TOOTH TALK: Treating periodontal disease

Dr. Igor Kaplansky

While spending money on fancy tooth whiteners for a selfie-ready smile, many people are overlooking an oral issue far worse than a cavity or chipped tooth. The American Dental Association reported that about half of all adults will have some form of periodontal disease, the biggest cause of tooth loss in adults aged 35 and older. PD ranges from simple gum inflammation to serious disease that can result in major damage to the soft tissue and bone that support the teeth.

Our mouths are full of bacteria, and along with mucus and other particles, they continually form a sticky, colorless “plaque” on teeth, that proper brushing and flossing clean away. Plaque that is not removed can harden and form tartar that will need removal by a dentist or dental hygienist, so it does not become a precursor to gingivitis. Built-up plaque and tartar cause inflammation of the gums. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular professional cleaning. In gingivitis, the gums become red, swollen and can bleed easily.

Neglected gingivitis can advance to periodontitis (“inflammation around the tooth”), in which gums pull away from the teeth and form pockets of infection. Your body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums and tissue that support the teeth are destroyed.

According to the National Institute of Health, smoking is one of the most significant risk factors associated with gum disease and inhibits healing. Hormonal changes in girls and women can make gums more sensitive and make it easier for gingivitis to develop. People with diabetes are at higher risk for developing infections, including gum disease.

Diseases such as AIDS and its treatments, and cancer treatments, can also negatively affect the health of gums. Hundreds of prescription and over the counter medications reduce the flow of saliva, making the mouth vulnerable to infections such as gum disease. Some medicines cause abnormal overgrowth of the gum tissue, making it difficult to keep teeth and gums clean.

And, some people have a genetic susceptibility that makes them more prone to severe gum disease than others.

People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have it. Although teenagers rarely develop periodontitis, they can develop gingivitis. Symptoms to watch for include persistent bad breath, red or swollen gums, tender or bleeding gums, painful chewing, loose or sensitive teeth, receding gums or longer appearing teeth.

If symptoms are advanced, your dentist may use an X-ray to see whether there is any bone loss, or refer you to a periodontist, an expert in the diagnosis and treatment of gum disease.

In advanced cases, plaque can be removed through several methods: Scaling, scraping off tartar from above and below the gum line; planing the root, which gets rid of rough spots on the tooth root where germs gather; and, in some cases, lasering. The latter procedure can result in less bleeding, swelling and discomfort compared to traditional deep cleaning methods. Medications may then be recommended to control bacteria.

Surgery might be necessary if inflammation and deep pockets remain. A dentist or periodontist may perform flap surgery to remove tartar deposits in deep pockets, or to reduce the pockets and make it easier to keep the area clean. This common surgery involves lifting back the gums and removing the tartar. The gums are then sutured back in place so that the tissue fits snugly around the tooth again. This sometimes results in the teeth appearing longer.

In addition to flap surgery, your dentist may suggest procedures to help regenerate any bone or gum tissue lost to periodontitis. Bone grafting, in which natural or synthetic bone is placed in the area of bone loss, can help promote bone growth. Guided tissue regeneration, in which a small piece of mesh-like material is inserted between the bone and gum tissue, helps keep the gum tissue from growing into the area where the bone should be. In cases where gum tissue has been lost, a soft tissue graft may be recommended to cover exposed tooth roots.

Every case of periodontal disease is different but in the vast majority of cases, the consequences could have been avoided by proper oral care. Brushing, flossing and regular checkups will keep your mouth and gums healthy.

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