Gum Disease

Periodontal Disease, also known as gum disease or periodontitis is a progressive disease. If it is left untreated it may result in tooth loss. The inflammation and irritation of the gingival tissues which surround and support the teeth causes gum disease. This inflammation is caused by toxins found in plaque, a culprit of ongoing bacterial infection in the mouth.

What is the pathology of gum disease?

At first, the bacterial infection colonizes in the gingival tissue. This results in deep pockets that form between the teeth and gums. The good news is -if treated promptly by periodontist, the effects of mild inflammation aka gingivitis are 100% reversible. If the bacterial infection is allowed to progress, the periodontal disease starts to destroy the gums and the underlying jawbone. This deterioration in the mouth promotes tooth loss. In some cases, bacteria from the periodontal infection can be carried to other area of the body by the bloodstream.

What are the causes of gum disease?

Gum disease is generally attributed to genetic and environmental factors. The positive news is that preventative measures can significantly lower the risk of developing periodontitis.

The following factors are known contributors to gum diseases:

• Poor dental hygiene- Good oral hygiene built through good dental habits and a balanced diet go a long way tin preventing dental disease. Regular dental visits with exams, cleanings, and x-rays is an important part in prevention. The combination of proactive home care and professional dental care will preserve the natural dentition and support of bony structure. Gingivitis or periodontitis are caused by bacterial toxins. When bacteria and calculus (tartar) are not removed, it impacts the gums and bone around the teeth leading to complications.
• Tobacco use- Conventional medicine has long publicized the dangers of smoking. Furthermore, research has shown that smoking and tobacco heavily contribute to the development and progression of gum disease. Smokers experience a slower recovery and healing rate. In addition, smokers are more prone to calculus (tartar) build up on teeth, deep pockets in the gingival tissue, and bone loss.
• Genetic predisposition- Genetics play a big role In the development of gum disease with as much as 30% population having a strong genetic predisposition. The population with the genetic predisposition is six times more likely to develop periodontal disease than those not genetically predisposed. There are proactive measures that predisposed individual can take such as genetic testing to determine susceptibility. Also, early intervention can be performed to keep the oral cavity healthy.
• Pregnancy and menopause- Hormonal changes experienced by women during pregnancy and menopause can cause the gum tissue to become more sensitive. This renders the oral cavity more susceptible to gum disease. During hormonal fluctuations, regular brushing and flossing is especially critical.
• Chronic stress and poor diet- Chronic stress and poor diet are lifestyle factors that when not properly managed negatively affect gum disease. Stress lowers the ability of the immune system to fight of disease. This gives bacterial infection an opportunity to beat the body’s defense system. Poor diet or malnutrition denies he body adequate nutritional resources to fight off periodontal infections and negatively affects the health of the gums.
• Diabetes and other medical issues- Many medical conditions can exacerbate or speed up the onset and progression of gum disease. Conditions like respiratory disease, arthritis, and osteoporosis are among those that are correlated with periodontal disease. Diabetes hinders the body’s ability to use insulin which worsens the bacterial infection in the gums.
• Grinding teeth- The clenching or grinding of teeth can heavily damage the supporting tissue surrounding the teeth. Grinding can be attributed to a “bad bite” or misalignment of teeth. The additional destruction of gingival tissue due to grinding can compound the complications of existing gum disease in an individual.
• Medication- The side effect of drugs such as oral contraceptive pills, heart medicines, antidepressants, and steroids affect the overall condition of teeth and gums, an opportunity for gum disease to develop. For example, steroid medication promotes gingival overgrowth which causes swelling and bacteria to colonize more readily in the gum tissue.

Treatment of Gum Disease

If you are diagnosed with gum disease, it is recommended that you a specialist such as a periodontist for a treatment plan.

A periodontist’s specialty is the placement of dental implants and treatment of gum disease. At your appointment with the periodontist, effective cleaning procedures in deep pockets such as sealing and root planing can be performed. The specialist can prescribe antibiotic and antifungal mediation to fight infections and stop gum disease in its tracks.

If tooth loss is a concern, the periodontist is able to perform tissue grafts t promote natural tissue regeneration. Dental implants can be inserted if a tooth or several teeth

are missing. A toothy looking smile can be recontoured by the periodontist by shaping the gingival tissue to create an even and aesthetically pleasing outcome.

The prevention of periodontal disease is critical in preserving natural dentition. An appointment with Dr. Levin to discuss the causes of gum disease will help prevent the onset, progression, and recurrence of periodontal disease.

Types of Periodontal Disease

There are many different types of periodontal disease with various ways in which these variations manifest. However, all require immediate treatment by a periodontist to halt the progression and save the gum tissue and bone. Here are some of the most common types of periodontal disease with the treatments used to correct them:

Gingivitis

Gingivitis is the most common, mildest form of periodontitis. It is caused by the toxins in plaque leading to periodontal disease. People at higher risk of developing gingivitis include: pregnant women, women taking birth control pills, people with uncontrolled diabetes, steroid users, and people use seizure and blood pressure medication.

Treatment: Gingivitis is completely reversible using a powerful combination of home care and professional cleaning. Dr. Levin may perform root planing and deep scaling procedures to cleanse the pockets of debris. A combination of antibiotics and medicated mouthwashes may be used to kill remaining bacteria and promote the healing of the pockets.

Chronic Periodontal Disease

Chronic periodontal disease is the most common form of the disease. It occurs more frequently in people over 45. Chronic periodontal disease is characterized by inflammation below the gum line and the progressive destruction of the gingival and bone tissue. It may appear that the teeth are growing in length, but in actuality the gums are gradually recessing.

Treatment: Unfortunately, unlike gingivitis, chronic periodontal disease cannot be easily cured because the supportive tissue cannot be rebuilt. The dentist can halt the progression of the disease using scaling and root planing procedures in combination with antimicrobial treatments. If necessary, the periodontist can perform surgical treatments such as pocket reduction surgery and tissue grafts. These surgical procedures will strengthen the bone and improve the aesthetic appearance of the oral cavity.

Aggressive Periodontal Disease

Aggressive periodontal disease is diagnosed when the rapid loss of gum attachment, the rapid loss of bone tissue and familial aggregation occurs in the oral cavity. The disease is the same as chronic periodontitis but the progression is much faster. Smokers and individuals with a family history of this disease are at an increased risk of developing aggressive periodontitis.

Treatment: The treatments for aggressive periodontal disease are the same as those for chronic periodontal disease, but aggressive periodontal disease sufferers are more likely to require a surgical intervention. This form of the disease is harder to stop and treat. The dentist can perform scaling, root planing, antimicrobial, and in some cases laser procedures in an attempt to save healthy tissue and bone.

Periodontal Disease Relating to Systemic Conditions

Periodontal disease, whether genetically or environmentally triggered can be a symptom of a systemic disease affecting the rest of the body. It depends on the underlying condition but the disease can behave like aggressive periodontal disease working quickly to destroy tissue. Heart disease, diabetes, and respiratory disease are the most common cofactors, though there can be many others. Many medical conditions intensify and accelerate the progression of periodontal disease even in cases where only a little plaque coats the teeth.

Treatment: Most importantly, the medical condition which caused the onset of periodontal disease must be controlled. The dentist will halt the progression of the disease using the same treatments used for controlling aggressive and chronic periodontal disease.

Necrotizing Periodontal Disease

This form of the disease rapidly worsens, more prevalent among people who suffer from HIV, immunosuppression, malnutrition, chronic stress, or smokers. Tissue death (necrosis) frequently affects the periodontal ligament, gingival tissues, and alveolar bone. Treatment: Necrotizing periodontal disease is extremely rare. Since it may be associated with HIV or another serious medical condition, it is likely the dentist will consult with a physician before commencing prescribing treatment. Scaling, root planing, antibiotic pills, medicated mouth wash, and fungicidal medicines are used to treat necrotizing periodontal disease.

Common Signs & Symptoms

It is important to note that periodontal disease can progress without any signs or symptoms such as pain. Regular dental checkups are critical. Below are some of the common signs and symptoms of periodontitis.

If you have any of these signs or symptoms, the advice of a general dentist like Dr. Levin or periodontist should be sought as soon as possible:

• Unexplained bleeding – Bleeding when brushing, flossing or eating food is one of the most common symptoms of a periodontal infection. The toxins in plaque cause a bacterial infection which makes the tissues prone to bleeding.
• Pain, redness, or swelling – A periodontal infection may be present if the gums are swollen, red, or painful for no apparent reason. It is essential to halt the progression of the infection before the gum tissue and jaw bone have been impacted. It is critical to treat the infection before it is carried into the bloodstream to other areas of the body.
• Longer-looking teeth – Periodontal disease can lead to gum recession. The toxins produced by bacteria can destroy the supporting tissue and bones thus making the teeth look longer and the smile appear more “toothy.”
• Bad breath/halitosis – Although breath odor can originate from the back of the tongue, the lungs and stomach, the food we consume, or from tobacco use. Bad breath can also be caused by old food particles that sit between the teeth and underneath the gumline. The deeper gum pockets are able to house more debris and bacteria causing a foul odor.
• Loose teeth/change in bite pattern – A sign of rapidly progressing periodontitis is the loosening or shifting of the teeth in the affected area. As the bone tissue gets destroyed, teeth that were once firmly attached to the jawbone become loose or may shift in position.
• Pus – Pus oozing from between the teeth is a definite sign a periodontal infection is in progress. The pus is a result of the body trying to fight the bacterial infection.

It is important to halt the progression of periodontal disease before it causes further damage to the gum tissues and jawbone. The dentist will initially assess the whole mouth to diagnose the stage and progression of the disease. When a diagnosis has been made, the dentist may treat the bacterial infection with antibiotics in conjunction with nonsurgical or surgical treatment or both.

In the case of moderate periodontal disease, the pockets under the gumline of the teeth will be cleared of debris using a procedure called scaling and root planing. The pockets may be filled with antibiotics to promote healing and kill any bacteria that remain.

Severe periodontitis can be treated in different ways, such as:

• Laser treatment – This can be used to reduce the size of the pockets between the teeth and the gums.
• Tissue & bone grafting – Where a considerable amount of bone or gum tissue has been destroyed, the dentist may elect to graft new tissue by inserting a membrane to stimulate tissue growth.
• Pocket elimination surgery – The dentist may choose to perform “flap surgery” to reduce the size of the gum pockets.