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National Institutes of Health
National Institute of Dental Research
NIH Publications No. 94-1142
What You Need To Know About Periodontal (Gum) Diseases
How you say it: Periodontal (pear ee oh don tal) Diseases The word 'periodontal' comes from the two Greek words that mean "around the tooth."
What are periodontal diseases?
Infections of the gum and bone that hold the teeth in place. They are commonly called gum diseases.
What causes these diseases?
Dental plaque--a sticky mass of harmful germs. Dental scientists have found that about a half dozen of the nearly 300 germs found in the mouth can cause gum diseases.
Can I prevent gum diseases?
Yes! You can prevent them by removing dental plaque.
How?
* Brush your teeth twice a day
* Floss your teeth once a day
* Have your teeth cleaned professionally at least once a year
* Also once a year: have a check©up by the dentist to make sure any signs of gum diseases are caught early.
How can I tell if I'm removing all the plaque?
Dental plaque is hard to see unless it's stained. You can stain plaque by chewing red "disclosing tablets," found at grocery stores and drug stores, or by using a cotton swab to smear green food coloring on your teeth. The red or green color left on the teeth will show you where there is still plaque--and where you have to brush again to remove it. Ask your dentist or dental hygienist if your plaque removal techniques are o.k.
If plaque is not removed, you may develop gingivitis, a condition that can be the first step toward the breakdown of your gums and bone that hold teeth in place.
Poor Oral Hygiene -> Plaque Build-Up ->
Gingivitis -> Periodontitis -> Possible Tooth Loss
Gingivitis is an infection of the gums. As a result of the infection, the gums become red, inflamed and can bleed during brushing.
It is a mild form of gum disease that does not include any loss of the bone and tissue that hold teeth in place. Gingivitis can usually be reversed with regular brushing and flossing.
Gingivitis is the first sign that something is wrong with your gums. If it is not treated it can progress to a more destructive type of gum disease called periodontitis.
Periodontitis is an infection of the tissues that help anchor the teeth. The infection can lead to loss of the bone that holds the tooth in its socket and might lead to tooth loss.
Since periodontitis affects more than just the gums, it is not controllable with regular brushing and flossing. Periodontitis must be treated by a dentist or periodontist (a dentist who specializes in treating gum diseases).
In its early stages, periodontitis usually does not have obvious symptoms. Pain, loosening of teeth, and abscess do not occur until the disease is very advanced. So it's important to visit the dentist on a regular basis so he or she can check for early signs of gum diseases. If gum diseases are not treated, the teeth may loosen and fall out. Will my dentist refer me to a periodontist? Your dentist might refer you to a periodontist if you have an advanced case of a gum disease, or if you have a milder form that is not responding to regular treatment.
Who gets gum diseases?
People usually don't show signs of advanced gum diseases until they are in their 30s or 40s. But it is not uncommon for teenagers to have gingivitis, the early stage of gum disease. The most common types of gum diseases develop as a result of neglect--poor brushing and no flossing.
Special Cases
Teenagers can develop a very severe form of gum disease called juvenile periodontitis. Scientists think this rare but aggressive type of gum disease might be inherited. Pregnancy, diabetes and other medical conditions also may trigger gum diseases. Smoking can make you prone to gum diseases. In fact, one study showed that smokers are five times more likely than nonsmokers to have gum diseases.
Diagnosis
Three ways a dentist can tell if you have periodontitis:
* By looking at the gums to see if they are red, swollen, and inflamed and by checking for tartar--hardened plaque---beneath the gumline. The dentist also will check for gum recession.
* By using an instrument called a probe to see if the gums bleed when they are probed and by checking for and measuring the periodontal pockets--spaces that form when unhealthy gums pull away from teeth. Usually, there is a space of 1©3mm between healthy gums and teeth. Deeper pockets may signal advanced disease.
* By taking mouth x-rays to check for any loss of the bone that helps anchor teeth, another sign of periodontitis.
The dentits uses the probe to measure the periodontal pocket. Most people find probing only midly uncomfortable.
Treatment
How are gum diseases treated?
By controlling the infection.
To control the infection...
* the dentist or hygienist removes the plaque that contains harmful germs
How?
By scaling and root planing
These are deep-cleaning procedures that get rid of the plaque.
Scaling means scraping off the tartar from above and beneath the gumline. Planing the tooth root until it is smooth gets rid of rough spots where. germs gather and allows the gums to heal closer to the teeth.
Scaling & Planing
* Your dentist might also prescribe a special anti©germ mouthrinse containing a chemical called chlorhexidine. These are the only mouthrinses approved for treating periodontitis.
* Sometimes, the dentist will prescribe an antibiotic that will help kill the germs that are causing periodontitis.
After the dentist scales and planes your teeth, you must brush and floss at home to keep the plaque from returning. You also will have to have a checkup with the dentist to see if the treatment has helped. Scaling and planing may need to be repeated every three to four months.
What About Gum Surgery?
Surgery might be necessary if: 1) scaling and planing do not bring the gum disease under control, or 2) the gum disease is very advanced and includes bone loss around the teeth.
Flap Surgery
A local anesthetic is given so the patient will not feel any pain or discomfort. Flap surgery involves lifting back the gums, removing the tartar, and then sewing the gums back in place.
Can baking soda help periodontitis?
Although baking soda and most toothpastes can be used to remove dental plaque, there is no evidence that they can stop or reverse tissue and bone loss caused by periodontitis.
I've heard a lot about lasers recently. How do they work and can they be used to treat periodontal diseases?
Simply put, a surgical laser works by emitting a concentrated beam of light strong enough to cut through tissue. Lasers can be used on soft tissue for certain surgical procedures related to the treatment of periodontal diseases. At this time, through, the Food and Drug Administration has not approved lasers for use on hard tissue--teeth and bone.
Research is under way to see if lasers can be used on teeth and bone.
Remember:
Prevent gum diseases by . . .
Flossing, Brushing, Having regular dental cleanings and check-ups
Diagnosis
On The Horizon:
New X-Ray Technology
* Computer-linked probes. A computer attached to the probe regulates the probing pressure so it is always the same. The computer also can compare the results of the current test to the previous one, since it stores measurements from each reading.
* Temperature probe. Detects temperature of the periodontal pockets to 1/100th of a degree centigrade. The hotter the site, the more likely there is gum disease. * New X-ray technology:
* Taking x-rays. Taking x-rays with an instrument similar to that found in a home video camera uses much less radiation than does the standard x-ray.
* Reading x-rays. The computer can compare two x-rays and highlight even the smallest changes in bone surrounding the teeth. Using the computer allows dentists to see details that would not be visible on a regular x-ray.
* Determining which germ is causing the infection. Knowing what type of bacterium is causing the infection could help determine the best treatment. Some bacteria can be removed by scraping plaque off the teeth, a process known as scaling. Others are harder to get rid of and may require an antibiotic--a medicine that can kill germs.
* Quick test for identifying active gum disease. The dentist takes a sample of fluid leaked from the gums that is found at the base of the teeth. It is analyzed for substances associated with active tissue and bone destruction.
Treatment
On The Horizon:
* Slow-release: antibiotics placed directly: into periodontal pockets. Tiny fibers or gels containing antibiotics are put into the pockets next to the tooth root where the medication seeps onto the affected area.
* Barrier membranes. During flap surgery, the dentist inserts these small, mesh-like pieces of fabric between the gum flap and the affected teeth. The mesh helps the soft tissue and bone grow back in place. A second surgery is needed to remove the mesh. The newest mesh will be able to break down and be absorbed by the body, eliminating the need for the second surgical procedure.
Barrier Membrane
* High-powered ultrasonic cleaning. A cleaning instrument that uses high-frequency sound waves is useful in breaking up tartar and removing plaque.
Ultra Cleaning Instrument
* Chemically modified antibiotics. These drugs lack the antibiotic property but have the ability to inhibit tissue destruction. They should help stop gum disease and should be safe for long-term use, without causing bacterial resistance.
* Low-Dose antibiotics. Researchers have found that low doses of doxycycline can slow the destruction of tissue and bone. At low doses, the drug doesn't seem to encourage the development of antibiotic-resistant germs.
* NSAIDs--Non-Steroidal Anti-Inflammatory Drugs. These aspirin-like medicines have been shown to slow bone loss in patients with periodontitis. Researchers are testing these medications.
National Institute of Dental Research
P.O. Box 54793
Washington, DC 20032
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