What is Gum Disease?

Gum disease, or periodontal disease is a chronic inflammation and infection of the gums and surrounding tissue. It is the major cause of about 70 percent of adult tooth loss, affecting three out of four persons at some point in their life. Periodontal diseases include gingivitis and periodontitis.

What causes gum disease?

Bacterial plaque – a sticky, colorless film that constantly forms on the teeth – is recognized as the primary cause of gum disease. If plaque isn't removed each day by brushing and flossing, it hardens into a rough, porous substance called calculus (also known as tartar).Toxins produced and released by bacteria in plaque irritate the gums. These toxins cause the breakdown of the fibers that hold the gums tightly to the teeth, creating periodontal pockets that fill with even more toxins and bacteria. As the disease progresses, pockets extend deeper, and the bacteria moves down until the bone that holds the tooth in place is destroyed. The tooth eventually will fall out or require extraction.

Are there other factors?

Yes. Genetics is also a factor, as are lifestyle choices. A diet low in nutrients can diminish the body's ability to fight infection. Smokers and spit tobacco users have more irritation to gum tissues than non-tobacco users, while stress can also affect the ability to ward off disease. Diseases that interfere with the body's immune system, such as leukemia and AIDS, may worsen the condition of the gums. In patients with uncontrolled diabetes, where the body is more prone to infection, gum disease is more severe or harder to control. Pregnant women experience elevated levels of hormones that cause the gums to react differently to the bacteria found in plaque, and in many cases can cause a condition known as "pregnancy gingivitis."

What are the warning signs of gum disease?

Signs include red, swollen or tender gums, bleeding while brushing or flossing, gums that pull away from teeth, loose or separating teeth, pus between the gum and tooth, persistent bad breath, a change in the way teeth fit together when the patient bites and a change in the fit of dentures. While patients are advised to check for the warning signs, there might not be any discomfort until the disease has spread to a point where the tooth is unsalvageable. That's why patients are advised to get frequent dental exams.

What does periodontal treatment involve?

In the early stages of gum disease, most treatment involves a special cleaning called scaling and root planning, which removes plaque and tartar around the tooth and smoothing the root surfaces. Antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early gum disease, called gingivitis, scaling and root planing and proper daily cleaning achieve a satisfactory result. More advanced cases may require surgical treatment, which involves cutting the gums – sometimes with the assistance of a laser – and removing the hardened plaque build-up and recontouring the damaged bone. The procedure is also designed to smooth root surfaces and reposition the gum tissue so it will be easier to keep clean.

How do you prevent gum disease?

Removing plaque through daily brushing, flossing and professional cleaning is the best way to minimize your risk. Your dentist can design a personalized program of home oral care to meet your needs.

What is the role of the general dentist?

The general dentist usually detects gum disease and treats it in the early stages. Some general dentists have acquired additional expertise to treat more advanced conditions of the disease. If the general dentist believes that the gum disease requires treatment by a specialist, the patient will be referred to a periodontist. The dentist and periodontist will work together to formulate a treatment plan for the patient.

How can I maintain treatment at home?

Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of periodontal therapy. Patients should visit the dentist every three to four months (or more, depending on the patient) for spot scaling and root planing and an overall exam. In between visits, they should brush at least twice a day, floss daily and brush their tongue. Manual soft nylon bristle brushes are the most dependable and least expensive. Electric brushes are also a good option, but don't reach any further into the pocket than manual brushes. Proxy brushes (small, narrow brushes) and other interdental cleaners are the best way to clean between the recesses in the teeth and should be used once a day. Wooden toothpicks and rubber tips should only be used if recommended by your dentist.

 

Gingivitis vs. Gum Disease: What's the Difference?

Eighty percent of American adults have some form of periodontal (gum) disease, but the beginning symptoms are usually painless, so many who are at risk do not recognize the signs and stages, according to a report in the September/October 2003 issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).

"Gum disease is a silent teeth killer because you can have it without knowing it," says AGD spokesperson Elwood Streeter, DDS.

Healthy gums appear coral pink, firm and form a sharp point where they meet the tooth. When excessive amounts of bacteria and food debris build up in the spaces between the teeth and gums, a sticky material called plaque is formed.

A plaque build-up can develop and harden into calculus (tartar), which irritates the gums. Bacterial byproducts (or toxins) in the tartar cause gums to become infected, red and tender, a condition called gingivitis. Gingivitis is the beginning stage of periodontal disease.

If you do not receive professional cleaning to halt the spread of gingivitis, the infection will spread from the gums to the ligaments and bone supporting the teeth. The tissues and ligaments will be destroyed; infections are likely to develop, causing a gum abscess, a collection of pus and swelling of gum tissues. Teeth may become loose and the gums may recede, creating increased spaces between teeth.

Dentists treat gingivitis by cleaning teeth to remove plaque and tartar and prescribing special mouthwashes or topical treatments. Treatment for periodontal disease involves more serious action such as antibiotics and antimicrobials, deep scaling of the root surface, removing infected gum tissue or extracting teeth. To avoid these potentially painful symptoms and treatments, it is important to catch the disease in its earlier stages.

"Gum disease can develop within weeks," cautions Itzhak Brook, MD, MSc, lead author of the journal report. He reminds patients to prevent periodontal disease by regular flossing, brushing and dental checkups. In addition, maintaining a healthy diet and low levels of stress boost the body's natural immune system, which fights bacteria in the mouth.

Early warning signs of gum disease:

Bleeding gums when brushing or flossing

• Mouth sores
• Bright red, red-purple or shiny gums
• Gums that are tender to the touch

 

Emotional Stress Could Cause Periodontal Disease

Emotional woes may place a strain on more than just your heart. According to the Academy of General Dentistry (AGD), emotional anxiety could affect your dental health.

"There's definitely a link between stress and dental health," says AGD spokesperson Nick Russo, DDS. "Stress affects the immune system, which fights against the bacteria that causes periodontal disease, making a person more prone to gum infection."

While stress has long been linked to heart troubles, researchers studied the effects of stress on dental health at the State University of New York at Buffalo, the University of North Carolina and the University of Michigan. More than 1,400 volunteers, ages 25 to 74, were studied to see how stress and coping abilities affect the risk for periodontal (gum) disease, which causes oral infection, inflamed and bleeding gums and loss of bone.

Those at greatest risk for periodontal disease were those who were highly emotional in dealing with financial problems. The oral health of those with financial troubles was compared with those who had other pressures, such as stress over children, spouse, single life or work. People strapped for cash had the most severe periodontal disease. But here's the good news: Those who dealt with their financial strain in an active and positive manner had no more risk of severe periodontal disease than those without money problems.

A Visit to the General Dentist can Prevent a Major Case of Tooth Loss

Do you know what common oral disease has been associated with heart disease, stroke, diabetes and preterm low-birth weight babies? According to the November 2006 issue of AGD Impact, the monthly newsmagazine of the Academy of General Dentistry (AGD), it's periodontal disease and can be easily prevented through regular visits to a general dentist, daily brushing, flossing, and professional cleaning. Periodontal disease is also known as gum disease and it can affect three out of four people in their lifetime.

Gum disease is a chronic inflammation and infection of the gums and surrounding tissue. The primary cause of gum disease is bacterial plaque which is a sticky, colorless film that constantly forms on the teeth. Toxins (poisons) produced and released by bacteria in plaque cause fibers that hold the gums tightly to the teeth to break down, creating periodontal pockets that fill with even more toxins and bacteria. The pockets may extend deeper, destroy the bone that holds the tooth in place and eventually cause the tooth to fall out.

Anne Murray, DDS, FAGD and AGD spokesperson, says that "risk factors for periodontal disease can include genetics, diet, tobacco use, medications, stress, poor nutrition and clenching or grinding your teeth."

"As a general dentist, we are our patients' primary care provider and that means that we manage their overall dental health care," says AGD President Bruce DeGinder, DDS, MAGD. "A general dentist takes responsibility for the diagnosis, treatment, and overall coordination of services to help meet our patients' oral health needs."

Treatment will consist of scaling and root planing, which involves removing plaque from around the tooth and smoothing the root surfaces. In the early stages of gum disease, called gingivitis, scaling and root planing and proper daily cleaning will achieve a satisfactory result. More advanced cases, however, may require surgical treatment.

"Sticking to a regular oral hygiene regimen is crucial for patients who want to sustain the results of therapy," says Dr. Murray. "Patients with gum disease should visit their general dentist every three to four months as well as floss daily and brush their teeth and tongue at least twice a day."

What are the warning signs of gum disease?

• Red, swollen, or tender gums that may bleeding while brushing or flossing
• Gums that pull away from teeth
• Loose or separating teeth
• Pus between the gum and tooth
• Persistent bad breath
• A change in the way teeth fit together when the patient bites
• A change in the fit of partial dentures