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Periodontal Disease

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Periodontal (gum) disease is insidious. It is an infection of the gums that starts out as plaque, an opaque film on the teeth that hardens to form tartar. As tartar accumulates, it harbors bacteria that attack the soft tissue around the gums. This is the early stage of gum disease known as Gingivitis. Left untreated, Gingivitis becomes Periodontitis which ultimately destroys the tissue surrounding your teeth AND the bone that holds your teeth in place. Except for bad breath and gums that bleed, there are very few early warning signals. The disease advances silently, often without pain, and before you know it, you are losing your teeth and you don't know why.

Tooth loss is only the most obvious indicator of gum disease. Scientific research has discovered linkage between gum disease and stroke, heart disease, diabetes - even an increased risk for pregnant women. When your gums become diseased, your entire immune system is weakened.

In the past, fear of painful dental surgery has kept people with gum disease from seeking the care they needed. Well, those days are gone forever.Lasers allow for much more conservative periodontal surgery with greatly reduced post operative pain. Laser procedures are done without scalpels, sutures, or the usual bothersome packing that make these surgeries so uncomfortable.

Periodontitis ..What is it?

Periodontitis is a form of gum disease. It is a chronic infection of the gums which is characterized by a loss of attachment between the tooth and the jawbone. It is the leading cause of tooth loss among adults in the United States.

Teeth are attached to the jaw by a series of very strong ligaments. The gums are also connected to the tooth by a complex series of microscopic fibers; and the gums lay over the tooth-bone attachment like a protective cover. Periodontitis begins in the shallow pocket where the tooth and gum meets, usually as a milder form of gum infection known as gingivitis. Bacteria can grow in this pocket, usually due to inadequate oral hygiene. The gum begins to pull away from the tooth deepening the pocket, making it harder to clean and encouraging the formation of tenacious tartar deposits below the gumline.

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Bone is lost as the infection progresses down the root and pockets form

Over time this infection can cause inflammation in the bone, causing it to slowly disappear, undermining the attachment to the tooth. This loss of bone is what distinguishes periodontitis from gingivitis, where no bone loss occurs. After many years this can lead to tooth loss.


Diagnosis

Periodontal disease is diagnosed with a thorough periodontal exam. A small, blunt probe is used to measure the depth of the gum pockets around every tooth in the mouth. Measurements are taken at six sites on each tooth. This depth gives an objective gauge of the health of the gums. If the pockets bleed easily during probing this is noted as well. This bleeding is a sign of inflammation of the pocket. The appearance of the gums is noted; infected gums appear red and puffy. The amount of tartar, or calculus, is determined. The mobility of all teeth is checked and the bite is evaluated. X-rays of all teeth are needed to evaluate the condition of the bone around each tooth and show calculus deposits below the gumline.

Bone loss on xray

Probing and xray showing loss of bone around teeth

Our office also now uses DNA testing by OralDNA Labs. There are two tests. The more common one identifies the patient's specific types of bacteria and recommends the proper antibiotics. The other test evaluates the patient's own DNA foe a specific enzyme that raises their risk of periodontitis.

A bite evaluation is important as well. We now use the T Scan III computerized bite analyzer. This innovative device shows the bite forces on each tooth in the mouth with great precision. It has been an invaluable tool in diagnosing the bite's role in accelerating periodontal bone loss.

Treatment

It is important to realize that periodontitis is chronic, insidious, and episodic in nature....

Chronic- Periodontitis is typically a slow moving condition, taking many months or even years to develop. Once the disease develops and is diagnosed, it is never really cured. Instead it is managed, much like other chronic conditions like high blood pressure or diabetes.

Insidious- Periodontitis is usually silent until its later stages. That is, patients typically have no symptoms until the disease has progressed very far. It must be diagnosed through a thorough periodontal exam. Symptoms which do occur late in the disease are bleeding gums, sore or itchy gums, loose teeth, change in bite, bad breath, and acute gum abscesses.

Episodic- The actual disease activity of infection causing bone loss does not occur at all times in all places in the mouth. Instead, the active stages occur in an on/off fashion at various locations in the mouth. This can only be determined by accurate exams initially and at recall.

These above factors are important to understand the treatment of periodontitis. The goal is to control the current active infection and then closely monitor for signs of disease activity on a regular basis. Once susceptible to this disease it must be monitored for the rest of the patient's life. The ultimate goal is to prevent further bone loss and keep the teeth involved for as long as possible.

Treatment regimens are determined on an individualize basis. Most traditional treatments follow the same basic pattern for mild periodontitis.First the infection is disrupted by thorough cleaning below the gumline by the doctor or hygienist. This cleaning is called "scaling an root planing" and may take one to four or more appointments. Local or topical anesthesia can be used for patient comfort. The goal is to remove the tartar and bacteria from the root surfaces to allow healing and reattachment of the gums. An individualized home care regimen is devised for the patient to control plaque. Plaque contains the bacteria which cause the disease and plaque hardens to become tartar. Controlling plaque levels through proper home care is critical to the success of the treatment.

The gums are given time to heal once scaling is done(2-4 weeks) and the mouth is reexamined to evaluate the success of the treatment and determine the need for further care. At this point laser treatments can be used to reduce localized pocketing.

Laser surgery, such as the Wavelength Optimized Periodontal Therapy we employ, is indicated for moderate to severe cases. Laser surgery of pockets kills many of the offending bacteria, removes diseased tissue, and encourages gum reattachment to the teeth. This can often be done without scalpels, sutures, or the discomfort associated with traditional periodontal treatments.

A recall interval is determined. Regular recall visits are crucial for managing this disease over the long term. Frequent recall allows regular, early removal of tartar accumulations, disruption of bacteria in deeper pockets, and close monitoring of disease activity throughout the mouth. Any further treatment needs can be addressed as soon as possible.

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