Gum Disease (Periodontal Disease)
It is not true that we must lose teeth as we age. If we maintain good oral hygiene and have regular professional cleanings and oral examinations, chances are we can keep our natural teeth for life. That involves not only caring for the teeth themselves, but also the structures that surround them: the gums and tooth-supporting bone. Gum disease, which is a bacterial infection, threatens these supporting tissues and also threatens the health of your vital organs.
Think of gum disease as “gum and bone disease”. When bacterial biofilm (plaque) grows around the gum line of your teeth, the body’s initial protective response is to become inflamed: red, puffy, and bleeding upon brushing or flossing. This inflammation is the body’s natural process of trying to reject foreign objects or infectious agents. Next, the bacteria become more destructive as they begin eating away at the gum tissue and the bone anchoring the root of the tooth. If left untreated, this condition leads to loose, drifting teeth, bad breath, and eventually tooth loss.
Periodontal Disease is the number one cause of tooth loss in adults. Think of a tooth like a fence post in the ground. If the ground around the fence post (root) erodes, the post loosens and begins to tip over with natural forces. Unfortunately, once bone support is lost around your teeth, it does not grow back. Following bone loss, the gum line recedes, exposing root surfaces. Gum recession can cause temperature sensitivity, increased risk of cavities, and unattractive smiles (long teeth with yellowed necks). Often, in the end stages of gum disease, a tooth develops an abscess and needs to be removed by a dentist.
In addition bad breath is a direct result of this degrading tissue. Since smoking is a significant risk factor in gum disease, the combination of gum disease and tobacco makes breath smell even worse. Reduced oxygenation and reduced ability to fight infection are two reasons we see smokers develop more gum disease than non-smokers.
Other factors that influence susceptibility to gum disease are:
- Genetics, which can be tested through DNA sample of your saliva
- The presence of dangerous (but identifiable and treatable) bacteria strains
- Imbalanced biting/grinding forces
- Increased stress levels
- Cancer, chemotherapy and other Immunosuppressing diseases
Gum Disease and Systemic Health
Medical research has now revealed that this gum tissue breakdown serves as a portal for dangerous bacteria and their toxic byproducts to enter the blood stream, causing harmful effects to the rest of the organs.
Maintaining good health of your gums and bone support will not only help you keep your teeth for a lifetime, it also helps you prevent:
- Heart disease
- Heart attack
- Pregnancy complications
- Erectile Dysfunction
- Alzheimer’s disease
- Colon cancer
- Kidney disease
- and more
Dangerous oral bacteria can enter the bloodstream and migrate to infect your blood vessel walls, heart, brain and other vital organs.
Gum inflammation puts pregnant women at significantly higher risk for preterm, low-birth weight babies and other fetal complications such as stillbirth.
We understand the close connections between the health of the mouth and the rest of your body and will do our best to help you co-manage your related medical conditions with your physician.
Periodontal Disease Assessment
At our office you will receive a comprehensive evaluation of gum health that will include gum "pocket" measuring around the neck of each tooth, an assessment of the inflammation in the tissue, gum recession measurements, mobility testing, necessary x-rays and other monitors — all to evaluate bone loss and gum tissue breakdown.
Additionally, as required, your gum health evaluation may include a few medical lab tests such as
- Genetic tests to see of your body has a heightened sensitivity to inflammation
- Bacterial DNA tests to identify the specific bacteria involved in your gum infection
We will also evaluate the other factors in your general health that may predispose you to an increased risk of gum disease.
Periodontal Disease Self-Assessment
Here is a simple self-assessment to help you determine your risk of periodontal disease: (You can take the test below or click here to take it electronically at selfscreen.net.)
Scoring: Yes=2 points, Occasionally=1 point, No=0 points
_______Do your gums bleed when you brush or floss?
_______Do your gums appear red (Do they match your lips rather than your skin)?
_______Do you suffer from bad breath?
_______Do you have any loose teeth or teeth that have shifted?
_______Do you smoke?
_______Are there areas on your gums that ever get swollen or sore?
_______Do you get food wedged between your teeth?
_______Do you see exposed roots at the gumline?
_______Are your teeth sensitive to cold temperatures?
_______Have you ever been told you have "gingivitis", "bone loss", "gum disease"?
_______Has it been more than a year since your last professional dental cleaning?
_______Have your parents or siblings lost teeth due to periodontal disease?
Score total points:
0-3 unlikely host of periodontal disease: learn more about prevention
4-7 low suspicion of localized periodontal disease/inflammation: seek consultation
8-11 moderate suspicion of generalized disease: seek consultation
12+ high suspicion of generalized disease: get immediate attention
Periodontal Therapy Procedures
Periodontal therapy includes both surgical and non-surgical techniques to restore health to the tissues that support the teeth (gums and bone) and prevent tooth loss. They include:
Scaling and Root Planing. The most prevalent treatment procedure is using instruments to remove bacterial toxins from the teeth and root surfaces in the areas of infection. This is usually assisted by a local anesthetic. Sometimes the gums are surgically retracted to gain access to tooth surfaces in deeper pockets.
Home Care. Stopping gum disease often requires self-care modification to accomplish specific plaque removal each day. In our office we equip each patient with the tools and skills necessary for each specific area we are treating. Putting the right tools in your hands and helping you learn how best to use them are critical elements in your ability to end gum disease. Some of these home care products include: spin brushes, water jets/piks, floss/flossers, interproximal brushes, stimudent toothpicks, and essential oil rinses when necessary.
Prescription Medications. There is no blanket antibiotic coverage that will help solve this disease long-term. The mouth is chalked full of bacteria and it is difficult to specifically attack the few creating the most damage. That said, sometimes it is helpful to place an antibiotic chip directly into an infected site. Other times, we are able to respond to the DNA bacteria testing with a very specific antibiotic for a short period of time.
Topical Fluoride Application. Once root surfaces are exposed, from a history of bone loss, they can become quite temperature sensitive. Less mineralized than enamel, root surfaces are also much more susceptible to caries (tooth decay). Regular fluoride application is critically important to decrease sensitivity and protect against decay. As a bonus, fluoride is a natural antimicrobial agent, and suppresses the biofilm formation.
Smoking Cessation. Because smoking plays such a critical role in bone loss and other systemic diseases, we take that seriously. Most smokers want to quit and most have tried. Our entire team recognizes how difficult that challenge can be and we empathize with our patients who want to face that. Dr. Susan and our clinical team are all trained in smoking cessation. We take every opportunity to understand your quit-history, learn what else is possible, and choose the most appropriate and predictable approach for your next attempt. We offer a variety of tools such as a measured brand-switching, step down method, acupuncture referrals, and prescriptions for Zyban and Chantix.
Bite Balancing (Equilibration). Achieving balanced forces on your teeth in function is sometimes the most critical factor in allowing bone to heal and grow stronger. Evaluating teeth, muscles and joints as one functional system is of primary importance. We begin with healthy, properly ‘seated’ joints (TMJs), and provide equal contacts on as many teeth as possible in closure. Controlling the lateral (side-to-side) bite forces by slightly reshaping the guiding teeth can make all the difference in long term stability. This is a painless procedure that often requires study models and a trial bite adjustment on these rendered models.
Co-Managing Systemic Disease. Controlling bone loss often requires helping you control the systemic disease factors such as diabetes, heart disease, osteoporosis, psychological/psychiatric disturbances including changes in stress levels, hormone imbalances, cancer/radiation/chemotherapy, prescription medications, etc. We are skilled and dedicated in co-managing such systemic complications with your physician. We can help you with health advocacy and understanding, including making referrals to skilled and caring physicians in the mid-Michigan area.
Your Role in Periodontal Health
Dental plaque is the main cause of periodontal disease, so it's essential to remove it every day with effective brushing and flossing. This doesn't mean scrubbing, which can actually cause your gums to recede. Proper techniques can be demonstrated for you, if you have any questions.
Of course, there are some areas of the mouth that a toothbrush and floss just can't reach, which is why it's so important to have regular professional cleanings at the dental office. Your regular dental exam is also a time when early signs of gum disease can be detected — before they become apparent even to you.
Eating a nutritious diet low in sugar, and staying away from tobacco in all forms, will also increase your periodontal health — and your chances of keeping your teeth for life.