If you have been told you have periodontal (gum) disease, you’re not alone. Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.
Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.
Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” or “calculus” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.
The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.
When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth”). In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.
- Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.
- Hormonal changes in girls/women.These changes can make gums more sensitive and make it easier for gingivitis to develop.
- Diabetes.People with diabetes are at higher risk for developing infections, including gum disease.
- Other illnesses.Diseases like cancer or AIDS and their treatments can also negatively affect the health of gums.
- Medications.There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medicines can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep teeth and gums clean.
- Genetic susceptibility. Some people are more prone to severe gum disease than others.
People usually don’t show signs of gum disease until they are in their 30s or 40s. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.
Symptoms of gum disease include:
- Bad breath that won’t go away
- Red or swollen gums
- Tender or bleeding gums
- Painful chewing
- Loose teeth
- Sensitive teeth
- Receding gums or longer appearing teeth
Any of these symptoms may be a sign of a serious problem, which should be checked by a dentist. At your dental visit the dentist or hygienist should:
- Ask about your medical history to identify underlying conditions or risk factors (such as smoking) that may contribute to gum disease.
- Examine your gums and note any signs of inflammation.
- Use a tiny ruler called a “probe” to check for and measure any pockets. In a healthy mouth, the depth of these pockets is usually between 1 and 3 millimeters. This test for pocket depth is usually painless.
The dentist or hygienist may also:
- Take an x-ray to see whether there is any bone loss.
The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. The doctor may also suggest changing certain behaviors, such as quitting smoking, as a way to improve treatment outcome.
The dentist, periodontist, or dental hygienist removes the plaque through a deep-cleaning method called scaling and root planing. Scaling means scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. This procedure can result in less bleeding, swelling, and discomfort compared to traditional deep cleaning methods.
The fibers and bone that support your teeth are destroyed causing your teeth to be loose or move. This movement of your teeth can affect your bite causing other dental problems and if not treated to save these teeth, they may need to be removed to prevent further damage.
Clinical studies prove that periodontal disease, when left untreated, can result in increased probing depths, loss of attachment, and loss of teeth. A plaque index greater than 70% and smoking were the most predictive factors….the overall result when periodontal disease is left untreated is destruction of the periodontal support apparatus and tooth loss.”
Medications may be used with treatment that includes scaling and root planning, but they cannot always take the place of surgery. Depending on how far the disease has progressed, the dentist or periodontist may still suggest surgical treatment. Long-term studies are needed to find out if using medications reduces the need for surgery and whether they are effective over a long period of time. Listed on the next page are some medications that are currently used.
|Medications||What is it?||Why is it used?||How is it used?|
|Prescription antimicrobial mouthrinse||A prescription mouthrinse containing an antimicrobial called chlorhexidine (also called irrigation)||To control bacteria when treating gingivitis and after gum surgery||It’s used like a regular mouthwash.|
|Arestin||Tiny particles of antibiotic Minocycline||To kill bacteria efficiently and reduce the size of periodontal pockets||After root planing, it’s placed in the pockets where the medicine is slowly released over time.|
|Antibiotic gel||A gel that contains the antibiotic doxycycline||To control bacteria and reduce the size of periodontal pockets||The periodontist puts it in the pockets after scaling and root planing. The antibiotic is released slowly over a period of about seven days.|
|Antibiotic microspheres||Tiny, round particles that contain the antibiotic minocycline||To control bacteria and reduce the size of periodontal pockets||The periodontist puts the microspheres into the pockets after scaling and root planing. The particles release minocycline slowly over time.|
|Enzyme suppressant||A low dose of the medication doxycycline that keeps destructive enzymes in check||To hold back the body’s enzyme response — If not controlled, certain enzymes can break down gum tissue||This medication is in tablet form. It is used in combination with scaling and root planing.|
|Oral antibiotics||Antibiotic tablets or capsules||For the short term treatment of an acute or locally persistent periodontal infection||These come as tablets or capsules and are taken by mouth.|
Flap Surgery. Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets or to reduce the periodontal pocket and make it easier for the patient, dentist, and hygienist to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. After surgery the gums will heal and fit more tightly around the tooth. This sometimes results in the teeth appearing longer.
Bone and Tissue Grafts. In addition to flap surgery, your periodontist or dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. A technique that can be used with bone grafting is called guided tissue regeneration. In this procedure, a small piece of mesh-like material is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow. Growth factors – proteins that can help your body naturally regrow bone – may also be used. In cases where gum tissue has been lost, your dentist or periodontist may suggest a soft tissue graft, in which synthetic material or tissue taken from another area of your mouth is used to cover exposed tooth roots.
Since each case is different, it is not possible to predict with certainty which grafts will be successful over the long-term. Treatment results depend on many things, including how far the disease has progressed, how well the patient keeps up with oral care at home, and certain risk factors, such as smoking, which may lower the chances of success. Ask your dentist what the level of success might be in your particular case.