Gum disease or periodontal disease is a bacterial infection that affects over 80% of patients to varying degrees. Not only is gum disease the number one causes of tooth loss in adults, we now know it plays a key role in a number of medical conditions. Although there is no cure, killing and controlling bacteria is the key to better health.
What is Gum Disease (Periodontal Disease)?
Gum disease or periodontal disease is an infection of the tooth parts that support and surround the tooth (see Parts of the Tooth): gum, ligament (or periodontal ligament), and bone. The activity and waste products of infectious bacteria cause the gums to become red, swollen and bleed easily (inflammation: pain, heat, swelling, redness and loss of function). The stage of the disease is determined by measuring the cuff of skin around the tooth in six places. In later stages the disease can also be seen on x-rays. Early detection and treatment along with proper home care can control the disease and help the patient keep their teeth for a life-time.
The disease can begin as early as four and five years of age and is evident when the patient has red gums around and between the teeth. By the teenage years, the gums are red and now swollen with heavy bleeding when touched. This stage of the disease is called gingivitis and is the only stage of the disease that is reversible.
As the disease progresses, the bacteria will attack the area of the tooth where the skin is attached to the tooth (periodontal ligament), causing it to loosen or unattach from the tooth creating a ‘pocket’. When the dentist or hygienist measures the gums and finds such condition, they are no longer considered healthy (0-3mm in depth is considered healthy). This stage of the disease is not reversible.
Without intervention, the disease will progress into deeper areas around the teeth where aggressive bacteria can thrive and create the environment where the patients’ own body will destroy the bone around the tooth, eventually causing tooth loss.
Early detection and treatment is the needed to control periodontal disease. Typical treatment may include a non-surgical approach of scaling and root planing, placement of medication into the pockets, and a plan for maintenance based on the severity of the disease.
In more advanced cases, periodontal surgery may be necessary to eliminate the pockets around teeth (decrease the pocket depth to 0-3mm), and possibly graft bone. All periodontal treatment is designed to reduce pocket depths, allowing the patient to control the growth of bacteria at home between dental visits.
Treatment: Scaling and root planning
Scaling and root planing is generally considered the initial, non-surgical procedure of choice in the treatment of periodontal disease. This procedure may involve just a few teeth or all the teeth and is designed to remove and kill bacteria, but also smooth the root surface making it more difficult for bacteria to stick to the root surface. This is followed by professional visits to determine if further treatment is necessary. The goal of treatment is to reduce the deep pockets, making it easier to remove and control the growth of bacteria.
Before Cleaning: These teeth are covered with tarter or calculus. This patient has advanced gum disease.
After the Tarter or Calculus is removed the gum tissue can begin to heal. YES: this is the same mouth!
No discussion regarding treatment of periodontal disease would be complete without the discussion of Lasers in Dentistry. Today’s dental lasers are revolutionizing the treatment of periodontal disease as lasers can not only effectively destroy bacteria, they can create an environment that causes the body to re-grow bone around the tooth.
Remove tarter (calculus: hardened deposits of bacteria)
Calculus, or “tartar,” as most people call it, is attached to the side of the tooth, either above or below the gum line. It is attached to the tooth like a barnacle on the side of a boat. The calculus itself will not harm you; it is the bacteria covering the calculus and being held up against the gum tissue is harmful. Calculus aids in the progression of the disease as the bacteria continues to infect the gums and the ligament and eventually creating an environment whereby your own body destroys bone.
Kill the bacteria in the base of the pocket
After: Once the plaque and tarter have been removed, the soft tissue will appear inflamed. However, the tissue can now heal because the disease causing agents have been removed.
The ultrasonic scaler is a tool that vibrates at a high frequency and sprays water and/or medication. The most damaging bacteria in this disease are called anaerobic bacteria (they grow without oxygen) and they are found in the deepest part of the pocket. The scaler reaches deep into the pocket and the vibrating frequency damages the bacteria, killing it.
Although ultrasonic scalers destroy bacteria, they are not as affective as the dental laser. Dental lasers are revolutionizing the treatment of periodontal disease. Lasers not only destroy bacteria, they create an environment that helps the pocket heal and the body to re-grow bone around the tooth.
Smooth the root surface
The root of the tooth is covered by cementum. Cementum receives its blood supply (all tissue needs a blood supply) from the ligament that surrounds the root and cushions the tooth in the bone. As the disease progresses, the gum tissue recedes and the surface of the root starts to become exposed.
Once the root is no longer covered, the surface of the root dies, (becomes necrotic). Once this takes place, the root surface becomes rough and irregular. This rough surface allows the bacteria to stick to the tooth easier and encourages the progression of the disease. Planing the root surface makes it more difficult for the bacteria to stick to the tooth. Therefore, smoothing the root helps the tissue heal.
Placement of medications
Some studies show that the placement of antibiotics or other medicines in the pockets will help control bacterial growth and therefore help control the disease.
Aid in home care
If pockets are too deep, the patient will have a more difficult time removing plaque. There may or may not be areas that don’t heal. These areas may require you to use other home care aids to clean these deep pockets. These include, but may not be limited to, the proxy brush, swab tips, a waterpik, or the rubber tip stimulator.
If you have been treated for gum disease, you will probably be instructed to return every three months for a professional cleaning. You will also need to do your part by thoroughly cleaning your teeth every day with a toothbrush, dental floss, and other tools because the disease is never cured, only controlled. Although you may think you are doing a great job with your home care, most people need to be monitored and have their technique altered from time to time to be shown where they are doing a good job and where they need improvement.
The conventional method for the reduction of deep pockets by is surgery. In severe cases, following healing, the teeth appear longer in the areas where more bone has been lost in the disease process. There’s a phrase that says “he looks a little long in the tooth”. This is because in order to surgically eliminate deep pockets, the gum tissue has to be reduced as part of the surgical procedure.
Dental Lasers eliminate this problem because laser treatment works deep in the pocket to kill bacteria and creating an environment for bone growth and reattachment of gum tissue. This means that following treatment with lasers, the destruction from bacteria can be reversed without leaving the teeth looking long and unattractive. However, commitment to homecare, and continuous monitoring and maintenance appointments are necessary to ensure control of the bacteria to prevent recurrence of the pockets.