or when you eat hard food?
- Have you noticed any spaces developing between your teeth?
- Do your gums ever feel swollen or tender?
- Have you noticed that your gums are receding (pulling back from your teeth) or your teeth appear longer than before?
- Do you have persistent bad breath?
- Have you noticed pus between your teeth and gums?
- Have you noticed any change in the way your teeth fit together when you bite?
- Do you ever develop sores in your mouth?
Find Out More
If you have any of these symptoms of periodontal disease, take action to protect your gums and your health.
- Learn about the causes, types, and treatments of periodontal disease.
- Don't let periodontal disease take away your smile. If you answered yes to any of these questions, consult a periodontist right away - and help save your natural teeth!
- If you've already lost a tooth to periodontal disease, you may be interested in dental implants - the permanent tooth replacement option.
- View online samples of AAP brochures about periodontal disease and your oral health.
FACTS AND FALLACIES ABOUT PERIODONTAL DISEASE
FALLACY: Tooth loss is a natural part of aging.
FACT: 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. It is the primary cause of tooth loss in adults 35 and over.
FALLACY: People with periodontal disease are "dirty" - they don't brush their teeth.
FACT: 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 interventive treatment may help them keep their teeth for a lifetime.
FALLACY: Oral health doesn't affect overall health.
FACT: Emerging research links periodontal disease to other health problems including cardiovascular disease; preterm low, birth weight babies; stroke; and diabetes.
FALLACY: Gum disease is a small, minor infection
FACT: The mass of tissue in the oral cavity is equivalent to the skin on your arm that extends from the wrist to the elbow. If this area was red, swollen, and infected, you would visit the doctor. Gum disease is not a small infection. It's result, tooth loss, leads to a very different lifestyle - dentures. The changes in your appearance, breath, and ability to chew food are dramatic.
FALLACY: Bleeding gums are normal
FACT: Bleeding gums are one of eight signs of gum disease. Think of gum tissue as the skin on your hand. If your hands bled every time you washed them, you would know something is wrong. Other signs of gum disease include: red, swollen or tender gums; gums that have pulled away from the teeth; persistent bad breath; pus between the teeth and gums (leaving bad breath); loose or separating teeth; a change in the way the teeth fit together; and a change in the fit of partial dentures.
FALLACY: Treatment for gum disease is painful.
FACT: New periodontal procedures including local anesthesia and over-the-counter medications, have made patients' treatment experiences pleasant and comfortable. Many patients find they are back to normal routines on the same day or by the next day.
FALLACY: Gum disease is easy to identify, even in its early stages, so my dentist would tell me if I had it.
FACT: You should always get involved in your dental care, so that problems are detected in the early stages. You should inform your dentist if any signs of gum disease are present; or if any changes in your overall health or medications occurred in between visits. Most importantly, you should ask your dentist about your periodontal health and what method was used to evaluate its condition. This level of participation enables you to work in a team approach with your dentist to identify subtle changes that may occur in the oral cavity.
FALLACY: Once teeth are lost, the only treatment options are crowns, bridges or dentures.
FACT: Dental implants are a permanent tooth-replacement option for teeth lost to trauma, injury or periodontal disease. Dental implants are so natural-looking, and feeling that many patients forget they ever lost a tooth.
FALLACY: Cavities are the number one cause of tooth loss.
FACT: Periodontal disease is the number-one cause of tooth loss. According to the 1996 American Dental Association/Colgate survey, U.S. dentists say gum disease is a more pressing oral health concern than tooth decay by a 2-to-1 margin.
FALLACY: gum disease is a bacterial infection, antibiotics can be used to treat it.
FACT: Research demonstrates that antibiotics can be a helpful adjunct to treating periodontal disease. However, medical and dental communities are concerned about the overuse of these medications in treating infections because of the possibility of the development of antibiotic resistant strains of bacteria. This overuse would be detrimental to patients if they develop a life-threatening illness for which antibiotics would no longer be helpful.
FALLACY: Pregnant women should skip professional dental checkups.
FACT: Teeth and gums are affected during pregnancy just like other tissues in the body. In order to decrease the risk of damaging the gums and tissues surrounding the teeth, you should schedule an appointment for a periodontal evaluation.
PERIODONTAL (GUM) DISEASE
Periodontal (gum) diseases, including gingivitis and periodontitis, are 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.
In the mildest form of the disease, gingivitis, the gums redden, swell and bleed easily. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.
Untreated gingivitis can advance to periodontitis. 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) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.
CAUSES OF PERIODONTAL DISEASE
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.
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 interventive treatment may help them keep their teeth for a lifetime.
Pregnancy and Puberty
As a woman, you know that your health needs are unique. You know that brushing and flossing daily, a healthy diet, and regular exercise are all important to help you stay in shape. You also know that at specific times in your life, you need to take extra care of yourself. Times when you mature and change, for example, puberty or menopause, and times when you have special health needs, such as menstruation or pregnancy. During these particular times, your body experiences hormonal changes. These changes can affect many of the tissues in your body, including your 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.
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.
Other Systemic Diseases
Diseases that interfere with the body's immune system may worsen the condition of the gums.
TYPES OF PERIODONTAL DISEASE
There are many forms of periodontal disease. The most common ones include the following:
Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is reversible with professional treatment and good at home oral care.
A form of periodontitis that occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
A form of periodontal disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss and is characterized by pocket formation and/or recession of the gingiva. It is recognized as the most frequently occurring form of periodontitis. 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
Periodontititis, often with onset at a young age, associated with one of several systemic diseases, such as diabetes.
Necrotizing Periodontal Diseases
An infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions including, but not limited to, HIV infection, malnutrition and immunosuppression.
TREATMENT OF PERIODONTAL DISEASE
Following are some of the procedures that periodontists use to treat patients diagnosed with a periodontal (gum) disease. The main cause of periodontal disease is bacteria in the form of a sticky, colorless plaque that constantly forms on your teeth; however, many other factors can cause periodontal (gum) disease or influence its progression.
1. 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 antimicrobials and host modulation, 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, however, and when it does not achieve periodontal health, surgery may be indicated to restore periodontal anatomy damaged by periodontal diseases and to facilitate oral hygiene practices.
2. Periodontal Surgery
If you're diagnosed with periodontal disease, your periodontist may recommend periodontal surgery. Periodontal surgery is necessary when your periodontist determines that the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:
- Pocket Reduction Procedures
- Regenerative Procedures
- Crown Lengthening
- Soft Tissue Grafts
Pocket Depth Reduction
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth.
Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.
Your periodontist has measured the depth of your pocket(s). A pocket reduction procedure has been recommended because you have pockets that are too deep to clean with daily at-home oral hygiene and a professional care routine.
During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.
What are the benefits of this procedure?
Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to help you maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it's important for you to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increase your chances of keeping your natural teeth - and decrease the chance of serious health problems associated with periodontal disease.
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed and pockets develop. Eventually, if too much bone is lost, the teeth will need to be extracted.
Your periodontist may recommend a regenerative procedure when the bone supporting your teeth has been destroyed. These procedures can reverse some of the damage by regenerating lost bone and tissue.
During this procedure, your periodontist folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue- stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue.
There are many options to enhance support for your teeth and to restore your bone to a healthy level. Your periodontist will discuss your best options with you.
What are the benefits of this procedure?
Eliminating existing bacteria and regenerating bone and tissue helps to reduce pocket depth and repair damage caused by the progression of periodontal disease. With a combination of daily oral hygiene and professional maintenance care, you'll increase the chances of keeping your natural teeth - and decrease the chances of serious health problems associated with periodontal disease.
Periodontal procedures are available to lay the groundwork for restorative and cosmetic dentistry and/or to improve the esthetics of your gum line.
You may have asked your periodontist about procedures to improve a "gummy" smile because your teeth appear short. Your teeth may actually be the proper lengths, but they're covered with too much gum tissue. To correct this, your periodontist performs crown lengthening.
Before crown lengthening
After crown lengthening
During this procedure, excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.
Your dentist or periodontist may also recommend crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.
What are the benefits of this procedure?
Whether you have crown lengthening to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health - your keys to smiling, eating and speaking with comfort and confidence.
Soft Tissue Grafts
Periodontal procedures are available to stop further dental problems and gum recession, and/or to improve the esthetics of your gum line.
Exposed tooth roots are the result of gum recession. Perhaps you wish to enhance your smile by covering one or more of these roots that make your teeth appear too long. Or, maybe you're not bothered by the appearance of these areas, but you cringe because the exposed roots are sensitive to hot or cold foods and liquids.
Your gums may have receded for a variety of reasons, including aggressive tooth brushing or periodontal disease. You may not be in control of what caused the recession, but prior to treatment your periodontist can help you identify the factors contributing to the problem. Once these contributing factors are controlled, a soft tissue graft procedure will repair the defect and help to prevent additional recession and bone loss.
Before soft tissue graft
After soft tissue graft
Soft tissue grafts can be used to cover roots or develop gum tissue where absent due to excessive gingival recession. During this procedure, your periodontist takes gum tissue from your palate or another donor source to cover the exposed root. This can be done for one tooth or several teeth to even your gum line and reduce sensitivity.
What are the benefits of this procedure?
A soft tissue graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve esthetics of your smile. Whether you have crown lengthening to improve function or esthetics, patients often receive the benefits of both: a beautiful new smile and improved periodontal health - your keys to smiling, eating and speaking with comfort and confidence.
3. Dental Implants
If you've already lost a tooth to periodontal disease or other reasons, you may be interested in dental implants - the permanent tooth replacement option.
4. Cosmetic Procedures
In addition to procedures to treat periodontal disease, many periodontists also perform cosmetic procedures to enhance your smile. Oftentimes, patients who pursue cosmetic procedures notice improved function as well. Cosmetic procedures include:
- Crown Lengthening (see above)
- Soft Tissue Grafts (see above)
- Ridge Augmentation
Sometimes when you lose one or more teeth, you can get an indention in your gums and jawbone where the tooth used to be. This happens because the jawbone recedes when it no longer is holding a tooth in place.
Not only is this indentation unnatural looking, it also causes the replacement tooth to look too long compared to the adjacent teeth.
A periodontist can fill in this "defect" with a procedure called ridge augmentation, recapturing the natural contour of your gums and jaw. A new tooth can then be created that is natural looking, easy-to-clean and beautiful.
Before ridge augmentation
After ridge augmentation
Ask a periodontist near you for a smile consultation. He or she can evaluate your smile and provide a range of treatments available to help achieve the look you want.