Framingham Cosmetic Dentistry - Periodontal (Gum) Diseases

Definitions:

Plaque - It is your oral health enemy. It is a silky film of combined food-bacteria that forms on teeth or at the gum line. Plaque breaks down sugars and starches in food and produces acids which penetrate the surface of the teeth, causing cavities (initially, chaulky-white de-mineralized teeth surface.) Plaque also produces by-products (toxins/enzymes) which irritate the gum and lead to gingivitis and eventually to an advanced stage of periodontitis.

Tartar (calculus) - It is calcified/hardened plaque combined with salivary minerals, left behind for more than 15 days, as a result of poor brushing/flossing. It is light brown, rough, hard, and stuck to the teeth, that cannot be brushed away anymore at home and needs to be removed professionally at a dental office. If it is not removed, it becomes a “plaque trap” harboring more bacteria and worsening the condition. It can be located even under gum line or above that, on the teeth. It is mostly seen on the back of lower front teeth.

External Stain - It is superficial brown discoloration on the surfaces of the teeth, acquired mostly by consumption of dark fruits (e.g. berries), meal coloring spices (e.g. paprika), drinks (e.g. soda, coffee, wine), as well as frequency of professional cleaning are factors that affect teeth staining/ darkening.

Gingivitis - It is the earliest stage/form of periodontal disease, mostly referred to as the inflammation of the soft tissue gum, around the teeth.

Periodontitis - It is untreated gingivitis which can progress and eventually involve the underlying tooth-supporting structures, including jaw bone, irreversibly. Simply put, it is a progressive bacterial infection that is a leading cause of tooth loss among adults, even though it can affect individuals of all ages from children to seniors. It can have a devastating impact on oral function and appearance.

Warning Signs & Symptoms & Diagnosis:

On the early stages, gums are red, swollen and easily bleed during brushing/flossing. The snug fitted pink healthy gum tissue, cuffing around the teeth, becomes loose, pulled away from teeth, and form pockets all around teeth that promoted collection of more plaque/calculus. The enlarged/deepened pockets allow food impaction as well as harmful bacterial accumulation which make it more and more difficult or impossible to practice effective oral hygiene. This inflammation/infection destroys the tissues that support teeth. It can be initially painless yet gradually worsen, presented with full blown sign and symptoms including tender receding gums (exposed roots), halitosis (persistent bad breath/foul odor), pus between teeth/gums, abnormal large spaces between teeth, mobile (loose) teeth and a change in the way your teeth fit together when you bite. Left untreated periodontal disease may eventually lead to more and more bone loss and even insufficient bone height which will not allow for any future replacement options, such as implants or even removable dentures (plates).

Types & Stages:

There are many types of periodontal disease. It starts from gingivitis and can lead to the following different types: chronic periondontitis (progressive loss of gum/bone), aggressive/juvenile periondontitis (rapid loss of tissues), necrotizing periondontitis, and periodontitis of systemic disease. Depends on the severity of the condition and bone loss, periodontal disease are categorized based on the stage they are diagnosed, such as early, moderate, severe periodontits. They are also classified as localized vs. generalized, as well as types I through V by the professionals.

Causes/Risk Factors (Medical/Behavioral):

The mouth is filled with countless bacteria, and at least 30 types of bacteria can produce periodontits. In addition to inadequate/poor oral hygiene/home care, there are several factors that increase the risk of developing periodontal disease, such as: smoking/chewing tobacco, systemic diseases (diabetes, HIV/AIDS infections), medications (steroids anti-epilepsy drugs). Other factors such as poorly-fitted dental prostheses, pregnancy and genetics can also play as fact ors to this infectious disease.

Local & Systemic Sequalae:

Periodontal disease plays a role in overall health, in addition to what it does locally in the oral cavity. Researchers have found that periodontal disease and other health problems such as cardiovascular disease (heart attack), stroke, and bacterial pneumonia are associated. Studies also suggest that pregnant women with periodontal disease may be at increased risk for delivering a pre-term and/or low birth-weight baby.

Prevention:

Three out of four adults are affected by gum disease at some point in their lives. You can help control the disease. Fight gum disease where it starts….do not wait until it hurts. Brushing your teeth at least twice daily and cleaning between your teeth daily with floss can help keep teeth/gums clean. Other specialized dental home care adjuncts/aids such as antimicrobial mouth rinses, water irrigator, etc can also further improve your oral health. In addition to good oral hygiene, eating a balanced diet/nutritious food for good general health and limiting especially sweet snacks can prevent the risk of these diseases. Regular maintenance dental check-ups, professional prophylaxis (cleaning), as well as visual and x-ray examinations of your oral cavity, every 4-6 months, also help ensure a lifetime of fresh, healthy and beautiful teeth, gums and smile.

Treatments:

Treatment methods depend upon the type and severity of the disease. It can simply be instruction on improving your daily oral hygiene, introduction of stronger mouth-rinses, antibiotics, bite correction, and/or one of the following common periodontal treatment modalities:

Non-Surgical - Scaling and root planning: special “deep” cleaning which involves removing plaque, tartar and stain deposits on the teeth and root surfaces, under local numbness/Novocain, to make you more comfortable during the procedure. Patients occasionally have sensitive teeth (to touch, temperature, or acidic drinks) temporarily, following periodontal procedures, when unwanted deposits are removed from root surfaces. This treatment can be scheduled for more than a visit. Localized chemotherapeutic antibiotics: substances directly placed in the periodontal pockets (below the gum-line) around the teeth.

Surgical - Soft-tissue (gum) surgery: reshaping or reducing gum line to achieve optimum ease of the teeth to re-create the normal bone architecture/shape. It might be necessary to graft artificial bone around some teeth.

No periodontal treatment can really reverse the condition or the already compromised foundation of the teeth, even though some regeneration may occur after some procedures. It may reduce the amount of the future deterioration and loss, ONLY if the patient is following the maintenance instruction given by the treating dentist completely. These treatments can be recommended and rendered by your family dentist, or co-managed with the effort of a periodontist (gum specialist). The follow-up/maintenance visits may alternate between your dentist and a periodontist. There are also wide varieties of periodontal procedures which are not introduced here, such as crown lengthening (removing some tissues around teeth to allow restoration), gum grafting (treatment of severely receded gum) or cosmetic/plastic surgeries.