Gum Disease

What is gum disease?
Gum disease or periodontal disease, a chronic inflammation and infection of the gums and surrounding tissue, is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life.

What causes gum disease?
Bacterial plaque - a sticky, colorless film that constantly forms on the teeth - is recognized as the primary cause of gum disease. Specific periodontal diseases may be associated with specific bacterial types. If plaque isn't removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar). Toxins (poisons) produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums rightly to the teeth, creating periodontal pockets, which fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

Do some factors increase the risk of developing periodontal diseases?
Yes, some factors can increase the risk of developing periodontal diseases. If one or more of the following apply to you, it is especially important that you practice good oral hygiene and follow your dentist's advice to maintain healthy teeth and gums.

• People who smoke or chew tobacco are more likely to have periodontal disease. And it's more likely to be more severe than in those who do not use any tobacco products.
• Some systemic diseases, such as diabetes, can lower your body's resistance to infection, making periodontal diseases more severe.
• Many medications, such as steroids, some types of anti-epilepsy drugs, cancer therapy drugs, some calcium channel blockers, and oral contraceptives can affect the gums. In addition, medications that reduce your salivary flow can result in a chronically dry mouth, which can irritate your oral soft tissues. Let your dentist know about your medications and update your medical history files at the dental office when any changes occur.
• Bridges that no longer fit properly, crooked teeth or fillings that have become defective can contribute to plaque retention and increase your risk of developing periodontal disease.
• Pregnancy or use of oral contraceptives increases hormone levels that can cause gum tissue to be more sensitive to the toxins and enzymes produced by plaque and can accelerate growth of some bacteria. The gums are more likely to become red, tender and swollen, and bleed easily.

Are there other factors?
Yes. Genetics is also a factor, as are lifestyle choices. A diet low in nutrients can diminish the body's ability to fight infection. Smokers and spit tobacco users have more irritation to gum tissues that non-tobacco users, while stress can also affect the ability to ward off disease. Diseases that interfere with the body's immune system, such as leukemia and AIDS, may worsen the condition of the gums. In patients with uncontrolled diabetes, where the body is more prone to infection, gum disease is more severe or harder to control.

What are the warning signs of gum disease?
Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, puss between the gum and tooth, persistent bad breath, change in the way teeth fit together when the patient bites, and a change in the fit of partial dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That's why patients are advised to get frequent dental exams.

What does periodontal treatment involve?
In the early stages, most treatment involves scaling and root planning - removing plaque and calculus around the tooth and smoothing the root surfaces. Antibiotics or antimicrobials may be used to supplement the effects of scaling and root planning. In most cases of early gum disease, called gingivitis, scaling and root planning and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums, and removing the hardened plaque build-up and recontouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.

How do you prevent gum disease?
Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. Your dentist can design a personalized program of home oral care to meet your needs. If a dentist doesn't do a periodontal exam during a regular visit, the patient should request it. Children also should be examined.

What is the role of the general dentist?
The general dentist usually detects gum disease and treats it in the early stages. Some general dentists have acquired additional expertise to treat more advanced conditions of the disease. If the general dentist believes that the gum disease requires treatment by a specialist, the patient will be referred to a periodontist. The dentist and periodontist will work together to formulate a treatment plan for the patient.

Is maintenance important?
Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of therapy. Patients should visit the dentist every 3-4 months (or more, depending on the patient) for spot scaling and root planning and an overall exam. In between visits, they should brush at least twice a day, floss daily, and brush their tongue. Manual soft nylon bristle brushes are the most dependable and least expensive. Electric brushes are also a good option, but don't reach any further into the pocket than manual brushes. Proxy brushes (small, narrow brushes) are the best way to clean in between the recesses in the teeth, and should be used once a day. Wooden tooth picks and rubber tips should only be used if recommended by your dentist.

Reprinted from AGD.

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