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Gum Disease (Periodontal Disease)


Gum disease is the most common term used for periodontal disease. However, there are other names referring to gum disease such as periodontitis and gingivitis. Regardless of the name, gum disease begins with bacteria growth in your mouth and ends with tooth loss if not properly treated. About 75% of all American adults have some form of periodontal disease after the age of 35.

Gingivitis is the mildest form of periodontal disease and is the bacterial infection within the tissues in the mouth. Bone and the teeth’s connective tissue are destroyed once gum disease sets in. The toxins, produced from the bacteria, damage the surrounding tissues and enter under the gum line. This disease can be tricky to detect since the signs and symptoms are virtually unnoticeable due to the lack of pain or discomfort. People who suspect gum disease should see a gum dentist, or periodontist, especially if their regular dentists recommend one. Of the different versions of gum disease, only gingivitis can be reversed. Periodontitis and periodontal disease are not reversible once the disease sets in and they have the potential to cause additional medical problems like heart disease. The bacteria from periodontitis have been found in the bloodstream of some people with periodontal disease. These bacteria can cause blood palates to build-up and stick together inside your arteries, which can lead to heart attacks and strokes.

Signs of Periodontal Disease

Healthy gums are firm, pink and have natural variations of color. Periodontitis is the result of untreated gingivitis. Before periodontal disease gets out of hand, there are symptoms that signify the presence of it, including:

  • No pain
  • Redness of the gums while brushing, flossing or after biting into hard food
  • Bleeding of the gums while brushing, flossing or after biting into hard food
  • Recurring swelling of the gums
  • Bad breath
  • Metallic taste in one’s mouth
  • Gum recession, or apparent lengthening of teeth
  • Deep pockets between teeth and gums
  • Loose teeth
  • Teeth that appear to be shifting

The biggest concern dentists have is the fact that all periodontal disease symptoms are virtually painless. Unfortunately, this is why so many people continue to neglect the problem or consider it insignificant. If you are experiencing these symptoms, you may want to meet with a periodontist for an examination.

Causes of Periodontal Disease

The biggest cause of periodontal disease is bacterial plaque. It is a sticky, colorless substance that coats your teeth. If left untreated, the bacteria begin to infect the gums and destroy the surrounding tissues that support the teeth and bones. If this occurs, the gums will separate from the teeth and form pockets that fill with more bacterial plaque, which leads to further infection. Some of the major factors that lead to bacterial plaque build-up include the following:

Irregular teeth - Teeth that are decaying, broken or chipped or have been improperly fitted with crowns, bridges, or dentures are perfect places for plaque to hide and build. Normal oral hygiene methods generally do not reach these places.

Poor Oral Hygiene - If you do not regularly brush, floss and/or rinse you may begin to suffer from the effects of bacterial plaque build-up.

Diet - If you do not have healthy nutritional habits, your body, including your teeth and gums, does not receive the nutrients needed to fight infections.

Behavior - If you abuse your body with drugs and alcohol, it loses the ability to fight infections. Piercings also compromise the body’s natural toughness, especially when in or around the mouth in this case. All of these things make you susceptible to periodontal disease.

Hormones - Women especially suffer from hormone changes all their lives- puberty, pregnancy and menopause. These changes can trigger changes in the body, thus increasing the chances for all sorts of diseases.

Genetics - Although not as common as in other hereditary diseases such as heart disease, genetics can indicate a predisposition for developing diseases such as periodontal disease.

Medications - Dentists are familiar with the way certain medications (anti-depressants, oral contraceptives, and some heart medicines) react to your gums and teeth. You should make your dentist aware of any medications you are taking.

Medical Conditions - People with certain diseases such as diabetes and leukemia are more susceptible to gum diseases due to lower resistance levels.

Tobacco Usage - After numerous studies, it has been proven that tobacco users are more susceptible to mouth diseases. Calculus forms much quicker and thicker, and within deep pockets between gums and teeth after several years of tobacco use.

Poor Functional Habits - Teeth grinding and clenching can damage the teeth and surrounding tissues. Pressure is applied to the teeth during these activities, but pressure is also applied to the gums, which weakens them.

Diagnosing Gum Disease

To check you for gum disease, your dentist will examine your teeth and check your gums for bleeding, loose teeth, and depth of pockets. Your dentist will also take x-rays to check for bone loss and additional problems that may have developed in the underlying bone. These exams, along with questions related to your diet and social habits will help your dentist diagnose you properly.

Gum Disease Treatment

Treating gum disease depends on the severity of the condition. Your dentist will be able to examine and create a dental treatment plan with you to begin treating the disease. If the condition is not yet severe, your dentist will remove any tartar through a professional cleaning, deep scaling and root planing (if applicable). Local anesthesia may be administered during these procedures, and, if needed, antibiotics are also administered. Antibiotics are given to a patient if the bacteria are pooled in the pocketed areas in the gums. Dentists may even prescribe you a medicated mouthwash to be used on a regular basis.

During a procedure called scaling, your dentist will use a handheld instrument called a scaler to remove calculus (hard material made of dead bacteria that has mineralized) and plaque all around your gum line. Ultrasonic scaling involves a high frequency current to remove the plaque and calculus. During a procedure called root planing, your dentist will remove bacteria by smoothing out the surface of the tooth’s root. Another procedure called subgingival debridement involves your dentist removing tooth surface irritants from beneath the gum line. This is done to prevent infections in the treated areas.

For some people, despite good oral hygiene, professional teeth cleanings are required every few months. Many times, dentists recommend using an antibacterial mouthwash in these situations. If the disease is caught in an early stage, your dentist will be able to control the depth of the pockets. He/she may inject inserts containing antibiotics or anti-inflammatory drugs to help fight and prevent infection. If antibiotics are started early enough, no other treatment may be necessary.

If the disease is not caught early and pockets are deep, you may need periodontal surgery. Typically a gingivectomy is performed. This procedure is minor and performed in a periodontist’s office. During this procedure the soft tissue wall of the pocket is removed. If damage to your bone has occurred, you may need to undergo a procedure called osseous surgery. During this procedure, the periodontist removes infected tissue and reshapes the gum and bone. After an osseous surgery, the gum line is covered with a periodontal pack (protective coating) for 1-2 weeks or until the gum heals. In most cases, eating and drinking habits are not interrupted with the periodontal pack. Periodontal flap surgery is sometimes done if there is a large pocket gap between the teeth and gums. If the bones contain bacteria, dentists can surgically reshape the bone to eliminate craters of bacteria. Another surgery, called regenerative surgery, involves an oral surgeon or periodontist using special inserts to try to regrow the jawbone and supporting tissues. This method is rather new in the dentistry world and involves grafting bone and soft tissue in hopes to strengthen thin gums and provide a better chance for bone re-growth. Laser therapy is sometimes used as a tool to reduce pocket sizes. Unfortunately, it is not used to restore damaged tissues.

Gum Disease Treatment Costs

Factors such as the type of treatment needed, the location of your dentist, the type of dental insurance you have and the technology used during the procedure will determine the cost of your gum disease treatment. Another major factor is the severity of the disease. If mild, you may only have to spend $500, but if severe, the procedure could cost you up to $10,000 to repair the damage.

Periodontal therapy averages around $75 per tooth, while periodontal maintenance costs average $115. The cost for regular dental prophylaxis ranges from $35-$75, and the average cost of periodontal scaling and root planning ranges from $140-$210 for treatment. Only your dentist will know exact costs of treating your gum disease.

Preventing Gum Disease

Here are some tips to help you prevent gum disease:

  • Brush, floss and rinse your teeth at least twice a day or after every meal
  • Visit your dentist regularly or as often as they recommend
  • Avoid sugary foods and drinks, unless eating during a meal
  • If you can not brush after eating, use sugar-less chewing gum or rinse your mouth with water
  • At the first sign of symptoms, make an appointment with your dentist
  • Eat crunchy, healthy foods for snacks, such as apples and carrots
  • Talk with your dentist about proper oral hygiene techniques

Talking to Your Dentist

Here are some suggestive questions to ask your dentist about gum disease:

  • How advanced is my condition?
  • Which treatment options are available?
  • Can you show me the best way to brush my teeth?
  • Which over-the-counter toothbrush, toothpaste and mouthwash do you recommend to your patients?
  • How often will I need to schedule follow-up visits? What can I expect during those visits?
  • If I can’t get to a toothbrush after eating, what can I do in the mean time?
  • Can you refer me to a periodontist? If so, will you still be a part of my dental team?
  • What symptoms should I watch for that may indicate treatment is not working or the disease is worsening?

Page updated February 2011



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