Treating Gum Disease
What is Periodontal Disease and why do I need to treat it?
Periodontal disease, or gum disease, can present as bleeding of the gums, loosening or drifting teeth, lengthening of the appearance of the teeth due to receding gums and underlying bone loss, pus coming from the gums, foul breathe, and sometimes pain and/or swelling. The most common form of gum disease involves only bleeding gums and is called gingivitis. Gingivitis is most often caused by poisons produced by plaque that lye along the gumline and cause irritation, but it can also be caused by fillings that are built too deep into the gums (compromised biologic width), reactions to dental filling materials, diseases like leukemia, or even some medications. Periodontal disease usually occurs after untreated gingivitis and can occur when the patient is genetically predisposed to gum disease and when the right types of bacteria (germs) are present in the mouth. Healthy patients that have adequate home care can usually fight the occurrence of gum disease because their bodies have adequate immune systems that can fight off infection. However, when the immune system becomes compromised as occurs in smokers, in aging people, in people with systemic diseases, etc., gum disease can attack.
In periodontitis, which used to be called pyorrhea, the skin because diseased and fails to provide an adequate barrier to the bone. The bone supporting the teeth then becomes infected. The body tries to avoid the plaque and tartar that harbors the offending germs by running away. The bone actually shrinks away in response. Eventually, the tooth will be lost. However, along the way, swelling, pus, and pain can occur. Usually, there is also quite a bit of bleeding in the gums during brushing, and the infection causes significant bad breath.
Once a person is diagnosed with gum disease, they always have gum disease. Gum disease, at this point in time, cannot be cured.
It can be managed, however, by thorough debridement (different degrees of “cleaning”), which may even require surgery. Typically, the most conservative treatments are attempted first, reserving surgery for areas that do not respond adequately to non-surgical treatments. Once the gum disease is initially managed, there are now treatments that may be considered to try to regain some of the bone lost due to gum disease. Typically, gum disease patients, however, need to be maintained with professional dental maintenance recall visits every 3-4 months for the remainder of the life of their teeth.
The first treatment for gum disease, periodontitis, usually involves non-surgical root planing
This is sometimes called “deep cleaning.” Precision mechanical hand instruments and often ultrasonic instruments are used to remove heavy tartar accretions and to plane the roots smooth to remove diseased build-up on the roots of the teeth. This procedure may require the teeth to be numb for comfort.
Modern therapeutic protocols often also include irrigation with a variety of medications, and sometimes adjunctive antibiotics are prescribed or specifically placed in deep periodontal pockets. Once scaling and root planing has been completed, it is very important that professional recare is provided every 90 days because research has shown that destructive colonies of periodontitis-causing bacteria take 90 days to mature.
If non-surgical therapy fails to achieve its desired result, periodontal surgery may be needed.
This can sometimes be done with a laser, or it may be done by making an incision in the gums to lift them up so that the root surfaces can be seen directly and bone grafting procedures or bone reshaping may be done at this time to improve the ability of the patient to clean the teeth and to promote healing.
Patients who need advanced periodontal therapy may be referred to a gum specialist, called a periodontist, but in the appropriate situations general dentists like Dr. Huff can perform these surgical procedures.
Additional Information on Gum Disease and Treatment
Is Gingivitis the Same Thing as Gum Disease?
Healthy gums do not bleed. Any amount of bleeding during brushing of minimal stimulation is, therefore, variation from health. Both gingivitis and periodontitis are forms of gum disease.
Classification of gum diseases is very difficult because they are caused by many different types of germs and are dependent on the overall health of each individual patient. However, recently it has been well established by sound clinical research that gum diseases are linked to low birth weight infants, stroke, and heart disease. It is also well understood that plaque, the slimy substance that protects germs, is a major factor in gum disease.
Therefore, dentists are looking much more carefully for all gum diseases than in the past and suggesting more forms of treatment than ever before in history. In light of modern research, it is important that any bleeding be considered “gum disease” and discussed seriously by each patient and his/her dentist. Gingivitis and periodontitis are both gum disease and need to be managed appropriately in light of its relationship to a person’s overall health.
What Is That Stick That You Put in My Gums at Each Check-Up?
Periodontal (gum) disease is a very common enemy of the astute dentist, and we now know that is can have very serious implications to those who suffer from it. Gum disease is linked to diabetes, low birth weight infants, heart disease, high blood pressure, and it is the major cause of tooth loss in adults today. This relationship now has an official term: the oral/systemic connection. Essentially, the process of untreated gum disease is as follows:
· Germs form plaque
· Plaque turns into tartar that is filled with germs
· The body sends in blood cells to kill the germs (red, bleeding and puffy gums)
· Bone is destroyed by the overactive blood cells sent to kill the germs
· Eventually the tooth is lost
In order for gum disease (periodontitis) to be diagnosed, there has to be a loss of bone. Soft tissue inflammation may or may not be true periodontitis, where bone has been destroyed, but it is usually an early warning sign that periodontitis may be around the corner. Dentists take x-rays to determine obvious bone changes, and we measure the cuff of gum tissue around each tooth. Each tooth should have a cuff of healthy gum tissue that is between 1 and 3 mm in depth, and no bleeding should occur with light measurement of this cuff. However, in the case of gingivitis and gum disease, these measurements can be anywhere from 4-12mm, and usually bleeding occurs as a result of unhealthy gum tissues. Healthy gums simply do not bleed. (However, the absence of bleeding does not necessarily mean that periodontal disease is not active—especially in the case of smokers.) Usually, the dentist measures 6 places on each tooth with the “stick,” call a periodontal probe, but some may just “spot-check” problematic areas occasionally. It is generally accepted and expected that a complete periodontal exam, including at least 6 measurements on each tooth, amounts of recession, etc., is conducted at least once a year for patients who have signs, symptoms, or a history of periodontal disease. Otherwise, at least some type of periodontal screening should be done regularly to rule out periodontal disease. Periodontal probing is as important of a diagnostic test as dental x-rays, which also should be done when indicated.
The periodontal probe is a thin, blunt ruler that has hash marks representing millimeter measurements; it can be made of plastic or of surgical-grade metal. The dentist or hygienists usually start on one side of the mouth and calls out each measuring point for someone to record. A thorough examination of the gums also includes bleeding points, recession measurements, and mobility measurements of each tooth. Depending on the situation, more frequent x-rays may also be needed to confirm or support the physical examination findings. The test is usually painless, unless the tissues are very unhealthy. However, periodontal measurements are subject to human error. Sound research tells us that there can be a difference of up to 2 millimeters in measurements from one clinician to another, and most dentists are trained to read periodontal records with this in mind. There are some digital calibration and recording systems that utilize special probes to convert electrical impulses into measurements; however, to date they have not shown a great deal of promise except in research settings.
Today, it is well understood and accepted that a “cleaning” no longer is an appropriate procedure. Dentists and hygienists should be treating according to appropriate diagnoses based on periodontal examination findings. Healthy patients with no gingival inflammation and little or no tartar require less therapy than do patients with gingivitis or severe periodontal disease, and patients with gum disease limited to one or two teeth require less therapy than patients with generalized gum disease. Therefore, fees charged should be appropriate for the level of therapy provided. In fact, insurance billing codes established by the American Dental Association now reflect this. Periodontal probing and appropriate dental x-rays to support accurate diagnoses are essential for fair coding and billing for the “cleaning” that you may need.
Is It Normal to Have to Have a Deep Cleaning More Than Once?
Periodontal disease has become the most common reason for tooth loss in the American adult population. Multiple research studies have been conducted during the past thirty years that have proven that, what used to be called “pyorrhea of the gums” and “periodontosis,” is an opportunistic infection caused by several different types of bacteria. Recent research has linked periodontal disease to systemic health compromises, such as heart disease, chronic respiratory infection, low birth weights, and stroke. Prior to the current level of understanding of what causes periodontal disease, the standard of care for treating this condition was the drastic removal of suspect teeth. However, now we know that periodontal disease is manageable if recognized and treated in its early stages.
Bone loss, inflammation of the gums, bleeding gums, and sometimes “gum boils” are characteristic of periodontal disease. The bacteria that cause periodontal disease are protected by plaque and cling to tartar on the root surface. These germs release poisons into the surrounding tissues that cause inflammation. The cells that the body sends to kill them also cause bone destruction in an attempt to distance the body from the offending organisms. Therefore, the basic premise of treating periodontal disease is to remove the tartar and to disrupt the colonies of bacteria that cause inflammation.
Usually, the cuff of gum tissue that surrounds healthy tooth has a trough between the gum and the tooth that is about 1-3 millimeters deep. It retains healthy, protective fluids and enzymes that are important for digestion. However, when tartar forms and bacteria are allowed to multiply, pockets develop in this trough. Usually, 4-7 millimeter pockets can be treated by a “deep cleaning,” which is properly called scaling and root planing, and is the first step in any treatment of periodontal disease.
During scaling and root planing, mechanical instruments and often ultrasonic instruments are used to remove heavy tartar accretions and to plane the roots smooth. Often, the gum tissues are numbed for this procedure. Modern therapeutic protocols often also include irrigation with a variety of medications, and sometimes adjunctive antibiotics are prescribed or specifically placed in deep periodontal pockets. Once scaling and root planing has been completed, it is very important that professional recare is provided every 90 days because research has shown that destructive colonies of periodontitis-causing bacteria take 90 days to mature.
Periodontal disease is site-specific and episodic. If untreated, periodontal disease attacks some teeth more aggressively than others and is more destructive at certain times in an individuals lifetime. Therefore, the status of a periodontal patient who appears to be stable at several recare appointments in a row may develop an area of reoccurrence in a very short time period and require more aggressive treatment at the next recare. Therefore, repeated and ongoing “deep cleanings” may be necessary, especially during periods of periodontal disease exacerbation.