- Q) What is gum disease (periodontal
disease)? (top)
- A) Gum disease, also called periodontal disease, periodontitis, or pyorrhea, is a complex disease which can be acute or chronic with flareups and quiet periods, like any chronic disease. Gum disease involves the inflammation of the gum tissue, and the resulting destruction of the bone that holds the teeth in the jaw by the inflammatory process. It is the Number 1 cause of tooth loss in adults. In fact, the American Dental Associtation estimates that between 70-80% of all adults will have it in some form or another.
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- Q) Why is it important?
(top)
- A) Over the past 15 years or so, we have been observing scientists link the chronic inflammation of gum disease to a number of serious diseases including rheumatoid arthritis, cardiovascular disease, and stroke.
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- Q) What causes gum disease
(periodontal disease)? (top)
- A) In its most basic form, the answer to this question is bacteria. There are over 300 different species of bacteria that live in our mouths, some of which cause gum disease. The process of gum disease itself occurs when bacterial toxins cause injury to the gum tissue. The body responds with inflammation, attempting to wall off the infection and kill the bacteria. The success of this process determines the ultimate effects of the destruction and the degree of gum disease. To know more about this process, one must know a bit about the gum tissue itself since it is the first line of defense against gum and bone destruction.
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- Q) What is important about
the gum tissue? (top)
- A) The gum tissue around the teeth overlies the bone that holds our teeth in place. What's not visible when one looks at the gums is the gum space. In actuality, the top of the gum that is visible is approximately 2-3 millimeters (about 1/8 inch) higher than the actual attachment of the gum, making a space similar to the cuff on a pair of pants. Within this space, bacteria live and multiply forming "dental plaque", a complex mix of the bacteria themselves, dead cells, toxins, and a sticky substance that allows the bacteria to attach directly to the tooth surface. The production of these toxins causes our bodies to respond in a localized reaction called inflammation. In gum disease, the fibers that attach the gum to the tooth are destroyed by the process of inflammation. Recent research has also implicated the bacteria byproducts directly in invading the gum tissue. Once these fibers are damaged, the bacterial infiltration can continue to deeper levels of the gum and bone typifying the advancing nature of gum disease.
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- Q) What contributes to
plaque formation? (top)
- A) When not properly removed, plaque will accumulate on its own since the bacteria secrete certain chemicals which allow it to attach to the sides of a tooth. However, there are a number of factors which can help the bacteria with their mission.
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- One factor which helps the bacteria is the accumulation of tartar along the tooth surface, both above and below the gum. Also known as calculus or calcified plaque, tartar is a long standing version of the plaque that becomes hardened by minerals in our saliva. It is here that one of the primary sites of bacterial accumulation occurs.
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- Another factor which aids plaque formation is improperly fitting dental fillings and restorations. Plaque accumulates around the rough and ill-fitting margins around dental fillings. In addition, if the filling or restoration is not structured properly, when it is not contoured properly to hold out the food, or when there are overhangs of material that do not follow the contours of the tooth it is restoring, it will allow the bacteria to accumulate more readily in a protected area where removal is difficult if not impossible. (This also contributes to halitosis)
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- Poorly designed partial denture clasps and saddles (area of a partial denture which replaces missing teeth) also contribute to the accumulation of plaque.
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- Naturally occuring factors which influence the accumulation of plaque include crowding of teeth, mouth breathing, rough root surfaces, and fissures and grooves along the surfaces of the teeth.
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- Q) What is gingivitis?
(top)
- A) Because inflammation of the gums must occur before the bone is destroyed, gingivitis, or inflammation of the gums is the precursor to gum disease. However, gingivitis may persist for years before the inflammatory process allows destruction of the bone to occur. The important thing to note about gingivitis is that it cannot be distinguished from gum disease simply by observation. To determine if someone has gingivitis or periodontal disease, a gum exam must be performed.
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- Q) What is a gum exam?
(top)
- A) A gum exam is performed by a dentist when he or she inserts a measuring device between the gum and tooth and measures the degree of seperation of the gum from the tooth. When the amount of seperation exceeds 3 millimeters, roughly an eighth of an inch, the bone has been destroyed to some extent. The higher the measurement, the greater the seperation and consequently, the greater the destruction. In most instances this exam can be done painlessly.
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- Another observation that the dentist must perform while doing a gum exam is the presence of bleeding. Since the inflammatory process is greater at the deeper levels of the pocket, a gum exam will also locate sites of inflammation using bleeding as a guide. If bleeding does occur during measuring, one can be assured that the same destructive process is still occuring.
Q) How do I know if I have gum disease? (top)- A) While there are a number of signs and even some symptoms of gum disease, the only true way to determine if gum disease is present is by having a gum exam. Even x-rays do not show many areas where the bone may have been destroyed. However, here are some signs to look for. According to the American Dental Association, there are eight signs of gum disease.
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- 1) Gums that bleed when teeth are brushed or flossed
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- 2) Red, swollen, or tender gums
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- 3) Gums that have pulled away from the teeth
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- 4) Pus around the gums or teeth
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- 5) Loose teeth or teeth that are moving
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- 6) Any change in the bite
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- 7) Change in the fit of a partial denture
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- 8) Bad breath or bad taste
- Q) Are there different
types of gum disease? (top)
- A) By far the most prevelant form of gum disease is adult periodontitis. This is classified into mild, moderate and severe types, depending on the amount of bone loss. Mild periodontitis occurs when the probing depths range from 4-5 millimeters. It is said to be moderate when the probing depths are between 6-7 millimeters, while severe periodontitis occurs when depths of 8 millimeters or above are observed. Since the teeth average between 10-12 millimeters long, the deeper the pocket (higher the measurement) the more severe the disease and the greater chance for tooth loss. Different readings can occur around different sites on the same tooth.
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- Q) What are the treatments
for gum disease?
(top)
- A) Actual treatment for gum disease depends on the severity of the problem. What all types of treatment do is to reestablish healthy gums that can act as a barrier to future disease. In fact, the primary goal of any treatment is to get the gum to reattach at a level that can be maintained by the patient. Therefore, the patient must remove the bacteria on a daily basis for permanent success to occur.
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- The first type of treatment involves what is called "deep scaling", "root planing", and "currettage". It is the most conservative treatment available and is commonly called the Non-Surgical approach. Since the greatest activity of gum disease occurs at the deepest level of the pockets, each individual pocket must be cleaned (deep scaling), the side of the root smoothed so there are no places for the bacteria to attach (root planing), and the gum tissue debrided (currettage) so that the bacteria that have invaded the gum are removed. This is almost always done with local anesthetic and rarely causes residual discomfort. In many cases it is best to do each pocket more than once as it is imppossible to remove all deposits and debris in the deeper pockets on the first treatment. When successful, the gum will reattach at a higher level than before thus reestablishing a better barrier to the bacteria and the disease process will be eliminated.
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- There are new ways to enhance these results that many dentists have incorporated into their practice. One of these is the use of chemical solutions that are squirted under the gum to kill the bacteria. This technique enhances the results of the conservative technique already mentioned. In addition, it is important to evaluate and individualize oral care techniques for the person requiring treatment. Many new instruments and techniques have come on the market lately that are much more effective in removing bacteria than anything available only a few years ago. When properly used they can make at home care easy and efficient.
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- In addition, we have been using lasers since 1990 to sterilize the pockets and eliminate the bacteria. In many instances, laser treatment combined with non-surgical treatment and other techniques mentioned above can prevent painful gum surgery.
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- The second major treatment is surgery. Surgery is not a cure for the disease, simply a different way to remove the diseased gum tissue.
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- The simplest type of surgery is called a gingevectomy. While this has given way to other procedures in recent years, it can still be successful in some situations. Basically, it involves the surgical removal of the disease gum tissue with the healing of the gum at a lower level. Depending on the pocket depth, this may involve massive tissue loss.
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- More common are the flap procedures. While there are different types of "flaps" and different techniques, the goal is to temporarily move the gum back during the surgery, remove the underlying disease process and if necessary, change the contour of the bone. This gum tissue is then sutured back in place. If healing is successful, the gum will reattach at a higher level than it was when the disease process was present, although never back to where it was originally. Newer surgical techniques include the implantation of new bone and the use of a synthetic bone matrix that stimulates bone growth. However, these techniques are limited and not recommended in every case.
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- The last treatment is the use of extractions, or removal of the teeth. Certainly, the goal of any treatment is to save the teeth, however there are times when the bone destruction is so great around one or more teeth that it threatens to infect the tooth next to it. If the adjacent tooth has a level of bone that can sucessfully be treated by one of the methods mentioned above, yet its next door neighbor cannot, then removal of the hopeless tooth can only help the long term prognosis.
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- Again, it cannot be emphasized enough that while treatment may re-establish a healthy gum condition, if the bacteria are not regularly and properly removed, the disease will reappear.
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- Q) If the cause is bacteria,
why not use antibiotics? (top)
- A) Antibiotics, while used in conjunction with the treatments mentioned above, can be a valuable addition to any treatment but are by no means the final answer. The use of antibiotics revolves around the principal of killing enough bacteria so that the natural immune system of the patient can take care of the rest. This works effectively in most places in the body, however, since the mouth is constantly exposed to our environment, our immune system must depend on our conscious effort to mechanically remove bacteria with the use of oral hygiene to be successful.
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- In 1999, a new antibiotic was introduced that targets the bacteria that cause periodontal disease. However, it’s use is recommended in conjunction with other treatments since it alone cannot keep the bacteria from re-appearing.
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- Q) What is gum recession?
(top)
- A) Gum recession occurs when the gum pulls away from the tooth and recedes down (or up) the root surface; at the same time, the bone dissolves with it. Apart from gum disease, recession occurs without inflammation because it is a result of an improper bite – one that functions outside of your biological limits.
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- Q) What are those hollowed out areas at the gum line of my teeth, the ones I can get a fingernail into? (top)
- A) They are the next step in the progression of gum recession if the cause is not corrected. They are the result of long term forces on the teeth in a direction that actually moves the tooth a micro amount in the socket. When this occurs over a long period, you get micro chipping of the root and even enamel. See our section on bite problems.
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- Q) What can be done about
gum recession and those eroded areas? (top)
- A) Unless the cause, an improperly functioning bite, is corrected the problem will continue to get slowly worse. Untreated, it can cause sensitivity, loose teeth, toothache, and even allow the bacteria of gum disease to take a stronger foothold. See our section on bite problems for further information.
For more information about whether Advanced Non-Surgical Gum Treatment can help you or for an initial appointment, contact
us today.
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