(periodontal disease)

Gum disease, or periodontal disease is the leading cause of tooth loss in the United States today. In its early stages, periodontal disease is simply a detachment of the gum tissue from the root surface of the tooth, which is a progressive process that begins with gingivitis. This detachment is caused by the collection of bacteria (or plaque) that adhere to the surface of the tooth, and gradually break down the seal which sticks the gum tissue to the tooth. This is an insidious process which occurs, usually over a period of years, and is rarely, if ever, painful.In its more advanced stages, periodontal disease is a chronic infection, which takes the form of bone degeneration in the socket around the root of the affected tooth, and results in looseness of the tooth. This condition is usually characterized by red, swollen gums which bleed easily, and often the presence of hard black deposits of calcified bacterial plaque on the surface of the teeth, called calculus.

Severely affected teeth, which usually are very loose as a result of a longstanding periodontal infection, can only be treated by removal. ( The condition of advanced periodontal disease was once called pyorrhea.)

This disease was once thought to be unrelated to general overall health, however recently a definite causal link has been established between the disease-causing bacteria in periodontal disease and the formation of blood clots which cause heart attacks.

TREATMENT OF GUM DISEASE

The ultimate goal in the treatment of periodontal disease is re-attachment of the gums to the tooth, so that a definite barrier is established against bacterial invasion.

Often, as treatment, a scaling and therapeutic root planing will be recommended. This procedure consists of scraping the surfaces of the teeth under the gumline to remove calculus deposits, and also to remove a microscopic layer of the outer root surfaces which has absorbed bacterial toxins. The resulting freshly clean, uncontaminated root surface should foster rapid re-attachment of the gum tissue.

This procedure is usually done under local anesthesia, and only minor postoperative discomfort is usually noted.

In cases where the periodontal disease has reached advanced stages, however, a therapeutic root planing is usually not effective in achieving long term gum attachment. This is primarily due to the presence of underlying irregularities in the bony sockets around the affected teeth, which are not conducive to good gum attachment. In these instances, periodontal surgery is usually recommended. Periodontal surgery is usually done after a therapeutic root planing has already been performed, and proven unsuccessful. The surgery usually involves recontouring of the bony irregularities, or defects, in order to re-establish the normal bony architecture which is conducive to re-attachment of the gums.

As this is considered minor surgery, it is usually done under local anesthesia. The gums are expected to be sore for at least three to four days post-operatively, and stitches which are placed are usually removed after one week.

After any type of periodontal treatment, the gums are expected to shrink and tighten up around the teeth. This usually results in some gum recession which can cause the newly exposed root surfaces to become sensitive to cold. In almost all cases, this is only a temporary inconvenience which subsides over a few weeks, but if persistent, can be treated usually very effectively with the use of toothpaste for sensitive teeth.

It is important to note that diligent oral hygiene forms the basic foundation for successful periodontal treatment and maintenance, plus regular follow-up care by a dentist.

Gum recession: some great myths dispelled

Gum recession is caused by brushing too hard. False. The gum level on each tooth is solely dependent upon the underlying bone level, therefore you would have to physically brush away the gum tissue and bone to cause recession. Improper brushing, however, can result in gum recession stemming from a failure to loosen the plaque that accumulates under the gumline. When brushing your teeth aim the toothbrush bristles into the crevice at the gumline, making small , circular , massaging strokes. This brushing method is contrary to that which was advocated many years ago, where patients were instructed to “brush down on the upper teeth and up on the lower teeth.” At that time it was believed that aiming the bristles toward the gumline would only force more bacteria into the crevice. It is now generally accepted that this old theory was flawed because it is only those bacteria which are allowed to form an adherance to the root surfaces that will cause gum detachment.

Using a hard toothbrush is more effective than using a soft toothbrush. False. The bristles of a hard toothbrush are thick and rigid. For this reason they tend not to reach into the tight crevice at the gumline, so the bacterial plaque is left undisturbed. Soft bristles, on the other hand, are thin and flexible which allows them to reach underneath the gumline to loosen the film of bacteria which is adhering to the tooth surface (plaque). Soft bristles are also less likely to cause abrasions at the neck of the tooth.

Gums naturally recede with age. False. Gum recession is caused by bacterial invasion under the gumline, which eats away the bone tissue under the gum. As long as you can keep the crevice under the gumline free of bacterial plaque, the gums should not recede. Often, older individuals have more gum recession (hence the expression “long in the tooth”) only because they are more likely over the course of time to experience periodontal disease (which is the disease process by which the gums recede), however periodontal disease makes no distinctions based on advancing age.

Gum recession means that you do not have good oral hygiene. False. Although in many cases this is true, there are also many people who have a condition known as insufficient attachment of the gums. As the name implies, if there is not enough gum tissue to attach firmly to the tooth and underlying bone, it’s easy for bacteria to encroach under the gumline and cause recession of the bone, which eventually results in recession of the gum.

If you look in your mouth you will notice that there are two distict types of “skin” tissue. Around the teeth there is pale pink gum tissue or gingiva which has a rough texture. This is the true gum tissue, and its purpose is to attach to the bone around the tooth to protect it, and to attach to the surface of the tooth to form a seal which keeps the bacteria out. Further away form the tooth is the much softer, smooth-appearing mucosa, which is the skin that forms the lining of the cheeks and lips. Mucosa, in contrast to gingiva, is very loosely attached to the tissues underneath it.

In many individuals, the zone of gingival attachment is not sufficiently broad enough to allow for a firm attachment which would normally defend the bone around the tooth from bacteria. In fact, in many instances, the zone of attachment is so narrow that it is essentially a loose mucosal attachment, which only provides a minimal degree of protection to the underlying bone. This loosely sealed gum tissue is especially susceptible to periodontal disease, often resulting in severe recession. This phenomenon can occur on any tooth, but is most frequently seen on the lower front teeth.

Prevention of gum recession.

Prevention and early treatment of gum recession are extremely important , because gum recession is usually irreversible. Gingivitis is the first warning sign of gum disease, which is characterized by easily bleeding gums, but this is often overlooked because it may be occurring in between the teeth, and only noticed when bleeding during flossing.
Proper professional care by your dentist is the cornerstone of healthy gums, but correct home care is also essential. In addition to regular flossing ,brushing properly with a soft toothbrush is a must. Since the bacteria which cause gum disease and recession accumulate under the gumline, plaque removal is the single most important preventive measure.