I don’t have gum disease, do I?

Most people don’t know they have periodontal (gum) disease, or even that the specialty of periodontics exists, until their dentist brings it to their attention. One of the reasons it comes as a surprise is that periodontal disease (also known as periodontitis, gum disease, or pyorrhea) is a silent disease, with few obvious symptoms in its early stages.

Periodontitis is a chronic disease. It takes a long time to develop and can be characterized by short periods of rapid tissue breakdown, followed by long periods of quiescence. With treatment, a periodontal condition can be controlled and maintained.

How do you know you have periodontal disease? The signs are subtle at first, and often can only be detected by a dentist or hygienist. These professionals are trained to look for:

• Pockets: Pockets occur when the collar of gum becomes infected and detaches from the tooth - creating a space. This space is a "pocket." A pocket is not necessarily formed when food gets stuck between teeth.
• Bleeding: In spite of its common occurrence, gums are not supposed to bleed any more than fingers, ears, or noses do on their own. If any of those start hemorrhaging, everyone knows to stop the bleeding, and look into it if it recurs. But when gums continue to bleed, many simply ignore it, as if it were "normal." Bleeding gums are not normal. When gums bleed, at the very least, a minor, reversible problem exists. Sometimes the bleeding is a sign that there are deeper problems, and without some kind of treatment, pockets and bone loss will continue to occur.
• Bone loss: Dental x-rays, taken at regular intervals, chronicle bone levels surrounding the teeth. Subtle changes can be seen, and when they are observed, they are definite markers that periodontal breakdown is occurring. Bone loss left untreated, progresses until teeth are compromised. Fact: seventy percent of all teeth removed from adults is from bone loss due to periodontal disease…not decay.
• Loose teeth: Often early signs of loose teeth are detected by the dentist or hygienist, not by the person. Looseness in teeth is a sign that something is wrong. When discovered, the cause needs to be determined and corrected.
• Spaces forming between front teeth: In general, teeth don’t shift their position, though crowding of the lower (mandibular) front incisors does occur as we age. However, when spaces start forming between some of the upper (maxillary) front teeth, it’s time to figure out why. Sometimes, so many new dental restorations have been placed on the back teeth, that the front teeth shift. This happens. But the more common reason for front teeth to flare out is due to advanced bone loss and the lack of tooth support that comes with progressive periodontal disease. Once it occurs, it should be treated before it gets worse.
• Halitosis: Bad breath may be a sign that significant periodontal problems exist in someone’s mouth. Once the periodontal problems are under control, bad breath often goes away.
• Abscess: Occasionally, the first time a person knows they have a gum problem is when they get a periodontal abscess. An abscess occurs when bacteria are trapped in a gum pocket. They have no way of escaping and the pocket expands, forming an abscess. If treated in time, little damage is done to the surrounding bone and tooth. Not treating an abscess in time, can lead to rapid and severe bone. When this happens, additional periodontal treatment is needed.

Like all chronic diseases, periodontal disease doesn’t go away. It won’t get better by itself. It can remain silent and in remission, only to act up at a later date. As the condition worsens, it’s harder to successfully treat. That’s why once gum problems are noticed or diagnosed, it’s best to initiate treatment as soon as possible.

Who treats periodontal disease?

Your dentist should be the first line of defense in treating your gum condition. Once he or she discovers that you have periodontal disease, a program to return your gums to good health should be initiated. Many dentists employ dental hygienists. Hygienists are specially trained to recognize and treat the early stages of periodontal disease. (However their are limits as to what hygienists can do for patients).

In advanced cases, thorough dental cleanings and scalings (sometimes curettage) and improved oral hygiene techniques, are not enough to treat periodontal problems. More has to be done to the pockets and bone. Many dentists are comfortable performing these procedures, and can effectively treat your periodontal condition. Some dentists are more familiar with bonding and bleaching and restoring teeth, and prefer to recommend dental specialists to treat advanced periodontal cases. That’s where periodontists come into the picture.

Periodontists

In a sentence, periodontists are charged with saving teeth. That’s their mission and goal for all patients. There are a variety of ways they do this. When teeth can no longer be treated and need to be removed, they are often replaced with titanium dental implant fixtures. These dental implants are as strong (actually they’re stronger) than natural teeth, and allow the patient to keep an intact set of teeth (dentition) without the need for removable bridges or dentures.

Once a diagnosis has been made and treatment plan established between the patient, their dentist, and the periodontist, the actual periodontal treatment is often performed in two phases.

The first phase is the initial preparation. This is when the patient learns how to properly brush their teeth and use dental floss. They are taught and encouraged to remove the bacterial film - called plaque - that sticks to their teeth and dental restorations. During these visits, the dentist/dental hygienist/periodontist, performs multiple scalings of the teeth, attempting to remove all the plaque and tartar (calculus) stuck to the teeth. Often, changes can be seen right away. Bleeding from the gums is reduced and the pockets get smaller. How much the pockets shrink indicates what is to be done for phase two.

The second phase of periodontal treatment consists of reevaluating the pocket depths and seeing if gums still bleed after the initial scalings. The more the patient exercises effective oral hygiene techniques, the more they can improve their condition. There are times when additional scalings help attain the goal of smaller pockets. But if the pockets are too deep at the time of reevaluation, then more treatment is needed before returning the dentition to periodontal health.

Surgery. Periodontal surgery helps save teeth. When the pockets are so deep that scalings will not effectively clean them out, the dentist or periodontist gently separates and peels back the gums from the underlying structures. Tartar and plaque can then scraped off the roots, much the same way splinters need to be removed when they’re stuck under the skin. But periodontal surgery accomplishes more than just scraping off tartar and plaque.

We know that bacteria impart chemicals onto the root surface called endotoxins. These endotoxins must be removed if connective tissue is to reattach to the roots, in the quest of making pockets smaller. Without removing the endotoxins, periodontal treatment is hampered. One way to remove endotoxin is to leech it out of the roots with mild acids…citric acid and tetracycline being two that are often used. Surgical access is essential to accomplish this. The other way to get the endotoxins off the roots is to scrape them off with careful scaling. Both are effective techniques performed during periodontal surgery.

Benefits: Surgical treatment results in cleaner roots, shallower pockets, and healthier gums. The patient and dental professional who treats them, can effectively maintain their periodontal health in this new and improved environment

What other treatments do periodontists perform?

Periodontists are dentists who have taken two or three years of advanced training beyond their dental school education. (As of 1997, all periodontal residencies have been lengthened to a minimum of three years). Like medical specialists, periodontists concentrate and gain expertise in one specific area. In this case, periodontists treat periodontal diseases and place dental implants and perform cosmetic dental surgeries.

What else do we do?

• Bone grafts to regenerate lost bone around teeth
• Gum grafts (called free gingival grafts, autogenous gum grafts, pedicle grafts, etc.) that cover exposed roots, increased the zones of attached gingiva, and thicken the gums when needed for cosmetic reasons
• Cosmetic surgeries - excessive gum is trimmed away, or thickened when needed.
• Dental implants - both for single or multiple teeth
• Remove teeth
• Adjust the bite
• Make nightguards
• Ridge augmentations (this replaces the tissue that’s lost when teeth are removed. It will make bridges more cosmetic. In some instances, ridge augmentations widen the jaw bone in places that would be too narrow to received dental implants.)
• maxillary sinus lifts and other jaw reconstruction techniques
• minor tooth movement (orthodontics) to correct some crooked teeth
• clean teeth

For more information about periodontists, contact the American Academy of Periodontology, 737 North Michigan Avenue, Suite 800, Chicago Illinois 60611-2690

http://www.perio.org or call at 1-800-282-4867.

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