PERIODONTAL DISEASES
Overview of
Periodontal Disease
Periodontal
disease is a localized infection of the gum tissues and underlying
bone supporting your teeth. It is a bacterial infection caused by
the normal germs that grow in your mouth living above and below the
gum collars. Your toothbrush cannot reach the germs below the gum
edge. There is a level of host susceptibility
involved, but most individuals develop some level of gum disease.
The normal
periodontal diseases range from simple gingivitis where gums are
red, puffy and possibly bleed to the outright loss of the bone that
holds your teeth.
If your dentist
does not check your gum collars for bone loss, a developing
periodontal condition will go undiagnosed. At some future
time, the teeth will become lose, drift out of position and develop
infections called abscesses. By the time that this occurs and the
patient seeks treatment, the bone will have been severely damaged.
Gingivitis is
an inflammation of the gum tissues that surround your teeth. Your
gum tissues are responding to mini-infections caused by bacterial dental
plaque growing on your teeth at and under the gums. Dental plaque is
a sticky accumulation of bacteria mixed with food debris. Mouth odor
can also be caused by these oral bacteria.
The visual
signs of gingivitis that you might see in a mirror are redness and
swelling. Bleeding is also common when you brush your teeth. In
addition, you might have bleeding when eating hard foods such as
biting into an apple or hard bread. You should never
have bleeding gums!
With proper and effective oral hygiene care at home, you can eliminate plaque. The early stages of gingivitis can be controlled and the damage reversed with effective oral hygiene care at home and regular periodontal or gum treatments in the dental office. Healthy gum tissues are pink, tight and never bleed.
This patient had severe gingivitis. One week after of treatment the tissues healed dramatically.
The left photo shows developing gingivitis after taking a heart medication causing tissue swelling and early inflammation. This patient was given Norvasc by her physician; other heart drugs that may cause gingivitis are Procardia and Cardizem. This class of medications is called 'calcium channel blockers.' The right photo shows a patient where laminates were placed on her front teeth, but they were done poorly causing severe gingivitis.
Periodontitis
Most patients
progress from gingivitis to periodontitis, the advanced stage of gum
disease, where the inflammation caused by bacteria damages your
bone. Your bone dissolves,
and the pockets or gum collars about your teeth become deeper. The
deepening pockets will hold more bacteria, and the disease
progresses. Without treatment, your gums will lose the connection to
the roots of your the teeth, your bone will dissolve and your teeth
become loose. They may drift out of position and drop down out of
the gums: this is common with the top front four teeth.
Once the bone
is lost, an improvement in oral hygiene and brushing by the patient
cannot reverse the disease as with gingivitis. Now, a periodontist
or highly qualified general dentist is needed to help you. Therapy
involves several stages of care:
1. instruction on special techniques to use at home for daily cleaning of the teeth and gum tissues
2.
gum treatment
consisting of scaling the teeth to remove tartar and the bacteria
growing above your gum collars
3.
scaling the
root surfaces to remove tartar and bacteria growing under the gum
collars within the pockets
4. re-evaluation for additional therapy needs: non-surgical or surgical as appropriate
Non-surgical treatment might include additional scaling and curettage of the gum collars or antibiotic treatment. For the past 12 years, I have successfully placed a special antibiotic cream called Atridox under the gum collar in the deeper pockets with great success. This treatment has eliminated the need for surgery for many of my patients. I have lectured to dentists on this fantastic material and keep statistical data over these 12 years showing consistent results. For some patients who have chronic issues, I sometimes use a 'one-a-day' low dose of antibiotic to control the bacteria under the gum collars.
After
treatment, the patient will return every three (3) months for
follow-up therapy. This is known as periodontal maintenance
treatment. You will be seen by my dental hygienist for a scaling and
polish. They will check the health of the gums and check for
pockets. I inspect each patient personally.
Most of my
patients who have received periodontal therapy over the past 33
years still have their teeth and many continue see me to this day
for their regular maintenance therapy. Some spend their winters in
warmer climates and return each spring for continuing care.
Gum Recession
Gum recession
is a result of bone loss from periodontal disease. After your bone
dissolves from gum disease, the overlying gum tissues frequently
shrink exposing the yellow appearing root of the tooth. This loss of
supporting bone and the covering skin tissue is frequently limited
to the lip side of the teeth.
Recession can
develop due to thin bone in the jaw or from drifting and shifting of
the teeth. Improper tooth brushing technique with medium or hard
toothbrushes can lead to recession as well as orthodontic movement
that move a tooth too far to the lip side of thin bone.
Gum grafting
therapy is highly successful. In each case, the basic treatment is
to provide a graft of collagen from the patient or utilizing
packaged collagen. The specific needs and options available for each
patient are discussed during the consultation appointment.
Gumline Cavities
Aging ‘Baby
Boomers’ and our senior patients commonly develop a dry mouth
syndrome due the reduction of saliva production in the salivary
glands. Aging salivary glands produce less saliva, and many
medications we take have a detrimental side effect
of drying the mouth. Regardless of the cause, the reduction of
saliva production leads to root or gum line cavities.
Gum recession
exposes the soft root surface that is highly susceptible to decay in
a mouth that is dry, or in a patient who does not brush away the
acidic bacterial plaque. Special fluoride treatment is recommended
to harden the root surfaces and protect them from acid decay.
Tooth Mobility
and Drifting
Your teeth support a great amount of bite pressure reaching up to
300+ pounds per square inch in the rear. All the teeth support your
bite and are positioned in your mouth to function together as a
group. Drifting teeth allow other teeth to move, and the problem
compounds.
When you lose
some of your supporting bone, the teeth
can no longer take the normal bite pressures and may drift out of
position. This most often affects the top front four teeth. Spaces
will develop between the teeth, and one or more teeth may appear
longer as they drop down out of place.
When you lose a tooth due to gum disease, decay or a fracture, the adjacent and opposing teeth usually shift position and drift. Once this shift occurs, you may require orthodontics to correct the problem. When a tooth is removed, it is important to replace it to maintain a balanced bite as soon as possible.
This first photo shows loss of gum tissue and bone with drifting of the front teeth. The second shows the upper rear molar tilting and the lower teeth elevating because the missing tooth was not replaced in a timely fashion. The third photo shows posterior upper teeth that have dropped down into the space left when the lower teeth were extracted but not replaced.
Crown Exposure Procedures
Frequently, decay may develop under an old filling or crown, or a tooth will fracture. If this occurs and the tooth is determined to still be strong and functional, your dentist may request that you have a small surgical procedure. To properly fit a crown on a tooth, your dentist must be able to cement it onto a clean and healthy root edge or margin. With decay or fractures that extend under the gum edge, this procedure shifts the gums slightly allowing your dentist to reach healthy root beyond the fracture or decayed edge. He can then prepare the margin and complete the crown.
The case below shows the upper gum tissues leveled and tooth structure exposed for restoration as well as the lower front teeth before and after exposure to lengthen the teeth for laminates.
