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Periodontal
(Gum) Diseases
| Introduction |
If you have been told you have periodontal
(gum) disease, you're not alone. An estimated 80 percent of
American adults 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.
Gum disease is a threat to your oral
health. Research is also pointing to possible health
effects of periodontal diseases that go well beyond your mouth
(more about this later). Whether it 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. |
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| What
causes periodontal disease? |
| 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 bacteria-harboring "tartar" that brushing doesn't
clean. Only a professional cleaning by a dentist or dental
hygienist can remove tartar. |
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| Gingivitis |
| 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. |
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| Periodontitis |
| 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 "pockets" that are 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 enzymes fighting
the infection actually start to break down the bone and connective
tissue that hold teeth in place. If not treated, the bones,
gums, and connective tissue that support the teeth are destroyed.
The teeth may eventually become loose and have to be removed.
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| Risk
Factors |
- Smoking.
Need another reason to quit smoking? Smoking
is one of the most significant risk factors associated with
the development of periodontitis. Additionally, smoking
can lower the chances of success of some treatments.
- 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 periodontal disease.
- Stress.
Research shows that stress can make it more difficult for
our bodies to fight infection, including periodontal disease.
- Medications.
Some drugs, such as antidepressants and some heart medicines,
can affect oral health because they lessen the flow of saliva.
(Saliva has a protective effect on teeth and gums.)
- Illnesses.
Diseases like cancer or AIDS and their treatments can also
affect the health of gums.
- Genetic
susceptibility. Some people are more
prone to severe periodontal disease than others.
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| Who
gets periodontal disease? |
| People usually don't show signs of gum
disease until they are in their 30s or 40s. Men are more
likely to have periodontal disease than women. 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. |
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| What
can I do to prevent gum disease? |
Here are some things you can do to
prevent periodontal diseases:
- Brush your teeth twice a day (with
a fluoride toothpaste)
- Floss every day
- Visit the dentist routinely for a
check-up and professional cleaning
- Eat a well balanced diet
- Don't use tobacco products
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| How
do I know if I have periodontal disease? |
Symptoms are often not noticeable
until the disease is advanced. They include:
- Bad breath that won't go away
- Red or swollen gums
- Tender or bleeding gums
- Painful chewing
- Loose teeth
- Sensitive teeth
Any of these symptoms may signal a serious
problem, which should be checked by a dentist. At your
dental visit:
- The dentist will ask about your medical
history to identify underlying conditions or risk factors
(such as smoking) that may contribute to periodontal disease.
- The dentist or hygienist will examine
your gums and note any signs of inflammation.
- The dentist or hygienist will use
a tiny ruler called a 'probe' to check for periodontal pockets
and to measure any pockets. In a healthy mouth, the
depth of these pockets is usually between 1 and 3 millimeters.
- The dentist or hygienist may take
an x-ray to see whether there is any bone loss.
- The dentist may refer you to a periodontist,
a specialist who treats gum diseases.
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| How
is periodontal disease treated? |
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. Additionally, modifying
certain behaviors, such as quitting tobacco use, might also
be suggested as a way to improve treatment outcome.
Deep
Cleaning (Scaling and Root Planing)
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.
Medications
Medications may be used with treatment
that includes scaling and root planing, but they cannot
always take the place of surgery. Depending on the severity
of gum disease, the dentist or periodontist may still suggest
surgical treatment. Long-term studies will be needed to
determine whether using medications reduces the need for
surgery and whether they are effective over a long period
of time. Here are some medications that are currently
used:
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What
is it? |
Why
is it used? |
How
is it used? |
| Prescription
antimicrobial mouthrinse |
A
prescription mouthrinse containing an antimicrobial
called chlorhexidine |
To
control bacteria when treating gingivitis and after
gum surgery |
It's
used like a regular mouthwash |
| Antiseptic
"chip" |
A
tiny piece of gelatin filled with the medicine chlorhexidine |
To
control bacteria 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
micro-spheres |
Tiny,
round particles that contain the antibiotic minocycline |
To
control bacteria and reduce the size of periodontal
pockets |
The
periodontist puts the micro-spheres 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 pill form. It is used in
combination with scaling and root planing. |
Surgical
Treatments
Flap
Surgery. Surgery might be necessary
if inflammation and deep pockets remain following treatment
with deep cleaning and medications. A 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.
Bone
and Tissue Grafts. In addition
to flap surgery, your periodontist may suggest bone or tissue
grafts. Grafting is a way to replace or encourage
new growth of bone or gum tissue destroyed by periodontitis.
A technique that can be used with bone grafting is called
guided tissue regeneration, in which a small piece of mesh-like
fabric 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.
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 severity of the disease,
ability to maintain oral hygiene at home, and certain risk
factors, such as smoking, which may lower the chances of
success. Ask your periodontist what the level of success
might be in your particular case.
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| Can
periodontal disease cause health problems beyond the mouth?
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Maybe. But so far the research
is inconclusive. Studies are ongoing to try
to determine whether there is a cause-and-effect relationship
between periodontal disease and:
- an increased risk of heart attack
or stroke,
- an increased risk of delivering preterm,
low birth weight babies,
- difficulty controlling blood sugar
levels in people with diabetes.
In the meantime, it's a fact that controlling
periodontal disease can save your teeth -- a very
good reason to take care of your teeth and gums. |
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