Types of Periodontal Diseases

At the very edge of the gumline, gum tissue is not attached to each tooth. Instead, there is a very shallow v-shaped groove called the sulcus between the tooth and gums. The normal space between teeth and healthy gums should be three millimeters or less. With periodontal diseases, this tiny space develops into a pocket. Generally, the more severe the disease, the greater the depth of the pockets.

Gingivitis is a mild, often reversible form of periodontal disease It develops as toxins in plaque irritate the gums, making them red, tender, swollen and likely to bleed easily. It can usually be eliminated by daily brushing, cleaning between teeth, and regular dental cleanings and checkups.

Gingivitis may lead to more serious, destructive forms of periodontal disease, called Periodontitis. This occurs when toxins destroy the tissues that anchor teeth into bone. The gums detach from the teeth and form pockets. Exposed tooth roots become susceptible to decay and sensitive to cold and touch. Tartar that forms below the gums inhibitis the reattachment of gum tissue to the teeth. It creates conditions that contribute to delayed healing and inflammation.

In some cases, so much ligament and bone are destroyed that the tooth, no longer stable, becomes loose in its socket. It may eventually fall out, or require extraction.

Factors That Can Increase Your Risk

Other factors can increase the risk, severity and speed at which periodontal diseases develop. If one or more of these applies to you, you may still have good oral health by following your dentist's advice and practicing good oral hygiene.

• People who smoke or chew tobacco are more likely to have periodontal disease. And, it's likely to be more severe than those who do not use any tobacco.
• Bridges that no longer fit properly, malocclusion (misaligned teeth) or fillings that have become defective can contribute to plaque retention and increase your risk of developing periodontal disease.
• Clenching or grinding your teeth may also contribute to the rate at which supporting bone is lost.
• Poor Diet may cause periodontal disease to progress or increase the severity of the condition, according to some research. There is some evidence that an inadequate diet makes mouth tissues less resistant to infection.
• Pregnancy or use of oral contraceptives increases hormone levels which can cause gum tissue to be more sensitive to the toxins in plaque and accelerate growth of some bacteria. The gums are more likely to become red, tender and swollen, and bleed easily.
• Systemic diseases, such as AIDS or diabetes, can lower resistance to infection, making periodontal disease more severe.
• Many medications, such as steroids, some types of antiepilepsy drugs, cancer therapy drugs, some calcium channel blockers, and oral contraceptives can affect the gums. Let your dentist know about your medications and update your medical history files at the dental office when any changes occur.

Preventing Peridontal Diseases

Here's how you can keep your teeth and gums healthy:

• Brush your teeth thoroughly twice a day with a fluoride toothpaste. This removes plaque from the outer, inner, and chewing tooth surfaces of the teeth. Choose a soft-bristled toothbrush and replace it every three to four months. A worn, frayed, or hard-bristled brush can injure the gums. Choose products that carry the American Dental Association Seal of Acceptance. The ADA Seal is an assurance of safety and effectiveness.
• Carefully clean between teeth with dental floss or other interdental cleaners to remove plaque from areas your toothbrush can't reach. It takes only a few minutes each day. A lifelong healthy smile is worth your time.
• If you need extra help in controlling gingivitis and plaque that forms above the gumline, your dentist may recommend using an ADA accepted anticicrobial mouthrinse as an effective addition to your daily oral hygiene routine.
• Eat a balanced diet for good general health.
• Schedule regular dental checkups.

Treating Periodontal Diseases

Treatment methods depend upon the type of disease and how far the condition has progressed.

The first step is usually a thorough cleaning that may include scaling to remove plaque and tartar deposits beneath the gumline. The tooth roots may also be planed to smooth the root surface allowing the gum tissue to heal and reattach to the tooth. In some cases, the occlusion (bite) may require adjustment.

Antibiotics or irrigation with antimicrobials (chemical agents or mouthrinses) may be recommended to help control the growth of bacteria that create toxins and cause periodontitis. In some cases, the dentist may place antibiotic fibers in the periodontal pockets after scaling and planing. This may be done to control infection and to encourage normal healing.

When deep pockets between teeth and gums (4 to 6 mm or greater) are present, it is difficult for the dentist to thoroughly remove plaque and tartar. Patients can seldom, if ever, keep these pockets clean and free of plaque. Consequently, surgery may be needed to restore periodontal health.

Using various surgical techniques, the dentist lifts the gum away to reach areas that require the removal of tartar and plaque, which cause chronic infection and delay healing. The tooth root is cleaned and smoothed. The gums are sutured back into place or into a new position that will be easier to keep clean at home.

Bone surgery may be used to rebuild or reshape bone that has been destroyed. Grafts of the patient's bone or artificial bone may be used, as well as the use of membranes. The dentist may use splints or other appliances to stabilize loose teeth and to guide the regeneration of tissue during healing.

If extensive gum tissue has been lost around the tooth root, a gingival graft may be used. The graft is taken from healthy tissue elsewhere in the mouth.

After surgery, the dentist may apply a periodontal pack over the teeth and gums to prevent contamination and reduce swelling and pain. An antibiotic and mild pain reliever may be prescribed.

If many teeth are involved, the surgery may be performed in more than one session.

Maintenance

Good oral hygiene at home is essential to help keep periodontal disease from becoming more serious or recurring. Following a period of active therapy, your dentist will want to see you at regular intervals. More frequent visits may be scheduled.

You don't have to lose teeth to periodontal disease. Brush, clean between teeth, eat a balanced diet and schedule regular dental visits for a lifetime of healthy smiles.