Dental DetailsDr. Carl Herrera

Periodontal Disease

Dental Details | Dr. Carl Herrera | December 1, 2009 at 12:00 am
Periodontal disease is as common as bad breath, and often the cause of bad breath.  This is the main reason people lose their teeth and get bridges or dentures.  It is treatable and controllable.  You do not have to lose your teeth as you get older.
The most common factor in periodontal disease is bacterial plaque.  Plaque is the almost visible coating that continually forms on the teeth.   If the plaque is not removed and disrupted every 24 hours, it causes inflammation of the tissue.
One of the first symptoms of periodontal disease is inflammation and bleeding of the gums, accompanied by damage to the underlying bone.  Since the bleeding happens often with no pain and we cannot visibly see the problem, we tend to overlook the need to do something.  Periodontal disease is a silent killer, sort of similar to heart disease in the area of pain symptoms; by the time you are having pain from gum disease, the disease process is usually very far advanced.
If plaque is not removed it hardens into a deposit called calculus (tartar).  This is mainly from minerals and salts in the saliva.  Calculus is like coral, it has a very rough surface, which attracts more plaque and makes cleaning more difficult.  Calculus deposits can usually only be removed by a dentist or a dental hygienist.
The tooth is held into the bone and gum tissue by Periodontal Ligaments (PDL).  They are little fibers that run from the bone and gum tissue to the root of the tooth (the cementum layer).  The tissues that attach the gums to the teeth are destroyed by the irritants in plaque.  The body is also trying to get away from the plaque, so the little fibers start letting go closest to the plaque.  Plaque moves down along the roots of the teeth making the periodontal pockets deeper.  This process can destroy the bone around the tooth and cause the loss of the tooth.  It is an ongoing battle between the body and the bacteria in plaque.
Some factors causing periodontal disease are systemic diseases, diabetes and some blood diseases that can lower the resistance of the tissue against infection, making periodontal disease more likely.  Some medications like anti-epileptic drugs, anti-rejection drugs for organ transplants and a few other  medications can aggravate or even cause periodontal conditions.  Other medications such as steroids, cancer therapy drugs, oral contraceptives and anything that causes the mouth to be extra dry, such as radiation or chemotherapy, can also be factors in periodontal disease.  Genetics are a factor, about 30 % of the population is more susceptible to gum disease, even with excellent hygiene.
Since the late ‘90s, research linking periodontal disease and other disease processes throughout the body has been a major part of the studies in dentistry.  Evidence to support the perio-systemic connection continues to mount in support of these links.
Pregnancy can cause periodontal disease because of increased hormone levels and the gums over-reaction to plaque.  The gums become red, tender and swollen and bleed easily.  One of the best preventions for pregnancy gingivitis is exceptional hygiene.
Dental conditions that cause periodontal disease are poor occlusion, crowding, loose partial dentures, a history of periodontal disease, poorly designed bridges and defective fillings.  Habits such as grinding or clinching the teeth may make gums and supporting bone more susceptible to periodontal disease.
Symptoms of periodontal disease are gums bleeding a lot, the gums are painful when brushing, teeth become loose, spaces show up that were not there before, and the gums pull away from the teeth and bad breath.
Proper brushing and flossing is a must to prevent periodontal disease.  Good brushing is not always easy and the proper use of floss can be difficult.   Some people can use a Proxabrush and interplak tooth brushes.  Each person should consult their dentist to figure out the best way to keep the teeth clean.  Any number of methods can be used.
For moderate to advanced periodontal disease, you may need root planning (S/RPs covered next month).  This is the smoothing of the roots surfaces so the plaque will not reattach as easily.  This treatment requires local anesthetic and several appointments. For cases that do not respond to other techniques, some type of gum surgery maybe required.  A comprehensive evaluation must be made to eliminate all of the causing factors.  The disease will not cure itself.  Without treatment, more tissue will become involved, i.e.: more bone will be destroyed and teeth lost.
The person free of periodontal disease can be assured of remaining free of this disease only if they continue to use all the methods available to eliminate the destructive pollutant plaque from their teeth.  Prevention requires the patient to continue to learn new and different ways of cleaning their teeth and gum crevices as the morphology changes with age.
As long as you have teeth, you have periodontal concerns.

Periodontal disease is as common as bad breath, and often the cause of bad breath.  This is the main reason people lose their teeth and get bridges or dentures.  It is treatable and controllable.  You do not have to lose your teeth as you get older.

The most common factor in periodontal disease is bacterial plaque.  Plaque is the almost visible coating that continually forms on the teeth.   If the plaque is not removed and disrupted every 24 hours, it causes inflammation of the tissue.

One of the first symptoms of periodontal disease is inflammation and bleeding of the gums, accompanied by damage to the underlying bone.  Since the bleeding happens often with no pain and we cannot visibly see the problem, we tend to overlook the need to do something.  Periodontal disease is a silent killer, sort of similar to heart disease in the area of pain symptoms; by the time you are having pain from gum disease, the disease process is usually very far advanced.

If plaque is not removed it hardens into a deposit called calculus (tartar).  This is mainly from minerals and salts in the saliva.  Calculus is like coral, it has a very rough surface, which attracts more plaque and makes cleaning more difficult.  Calculus deposits can usually only be removed by a dentist or a dental hygienist.

The tooth is held into the bone and gum tissue by Periodontal Ligaments (PDL).  They are little fibers that run from the bone and gum tissue to the root of the tooth (the cementum layer).  The tissues that attach the gums to the teeth are destroyed by the irritants in plaque.  The body is also trying to get away from the plaque, so the little fibers start letting go closest to the plaque.  Plaque moves down along the roots of the teeth making the periodontal pockets deeper.  This process can destroy the bone around the tooth and cause the loss of the tooth.  It is an ongoing battle between the body and the bacteria in plaque.

Some factors causing periodontal disease are systemic diseases, diabetes and some blood diseases that can lower the resistance of the tissue against infection, making periodontal disease more likely.  Some medications like anti-epileptic drugs, anti-rejection drugs for organ transplants and a few other  medications can aggravate or even cause periodontal conditions.  Other medications such as steroids, cancer therapy drugs, oral contraceptives and anything that causes the mouth to be extra dry, such as radiation or chemotherapy, can also be factors in periodontal disease.  Genetics are a factor, about 30 % of the population is more susceptible to gum disease, even with excellent hygiene.

Since the late ‘90s, research linking periodontal disease and other disease processes throughout the body has been a major part of the studies in dentistry.  Evidence to support the perio-systemic connection continues to mount in support of these links.

Pregnancy can cause periodontal disease because of increased hormone levels and the gums over-reaction to plaque.  The gums become red, tender and swollen and bleed easily.  One of the best preventions for pregnancy gingivitis is exceptional hygiene.

Dental conditions that cause periodontal disease are poor occlusion, crowding, loose partial dentures, a history of periodontal disease, poorly designed bridges and defective fillings. Habits such as grinding or clinching the teeth may make gums and supporting bone more susceptible to periodontal disease.

Symptoms of periodontal disease are gums bleeding a lot, the gums are painful when brushing, teeth become loose, spaces show up that were not there before, and the gums pull away from the teeth and bad breath.

Proper brushing and flossing is a must to prevent periodontal disease.  Good brushing is not always easy and the proper use of floss can be difficult.   Some people can use a Proxabrush and interplak tooth brushes.  Each person should consult their dentist to figure out the best way to keep the teeth clean.  Any number of methods can be used.

For moderate to advanced periodontal disease, you may need root planning (S/RPs covered next month).  This is the smoothing of the roots surfaces so the plaque will not reattach as easily.  This treatment requires local anesthetic and several appointments. For cases that do not respond to other techniques, some type of gum surgery maybe required.  A comprehensive evaluation must be made to eliminate all of the causing factors.  The disease will not cure itself.  Without treatment, more tissue will become involved, i.e.: more bone will be destroyed and teeth lost.

The person free of periodontal disease can be assured of remaining free of this disease only if they continue to use all the methods available to eliminate the destructive pollutant plaque from their teeth.  Prevention requires the patient to continue to learn new and different ways of cleaning their teeth and gum crevices as the morphology changes with age.

As long as you have teeth, you have periodontal concerns.

Dr. Carl Herrera

About the author Dr. Carl Herrera

Dr. Herrera practices at Family & Cosmetic Dentistry, located at 3311 Watt Avenue in Sacramento. He can be reached at (916) 483-3213, and you can find him online at http://www.drcarlherrera.com.
More posts by Dr. Carl Herrera

Leave a Reply