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Periodontics

Questions


What is periodontal disease?

In the broadest sense, the term gum disease--or periodontal disease--describes bacterial growth and production of factors that gradually destroy the tissue surrounding and supporting the teeth. "Periodontal" means "around the tooth."

Gingivitis and periodontitis are the two main stages of periodontal disease. When gingivitis is left untreated, it can advance to periodontitis. At this point, the inner layer of the gum and bone pull away from the teeth (recede) and form pockets which collect debris, are difficult to clean, and can become infected.

Bacterial toxins and the body's immune system fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. If the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. When unchecked, this will eventually lead to the loss of teeth.

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What are the signs and symptoms of periodontal disease?

Periodontal disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. They include:

  • gums that bleed during and after toothbrushing
  • red, swollen or tender gums
  • persistent bad breath or bad taste in the mouth
  • receding gums
  • formation of deep pockets between teeth and gums
  • loose or shifting teeth
  • changes in the way teeth fit together on biting, or in the fit of partial dentures.

The American Academy of Periodontology (AAP) says that up to 30 percent of the U.S. population may be genetically susceptible to gum disease. And, despite aggressive oral care habits, people who are genetically predisposed may be up to six times more likely to develop some form of gum disease.

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How is periodontal disease treated?

The goal of periodontal treatment is to control any infection that exists and to halt progression of the disease. Opinions about which treatment methods to use vary in the periodontal field. For some people, certain procedures may be safer, more effective, and more comfortable than others may be. Which treatment your dentist or periodontist chooses will most likely depend on how far your disease has progressed, how you may have responded to earlier treatments, or your overall health


  • Curettage--a scraping away of the diseased gum tissue in the infected pocket, which permits the infected area to heal.

  • Flap surgery--involves lifting back the gums and removing the tartar. The gums are then sewn back in place so that the tissue fits snugly around the tooth. This method also reduces the pocket and areas where bacteria grow.

  • Bone grafts--used to replace bone destroyed by periodontitis. Tiny fragments of your own bone, synthetic bone, or donated bone are placed where bone was lost. These grafts serve as a platform for the regrowth of bone, which restores stability to teeth.

  • Soft tissue grafts--reinforce thin gums or fill in places where gums have receded. Grafted tissue, most often taken from the roof of the mouth, is stitched in place over the affected area.

  • Guided tissue regeneration--stimulates bone and gum tissue growth. Done in combination with flap surgery, a small piece of mesh-like fabric is inserted between the bone and gum tissue. This keeps the gum tissue from growing into the area where the bone should be, allowing the bone and connective tissue to regrow to better support the teeth.

  • Bone (osseous) surgery--smoothes shallow craters in the bone due to moderate and advanced bone loss. Following flap surgery, the bone around the tooth is reshaped to decrease the craters. This makes it harder for bacteria to collect and grow.

  • Medications--in pill form are used to help kill the germs that cause periodontitis or suppress the destruction of the tooth's attachment to the bone. There are also antibiotic gels, fibers or chips applied directly to the infected pocket. In some cases, a dentist will prescribe a special anti-germ mouth rinse containing a chemical called chlorhexidine to help control plaque and gingivitis. These are the only mouth rinses approved for treating periodontal disease.

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What causes periodontal disease?

While plaque is the primary cause of periodontal disease, the American Academy of Periodontology (AAP) says that other factors are thought to increase the risk, severity, and speed of gum disease development. These can include:

  • Tobacco use--one of the most significant risk factors associated with the development of periodontitis. People who smoke are seven times more likely to get periodontitis than nonsmokers, and smoking can lower the chances of success of some treatments.

  • Hormonal changes--may make gums more sensitive and make it easier for gingivitis to develop.

  • Stress--may make it difficult for the body's immune system to fight off infection.

  • Medications--can affect oral health because they lessen the flow of saliva, which has a protective effect on teeth and gums. Some drugs, such as the anticonvulsant medication diphenylhydantoin and the anti-angina drug nifedipine, can cause abnormal growth of gum tissue.

  • Poor nutrition--may make it difficult for the immune system to fight off infection, especially if the diet is low in important nutrients. Additionally, the bacteria that cause periodontal disease thrive in acidic environments. Eating sugars and other foods that increase the acidity in the mouth increases bacterial counts.

  • Illnesses--may affect the condition of your gums. This includes diseases such as cancer or AIDS that interfere with the immune system.

  • Clenching and grinding teeth--may put excess force on the supporting tissues of the teeth and could speed up the rate at which these tissues are destroyed.

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What medications are available to treat periodontal disease?

A number of products are available to control infection and reduce inflammation.

Name What It Is Why It’s Used How It’s Used
Colgate Total
triclosan and fluoride toothpaste
Over-the-counter toothpaste containing the antibacterial triclosan The antibacterial ingredient reduces plaque and resulting gingivitis. The fluoride protects against cavities. Used like a regular toothpaste
Peridex or generic
chlorhexidine mouth rinse
Prescription mouth rinse containing an anti-microbial called chlorhexidine To control bacteria, resulting in less plaque and gingivitis Used like a regular mouthwash
Periochip A tiny piece of gelatin filled with chlorhexidine To control bacteria and reduce the size of periodontal pockets Chip is placed in the pockets after root planing, where the medicine is slowly released over time.
Atridox A gel that contains the antibiotic doxycycline To control bacteria and reduce the size of periodontal pockets Placed in pockets after scaling and root planing. Antibiotic is released slowly over a period of about seven days.
Actisite Thread-like fiber that contains the antibiotic tetracycline To control bacteria and reduce the size of periodontal pockets These fibers are placed in the pockets. The medicine is released slowly over 10 days. The fibers are then removed.
Arestin microspheres Tiny round particles that contain the antibiotic minocycline To control bacteria and reduce the size of periodontal pockets Microspheres placed into pockets after scaling and root planing. Particles release minocycline slowly over time.
Periostat A low dose of the medication doxycycline that keeps destructive enzymes in check To hold back the body’s enzyme response—if not controlled, certain enzymes can break down bone and connective tissue. This medication is in pill form. It is used in combination with scaling and root planing.

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