What is Periodontal disease?
The word “periodontal” literally means “around the tooth”. Periodontal disease is an infection (or disease) that destroys the gum and bone around the teeth and can ultimately lead someone to lose his/her teeth if too much bone and gum are lost.
Periodontal disease is not always, but many times, a silent threat to one’s teeth. Just like high blood pressure or cholesterol, one may have periodontal disease and not realize it until it is too late. At the end stages of periodontal disease, the teeth begin to loosen and can fall out of the mouth on their own. Periodontal disease affects over 30% of the population. Although periodontal disease is a complex disease, about 50% of the time we find that someone affected will have a family member (mother, father, brother, sister) who had or has the infection.
Very simplistically, there are two types of bacteria in the mouth, “good” bacteria and “bad” bacteria. The “good” bacteria are found in shallow pockets (the area between the tooth and the gum where bacteria can hide) and the “bad” bacteria are found in deeper pockets in the mouth around the teeth. Although periodontal disease is a very complex disease with many factors involved in the process, the loss of the bone and gum around the tooth are due to the person’s body overreacting to “bad” bacteria in the mouth. Everyone has bacteria in the mouth; however, about 30% of the population have a condition in which their bodies see specific “bad” bacteria in the mouth as a threat due to their genetic makeup. These bacteria release poisons around the teeth and cause the body’s immune system to respond to the threat. The body then treats the “bad” bacteria as an infection and recruits cells normally seen in inflammation and infection to destroy the bacteria. The body’s cells then release chemicals to fight the bacteria, which actually harm the body and destroy the gum and bone around the teeth. Therefore, it is not only the “bad” bacteria that cause the bone loss, but the body’s overreaction to the bacteria. Currently, we can not change one’s genetic makeup; however, if we can keep the bacteria levels that cause one’s body to overreact and cause bone loss below the level that the body sees as a threat, then we can control the amount of bone loss and help one maintain his/her teeth. This is where a periodontist can help.
When does it occur?
Periodontal disease can occur at any age. It can occur in children as early as 6-7 years old (this is rare and is called aggressive periodontitis) or much later in life. The vast majority of the time, the process is seen and diagnosed when someone is in his/her 40-50’s (this is called chronic periodontitis). However, the only way to know if you have periodontal disease is to see a periodontist or a general dentist for an evaluation.
What are signs of Periodontal disease? Do you have Periodontal disease?
There can be many signs of periodontal disease or no visible signs at all. The most common signs are:
• Bleeding, swollen gums which may or may not be tender
• Loose teeth that may begin to flare out and sometimes fall out of the mouth on their own (you may have more space between your teeth than before)
• Buildup on your teeth that is not easily removed
• Evidence of bone loss (such as the teeth appearing longer or beginning to see the roots of the teeth exposed in the mouth
• A foul taste or odor in the mouth.
What are possible medical consequences of Periodontal disease?
As stated before, periodontal disease is an infection where one’s body “overreacts” to specific bacteria in the mouth. The body’s “overreaction” by releasing chemicals and cells normally seen in infection and inflammation cause bone, gum, and tooth loss, not the bacteria. The current theory is that this same inflammation that travels throughout the bloodstream may, in some instances, increase one’s risk of having a heart attack, premature low-birth-weight baby, or stroke. There is much ongoing research in these areas of medicine and dentistry to establish the relationship of periodontal disease to other systemic medical problems.
Heart Attack
Researchers have found that a person with periodontal disease has a 2x greater risk of having a heart attack than a person without periodontal disease. One theory is that the inflammation associated with periodontal disease may cause plaque buildup in the arteries and contribute to swelling of the arteries.
Diabetes
Researchers have found that there is a definite link between periodontal disease and diabetes. It has been shown that a person who has diabetes has an increased risk of having periodontal disease. The cause may be that diabetics do not heal as well and are more susceptible to infections. Periodontal disease is the sixth leading complication associated with diabetes. It has also been shown that if a diabetic who has periodontal disease seeks periodontal care, his/her blood sugar levels are easier to control than a diabetic that does not seek periodontal care. Therefore, it is especially important that a person with diabetes maintain good oral care with a dentist or periodontist.
Premature, low birth-weight babies
Researchers have shown that a woman with untreated periodontal disease has a 7x increase in the risk of having a premature, low birth-weight child than a woman without periodontal disease. The current theory as to the reason is that the inflammation seen in periodontal disease may trigger the release of chemicals that cause the uterus to contract and labor to begin. Some studies have shown that actually treating periodontitis during pregnancy can reduce the risks of a preterm baby. If you are pregnant and have any of the signs associated with periodontal disease (please see the section “what are signs of periodontal disease”), it is recommended that you see a periodontist or dentist for an evaluation.
Osteoporosis
There is some new evidence that suggests that a postmenopausal woman has a higher incidence of periodontal disease. This may be the case because a woman with osteoporosis may begin to lose bone density in the jawbone and this could affect tooth stability. However, in one study conducted, estrogen replacement therapy has been shown to help slow the progression of the disease. It is recommended that if a post menopausal woman has signs associated with periodontal disease, she see a periodontist or dentist for an evaluation.
How is Periodontal disease treated?
If you have periodontal disease, it does not mean that you are doomed to wear dentures. If treated early enough and as directed, it is possible to maintain one’s teeth for a lifetime. Treatments consist of either non-surgical or surgical therapies designed to decrease the bacteria levels that cause one’s body to “overreact”. Our goal in treatment is aimed at getting rid of the deep pockets, or craters, around the teeth as listed below.
Treatments
S&RP (Deep Cleaning or Scaling and Root Planing)
This is a therapy in which the teeth and gums are “numbed” just like you were having a filling done. While you are numb, the dentist or hygienist can clean deeply into the gums to remove any buildup on the teeth and can also remove and disrupt the bacteria around the teeth. The goal is to remove hiding places of bacteria and also to remove bacteria, so that the bone loss can be halted. This treatment may be all that is necessary; however, if the disease process is advanced, other treatments may be needed as well. This is described under the heading “osseous recontouring”.
Re-evaluation
A re-evaluation appointment is usually performed after a S&RP (deep cleaning) appointment to determine how effective the therapy has been thus far. It is much like the initial appointment, but we are checking to see if areas have improved due to our therapy and we determine what further course, if any, is needed at this appointment as well.
Osseous Recontouring
Osseous recontouring is a procedure that is performed if there is significant bone loss around the tooth. In this procedure, the gums are gently pushed back so that the infection around the tooth can be removed, and the tissue is recontoured so that any remaining “hiding places” for bacteria are resolved. The goal of the procedure is to allow “good bacteria” to maintain in the area and to eliminate the “bad bacteria” that live in deeper sites around the teeth when one has periodontal disease. This therapy is very effective in periodontal treatment.
Maintenance
A periodontal maintenance appointment is essentially a regular cleaning appointment where your teeth are cleaned, polished, and checked to make sure your periodontal disease is under control. The maintenance appointment usually occurs every 3-6 months depending on one’s periodontal situation and need. We prefer to alternate these appointments between the periodontist and the general dentist (i.e. one would see the periodontist for the maintenance (cleaning) and 3-6 months later his/her general dentist for the cleaning). This way, the periodontist can keep a close watch on the gum and bone levels, and the general dentist is looking at this issue and possible cavities as well.
Can Periodontal disease come back?
The short answer is yes. There is no cure for periodontal disease, only treatment. If one does not follow up with the recommended periodontal care, the “bad bacteria” levels once again rise, the body once again overreacts to these bad bacteria, and the process begins again. However, with recommended periodontal care and good home care, usually periodontal disease can be controlled and one can maintain his/her teeth.
I have Periodontal disease. Are my children at risk?
The answer is yes. If they are your biological children, they have about a 50% chance of developing periodontal problems since we see a genetic component to the disease. It is recommended that your children have regular dental checkups to monitor their oral health.
What are the consequences of no treatment?
If no treatment is performed to stop the continued bone loss seen in periodontal disease, the person will continue to lose so much bone around the teeth that the teeth can ultimately get loose and fall out of the mouth or need to be removed. The earlier periodontal disease is treated, the better chance one has to maintain his/her teeth for a lifetime. Therefore, an evaluation by a periodontist is highly recommended.
