Gum Disease and Gum (Periodontal) Treatment

Gum disease is prevalent in one form or another in over 80% of the adult population. It is prevalent in children as well. With the high sugar, low nutritional diets of today's children and their parent's gum disease as well as overall health is getting worse rather than better. Gum health is often indicative of overall health. Let's look at some of the gum (periodontal) conditions and their treatment.

Gum Disease- "My gums only bleed the normal amount"

The earliest stage of gum disease, gingivitis or gum inflamation, usually can be stopped before it causes significant destruction of soft tissue or bone. Sometimes the gums bleed when you brush. You should wet your toothbrush and brush your teeth and check the brush to see if there is any pink coloring on the bristles. If you see pink or red, you certainly have some form of gum disease. If nothing is present, you may have gum disease and it may have advanced to the point where it no longer bleeds easily...unfortunately this may be a worse sign than is there were pink present. Make sure to ask your dentist to assess the health of your gums and bone. Most cases of gingivitis (early gum disease) can be treated with a combination of special in the dental office gum therapy, therapeutic agents, advanced tooth and gum cleansing instruments. If you are a smoker, you create the environment for gum disease to flourish. Smokers are significantly more susceptible to gum disease, bone and tooth than non-smokers.

"I have noticed that my teeth have moved, have spaces between them or seem a little loose"

As gum disease progresses, conditions caused by infections of the bone and the surrounding soft tissue and gums that support the teeth in the jaw become prevalent. The big problem for you is that these conditions rarely hurt or are uncomfortable until it's too late. The disease can progress unabated, causing destruction of the soft tissue and bone, which leads directly to unsightly teeth, bad breath, loose teeth, chronic infections and tooth loss. To combat this condition, an aggressive defensive attack of the contributing factors and the offending pathogens is necessary. Therapeutic treatment ranging from removing the calculus (tartar) and detoxifying the root surfaces along with anti-microbial (killing the germs) therapy to sophisticated periodontal (gum and bone) surgery, possible laser therapy. If you are fortunate enough to discover your periodontal conditions early enough, there may be an opportunity to replace lost bone and gum tissue to regenerate that which has been destroyed. Your dentist will be able to assist you in developing a plan to help you save your teeth if you haven't waited too long.

Providing you haven't waited too long, there are treatments available to you at various stages of periodontal disease can make you, you gums and the bone supporting the teeth healthier. In past generations, people felt that losing teeth was a normal part of getting older, much like losing hair and getting g wrinkles, but that does not have to be the case with your dental health. With the miracles of today's dental treatments nearly everyone can keep their teeth if they are willing to seek the counsel of a dentist who helps people save their teeth. With appropriate support from your dentist to keep your gums and bone healthy, you should be able to keep your own teeth for the rest of your life. (If you have indeed waited too long, all is not lost. With the advent of implants and bone grafts, even if you have lost your teeth, you may be able to get new teeth back..Ask your dentist what's possible for you.)

The main goals of periodontal treatment are to:

My Gums have Receded and my tooth looks longer. Do I have gum disease?

Your gums can recede, shrink and make your tooth look longer even if there is no infection present. One of the most significant causes of receding gums is a malfunctioning bite. (Think of it as how your teeth fit together when you chew. If they fit together poorly, you can easily damage the tooth, the bone and the gum. Sometimes only 1 of them is affected, other times more than 1 or all are involved. The bone can literally destroyed by the abnormal, stressful forces on the teeth and the gum can recede down the root of the tooth when this occurs. Using a hard- or medium-bristled toothbrush can cause gums to be moved away. Applying too much force even with a soft bristled tooth brush can also cause gums to recede over time. The best brush to use is either a soft bristle manual brush with normal force or a dentist recommended electric tooth brush or cleansing device. The bad news is that when the gums recede, the roots of the teeth (softer and far less protected than the top part of the tooth) are exposed to all the elements that are present in the mouth. Teeth can become sensitive to hot and/or cold temperature changes. Some foods, particularly sweets can really cause sensitivity. On top of that, when gum recession is present, the root surfaces are more prone to developing root cavities. The good news is that many times this recession can be treated and reversed. Gum tissue grafts or regeneration procedures can cover the exposed root surfaces and return you teeth to a healthier situation.

When I smile, I show lots of gums. I have Gummy Smile.

Some people have what is known as a "gummy smile." This condition is prevalent where the teeth look normal or smaller looking and the gums are more prominent. (It reminds people of the TV horse of years past, Mr Ed.) A dramatic change can occur when the excess gums are reshaped and redesigned to create a normal healthy appearance. Some people have this as a result of the way their face has grown. Other people who are taking prescription medications for medical problems that can stimulate gum growth and you can end up with an overgrowth of gum tissue. Excess gum tissue can be removed and the tissue can be properly reshaped to treat a healthier and more appealing smile.

Scaling And Root Planing (Smoothing and detoxifying the roots)

Scaling and root planning, as it is technically known, is a conservative and many times, a very effective form of treatment for gum disease. Especially in the early stages of gum disease, like gingivitis, scaling and root planning, along with an evaluation of contributing health factors that you may be causing, may be all that is needed to get the disease under control. With more advanced gum disease, this would be the preparatory phase or initial therapy before the corrective surgical treatment.

Why Scaling and Root Planing can help you save your teeth.

Scaling is the removal of calculus (tartar) and plaque from the tooth. Gum disease is particularly a problem when the calculus (tartar) gets below the gum on the root surface where you can no longer clean it. It becomes a haven for pathogens who are up to no good. Special ultrasonic scalers can be used to initially break down the hard calculus. Then, special hand-held instruments like scalers and curettes are used to do fine scaling. Bacteria is more likely to stick to the rough surfaces (the root). The root surface is smoothed in a process called root planing. This helps removes any remaining calculus or "contaminated" cementum on the root and leaves the surface less susceptible to the bacteria. If you have gingivitis or periodontitis that is localized to one part of your mouth, scaling and root planing can be done in just that area. However, if you have a more generalized form of periodontitis spreading throughout your mouth, your dentist typically will do a quarter(a quadrant) or half of the mouth at one time. This means that two to four visits may be necessary to complete the scaling and root planing.

Will this be uncomfortable to me?

For some patients, scaling and root planing could be uncomfortable without the area being numbed. Generally the dentist will numb the portion of the mouth being worked on. For two to three days after the treatment, you may have some tenderness and increased sensitivity to hot and cold temperatures, so you will want to avoid any drastic temperature deviations. To treat tenderness, warm salt water rinses or a special rinse recommended by your dentist will be very helpful. To relieve any discomfort an over-the-counter pain reliever like Advil or Aspirin will be useful.

What to do after treatment.

Patients may be asked to rinse with warm salt water periodically, about five times during the day, for the first day, to flush out any debris loosened by the treatment. Normal brushing and flossing should be continued. There may be some minor bleeding, but this is normal and will stop in a day or two. Some patients may be prescribed an antibiotic, an antimicrobial or a fluoride rinse. Your dentist will know what will be best in your particular situation.

Possible Side Effects Of Scaling and Root Planing Treatment.

One of the symptoms of some periodontal diseases is swollen gums. Treating gum disease decreases the inflammation and also gets rid of pockets (spaces where bacteria and debris can hide) that can trap plaque. Sometimes the pocket heals and shrinks and the gums will get less prominent or recede. It may be as little as one or two millimeters, or possibly more. There is always the possibility that due to the recession some of the root may be exposed, which will make the tooth look longer, make the tooth more sensitive to hot and cold temperatures and make root cavities more likely. This can be treated with a different type of gum therapy.

Antimicrobial Therapy

Because periodontal diseases are basically due to bacterial infections, your dentist may use antibiotics to treat them. Gum abscesses ("gum boils") are probably the most common situation for which your dentist might prescribe antibiotics. Other circumstances that might warrant their use are severe forms of periodontitis or poor responses to conventional modes of periodontal therapy. If antibiotics are indicated, your dentist will prescribe one of the medications that are known to be effective against the bacterial organisms that cause periodontal disease. They may even culture the organism to determine what particular antimicrobial will be most effective in your situation. You should not take antibiotics left over from your last throat infection or any other prescription antibiotic that has not been specifically prescribed by the dentist to treat gum disease as the infection could get worse rather than better.

How antimicrobials can help and how they work

Periodontal antibiotic treatment can be administered two ways: locally and systemically.

Local antibiotic treatments are those that are applied directly to the infected area, much as you might put an antibiotic cream on a finger cut. Common reasons for the use of local antibiotic treatments include periodontal infections involving one or a few teeth in an otherwise healthy mouth or recurrence of disease following periodontal treatment. Because saliva would wash away any typical cream or ointment, the delivery methods for local antibiotics are cleverly devised. One of the more popular locally-delivered products is a gel that is injected into a periodontal pocket and then eventually hardens. Another way is to introduce a small string impregnated with a special antibiotic. Over the next seven to 10 days, the antibiotic is slowly released, helping to eliminate the bacterial infection. Typically, locally delivered antibiotics are inserted after the teeth have been treated with scaling and root planing .

Systemic antibiotic treatments are those taken by pill. They are called systemic because they affect the whole system (body). The pill is dissolved in the stomach and the antibiotics are absorbed into the bloodstream and circulated throughout the body. The benefit is that the antibiotic can kill bacteria anywhere in the mouth (as well as throughout the body), including any bugs hiding deep in the pockets or elsewhere in the mouth. Because there are several different types of bacteria in the mouth that can cause periodontitis, the doctor often will take a sampling of the plaque in your mouth, send it to a laboratory for testing, and then prescribe an antibiotic effective against the particular bacteria in your mouth.

Side Effects Of AntimicrobialTreatment

Antibiotics can cause side effects in some people. The most common side effects are nausea, diarrhea and stomach upset. An allergic reaction, mainly a rash and itching, can occur. Make sure your dentist is aware of any medication allergies you may have. If you are concerned about any side effects, contact your dentist.