Framingham Cosmetic Dentistry - Periodontal (Gum) Diseases

Types & Stages :

Healthy Gums - Healthy gums are generally pink and anchor the teeth firmly in place.

Gingivitis -Gingivitis is an early stage of gum disease. Gingivitis develops as toxins, enzymes, and other plaque byproducts irritate the gums, making them tender, swollen and likely to bleed easily. Gingivitis generally can be stopped with proper oral hygiene and minor treatment from your dentist. If this is achieved, your gums can return to a healthy state.

Periodontitis - Moderate gum disease is when the tooth's bone tissue starts to deteriorate. Periodontitis occurs when plaque byproducts destroy the tissues that anchor your teeth in the bone. The gums deteriorate and begin detaching themselves from the teeth forming gum pockets, which allows more plaque to collect below the gum line. This causes the roots of the teeth to become susceptible to decay. Generally, patients notice an increase in sensitivity to hot and cold and to touch.

Advanced Periodontitis - With severe periodontitis, a radical amount of gum tissue and bone tissue is lost. Usually, teeth lose more support as the disease continues to destroy the periodontal ligament and bone. Teeth become loose and may even need to be extracted. This causes difficulties in normal everyday chewing and biting habits. If advanced periodontal disease is left untreated, patients run the risk of other serious health problems.

Causes/Risk Factors (Medical/Behavioral):

Bacteria - Our mouths are full of bacteria.

Plaque - Bacteria constantly form’s a sticky, colorless “plaque” on the teeth.

Tartar - Plaque that is not removed hardens to form bacteria-harboring "tartar."

Inflammation - Inflammation of the gums is called "gingivitis." If left untreated, it can advance to "periodontitis," which is an inflammation around the tooth that affects the bony support.

Gums Pull Away from Tooth - In Periodontitis, gums pull away from the teeth and form "pockets" that are infected. Plaque and tartar spread and grow below the gum line and break down the bone and connective tissue.

Studies have shown links between periodontal (gum) disease, heart disease and other health conditions. Research further suggests that gum disease may be a more serious risk factor for heart disease than hypertension, smoking, cholesterol, gender and ages. Researchers conclusions suggest that bacteria present in infected gums can become loose and move throughout the body through the bloodstream. Once bacteria reach the arteries, they can irritate them in the same way that they irritate gum tissue causing arterial plaque, which can cause hardening and affect blood-flow.

Warning Signs & Symptoms & Diagnosis:

Plaque is essentially the start of gum disease problems. Plaque is a build-up of particles from the foods you eat every day. Once sugars are introduced to plaque, it turns into a tooth eating acid that sits just above the gum line. If regular oral care isn't standard, the acid will start eating at the teeth and gums. Plaque that is allowed to sit for a prolonged period of time can cause cavities, gingivitis, and other problems in your mouth. If it's left longer than that, serious dental procedures may be required to restore your decaying smile.

Gum disease can expose tooth roots to the elements including all foods and liquids you take in every day. When gums become infected, the roots become more sensitive to hot and cold temperatures. This can be extremely uncomfortable and patients who experience this problem should see a dentist right away.

Prevention:

New patients receive a comprehensive examination which includes a screening for oral cancer, gum and bone disease, blood pressure, and systemic disorders. A routine oral exam is performed on established patients to determine any changes in dental and health status since the previous visit. Your gum tissue is measured with a fine instrument ruler to calibrate in millimeters pocket depth between the tooth and the connective gum tissue around the tooth. Pockets measuring 4, 5, 6 millimeters and up is cause for concern and requires immediate attention. The deeper the pocket, the greater the extent plaque bacteria collects and infection in gum disease develop. X-rays are taken as needed. Tooth scaling and root planing occur as needed. Routine cleanings also include a professional polishing (prophy) that removes only the soft sticky plaque that is above the gum line.

Brushing:

Step 1 - Place bristles along the gum line at a 45 degree angle. Gently brush using a circular motion along the outer and inner tooth surfaces.
Step 2 - Brush each tooth individually. Tilt brush vertically behind the front teeth. Using the front half of the brush, use the same circular motion.
Step 3 - Place the brush against the biting surface of the teeth and use a gentle back-and-forth motion.
Brush the tongue to remove odor-producing bacteria.

Flossing:

Break off about 18 inches of Floss and wind some of it around your middle finger (3 turns). This finger will take up the floss as it becomes dirty. Shorten the length between the two fingers to 6 inches and wind some floss (1turn) around the opposite middle finger. Hold the floss tightly between your thumbs and index fingers. Guide the floss between your teeth using a gentle rubbing motion. When the floss reaches the gum line, curve it into a C shape against one tooth. Gently slide it into the space between the gum and the tooth. Hold the floss tightly against the tooth as you gently rub the side of the tooth with an up and down motion. Before retrieving it, clean the adjacent tooth surface. As you finish cleaning each contact wind the dirty floss once around the first middle finger and slide more new length of floss to proceed to the next contact.

 

Treatments:

Scaling - Tooth scaling removes plaque, tartar and hard crusty calculus deposits, which are loaded with bacteria. Sub-gingival tooth scaling is necessary when plaque and tartar are detected below the gum line.

Planing - After scaling the tooth roots may need to be planed to smooth the root surface. Soft tissue will re-attach itself to a smooth tooth surface. Your dentist may also recommend medications to help control infection, pain, or to encourage healing.

Tissue Graft - Root exposure resulting from gingival tissue recession may pose multiple problems for patients:
- Undesirable esthetics
- Root sensitivity
- Impaired oral hygiene
- Increased caries susceptibility
- Teeth may become loose
A gingival tissue graft will restore the proper gum tissue structure around the tooth.

Flap Surgery - When deep pockets between teeth and gums (6 millimeters or deeper) are present, it is difficult for a dentist to thoroughly remove the plaque and tartar. Flap surgery is a procedure where the gum flap is lifted away from the tooth. Diseased tissue and sometimes bone is removed. The rough surfaces of the tooth are then smoothed by root planing. The area is medicated and the gum flap is replaced and sutured allowing the bone and gum tissue to heal. One of the goals of flap surgery is to reduce the depth of the periodontal pockets to make them easier to keep clean.