HAPPY GUMS LEAD TO A HAPPY SMILE

Having painful gums or gum recession? Let our team help you with this issue by creating a plan to help make your gums healthy again.

 

Healthy gums are vital to your oral health.

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What is Periodontics?

The term “periodontics” refers to the dental specialty that pertains to the prevention, diagnosis and treatment of periodontal disease that affects the gums and jawbone.  The gum tissues serve to surround and support the teeth and the underlying jawbone anchors teeth firmly in place. Periodontists have completed several years of extra dental training and are concerned with maintaining the function, health and aesthetics of the jawbone and tissues.

In the case of mild/moderate periodontal problems, the focus of the periodontist will be on curing the underlying bacterial infection and then providing advice on the most appropriate home cleaning methods.

Sometimes a deep scaling is needed to remove the bacterial plaque and calculus (tartar) from the teeth and tissues.  Where periodontal disease is advanced and the jawbone has regressed significantly, more intensive cleaning may be recommended and loose teeth that cannot be saved will be removed.

The periodontist is trained in all aspects of dental implant procedures, which can restore functionality to the mouth when teeth have been affected by periodontitis.

Because periodontal disease is progressive, it is essential to remove the bacteria and calculus build up to halt the spread of the infection.  Your dentist will be happy to advise you on effective cleaning methods and treatment options.

Fixing Your Gums Can Avoid Tooth Loss

There are several reasons why periodontal treatment may be necessary:

  • Moderate/advanced gum disease – This occurs when the gums are bleeding, swollen or red around most teeth and the jawbone has begun to recede.

  • Localized gum recession – The infection which propagates moderate or advanced gum disease often begins in one area.  Gum recession may also be caused due to over brushing with a hard bristle brush, or due to a tooth that is not positioned properly.  Immediate treatment is required to prevent further spreading.

  • Before crown lengthening – The periodontist may lengthen the crown of the tooth by removing surrounding soft tissue to provide more tooth exposure.

  • Ridge augmentation – This procedure, often called “recontouring” may be required to correct an uneven gum line.  Before embarking on treatment, a periodontist needs to treat any bacterial infections and periodontitis.

When to See a Periodontist

A periodontist is a dentist specializing in the prevention, diagnosis and treatment of infections and diseases in the soft tissues surrounding the teeth, and the jawbone to which the teeth are anchored.  Periodontists have to train an additional three years beyond the four years of regular dental school, and are familiar with the most advanced techniques necessary to treat periodontal disease and place dental implants.  Periodontists also perform a vast range of cosmetic procedures to enhance the smile to its fullest extent.

Periodontal disease begins when the toxins found in plaque start to attack the soft or gingival tissue surrounding the teeth.  This bacterium embeds itself in the gum and rapidly breeds, causing a bacterial infection.  As the infection progresses, it starts to burrow deeper into the tissue causing inflammation or irritation between the teeth and gums.  The response of the body is to destroy the infected tissue, which is why the gums appear to recede.  The resulting pockets between the teeth deepen and if no treatment is sought, the tissue which makes up the jawbone also recedes causing unstable teeth and tooth loss.

Referrals from General Dentists and Self Referral

There are several ways treatment from a periodontist may be sought.   In the course of a regular dental check up, if the general dentist or hygienist finds symptoms of gingivitis or rapidly progressing periodontal disease, a consultation with a periodontist may be recommended.  However, a referral is not necessary for a periodontal consultation.

If you experience any of these signs and symptoms, it is important that you schedule an appointment with a periodontist without delay:

  • Bleeding while eating or brushing – Unexplained bleeding while consuming food or during the course of daily cleaning is one of the most common signs of periodontal infection.

  • Bad breath – Continued halitosis (bad breath) which persists even when a rigorous oral hygiene program is in place, can be indicative of periodontitis, gingivitis or the beginnings of an infection in the gum tissues.

  • Loose teeth and gum recession – Longer looking teeth can signal recession of the gums and bone loss due to periodontal disease.  As this disease progresses and attacks the jawbone, (the anchor holding the teeth in place) the teeth may become loose or be lost altogether.

  • Gangrene in the tissues – Gangrene is hard to self diagnose but the general dentist and periodontist will check for its presence in the soft tissues, alveolar bone and periodontal ligament.

  • Related health conditions – Heart disease, diabetes, osteopenia and osteoporosis are highly correlated with periodontitis and periodontal infections.  The bacteria infection can spread through the blood stream and affect other parts of the body.

Diagnosis and Treatment

Before initiating any dental treatment, the periodontist must extensively examine the gums, jawbone and general condition of the teeth.  When gingivitis or periodontal disease is officially diagnosed, the periodontist has a number of surgical and non surgical options available to treat the underlying infection, halt the recession of the soft tissue, and restructure or replace teeth which may be missing.

  • Gingivitis/mild periodontal disease – When the gum pockets exceed 4mm in depth, the periodontist or hygienist may perform scaling and root planing to remove debris from the pockets and allow them to heal.  Education and advice will be provided on an effective cleaning regime thereafter.

  • Moderate periodontal disease – If the gum pockets reach 4-6mm in length, a more extensive scaling and root planing cleaning might be required.  This cleaning is usually performed under local anesthetic.

  • Advanced periodontal disease – Gum pockets in excess of 6-7mm are usually accompanied by bone loss and gum recession.  Scaling and root planing will always be performed as the initial nonsurgical treatment.  In addition to tose nonsurgical treatments, the periodontist may recommend surgical treatment to reduce pocket depth.

  • Tooth loss – Where one or several teeth are missing due to periodontal disease, dental implants are an effective option.  If the bone is strong enough to provide a suitable anchor for the prosthetic tooth, the implant can be placed.  However, if the bone is severely eroded, bone grafts may be performed by the periodontist to provide a suitable anchor for the new tooth/teeth.

Antibiotic Treatment

Periodontal disease, which is also known as gum disease and periodontitis, is a progressive disease which, if left untreated, may result in tooth loss.  Gum disease begins with the inflammation and irritation of the gingival tissues which surround and support the teeth.  The cause of this inflammation is the toxins found in plaque which cause an ongoing bacterial infection.

 

The bacterial infection colonizes in the gingival tissue, and deep pockets form between the teeth and the gums.  If treated promptly by a periodontist, the effects of mild inflammation (known as gingivitis) are completely reversible.  However, if the bacterial infection is allowed to progress, periodontal disease begins to destroy the gums and the underlying jawbone, promoting tooth loss.  In some cases, the bacteria from this infection can travel to other areas of the body via the bloodstream.

Common Causes of Gum Disease

There are genetic and environmental factors involved in the onset of gum disease, and in many cases, the risk of developing periodontitis can be significantly lowered by taking preventative measures.

Here are some of the most common causes of gum disease:

  • Poor dental hygiene – Preventing dental disease starts at home with good oral hygiene and a balanced diet.  Prevention also includes regular dental visits which include exams, cleanings, and x-rays.  A combination of excellent home care and professional dental care will preserve the natural dentition and support of bony structures.  When bacteria and calculus (tartar) are not removed, the gums and bone around the teeth become affected by bacterial toxins and can cause gingivitis or periodontitis, which ultimately lead to tooth loss.

  • Tobacco use – Research has indicated that smoking and tobacco use are some of the most significant factors in the development and progression of gum disease.  In addition to smokers experiencing a slower recovery and healing rate, smokers are far more likely to suffer from calculus (tartar) build-up on teeth, deep pockets in the gingival tissue, and significant bone loss.

  • Genetic predisposition – Despite practicing rigorous oral hygiene routines, as much as 30% of the population may have a strong genetic predisposition to gum disease.  These individuals are six times more likely to develop periodontal disease than individuals with no genetic predisposition.  Genetic tests can be used to determine susceptibility and early intervention can be performed to keep the oral cavity healthy.

  • Pregnancy and menopause – During pregnancy, regular brushing and flossing is critical. Hormonal changes experienced by the body can cause the gum tissue to become more sensitive, rendering them more susceptible to gum disease.

  • Chronic stress and poor diet – Stress lowers the ability of the immune system to fight off disease which means bacterial infection can beat the body’s defense system.  Poor diet or malnutrition can also lower the body’s ability to fight periodontal infections, as well as negatively affecting the health of the gums.

  • Diabetes and underlying medical issues – Many medical conditions can intensify or accelerate the onset and progression of gum disease including respiratory disease, heart disease, arthritis and osteoporosis.  Diabetes hinders the body’s ability to utilize insulin which makes the bacterial infection in the gums more difficult to control and cure.

  • Grinding teeth – The clenching or grinding of teeth can significantly damage the supporting tissue surrounding the teeth.  Grinding one’s teeth is usually associated with a “bad bite” or the misalignment of the teeth.  When an individual is suffering from gum disease, the additional destruction of gingival tissue due to grinding can accelerate the progression of the disease.

  • Medication – Many drugs including oral contraceptive pills, heart medicines, anti-depressants, and steroids affect the overall condition of teeth and gums, making them more susceptible to gum disease.  Steroid use promotes gingival overgrowth, which makes swelling more commonplace and allows bacteria to colonize more readily in the gum tissue.

Signs & Symptoms of Periodontal Disease

Periodontal disease (also known as periodontitis and gum disease) is a progressive condition and the leading cause of tooth loss amongst adults in the developed world.  Periodontal disease occurs when the toxins found in plaque begin to irritate or inflame the gingiva (gum tissue).  The resulting bacterial infection often known as gingivitis, can eventually lead to the destruction of the gum tissue and underlying bone.  If periodontal disease is not treated, it can also lead to loose teeth or tooth loss.

There are many common types of periodontal disease including aggressive, chronic, necrotizing periodontitis, and periodontitis associated with systemic diseases.  Each of these types of periodontal disease has its own distinct characteristics and symptoms, and all require prompt treatment by a dentist to halt subsequent bone and tissue loss.

Common Signs and Symptoms:

It is extremely important to note that periodontal disease can progress without any signs or symptoms such as pain.  This is why regular dental checkups are exceptionally important. Described below are some of the most common signs and symptoms of periodontitis.

If you have any of these signs or symptoms, the advice of a general dentist or periodontist should be sought as soon as possible:

  • Unexplained bleeding – Bleeding when brushing, flossing or eating food is one of the most common symptoms of a periodontal infection.  The toxins in plaque cause a bacterial infection which makes the tissues prone to bleeding.

  • Pain, redness or swelling – A periodontal infection may be present if the gums are swollen, red or painful for no apparent reason.  It is essential to halt the progression of the infection before the gum tissue and jaw bone have been affected.  It is also critical to treat the infection before it is carried into the bloodstream to other areas of the body.

  • Longer-looking teeth – Periodontal disease can lead to gum recession.  The toxins produced by bacteria can destroy the supporting tissue and bones, thus making the teeth look longer and the smile appear more “toothy.”

  • Bad breath/halitosis – Although breath odor can originate from the back of the tongue, the lungs and stomach, the food we consume, or from tobacco use, bad breath can also be caused by old food particles that sit between the teeth and underneath the gumline. The deeper gum pockets are able to house more debris and bacteria, causing a foul odor.

  • Loose teeth/change in bite pattern – A sign of rapidly progressing periodontitis is the loosening or shifting of the teeth in the affected area.  As the bone tissue gets destroyed, teeth that were once firmly attached to the jawbone become loose or may shift in position.

  • Pus – Pus oozing from between the teeth is a definitive sign that a periodontal infection is in progress.  The pus is a result of the body trying to fight the bacterial infection.

Treatment of Periodontal Disease

There are many surgical and nonsurgical treatments the periodontist may choose to perform, depending upon the exact condition of the teeth, gums and jawbone.  A complete periodontal exam of the mouth will be done before any treatment is performed or recommended.

Here are some of the more common treatments for periodontal disease

  • Scaling and root planing – In order to preserve the health of the gum tissue, the bacteria and calculus (tartar) which initially caused the infection, must be removed.  The gum pockets will be cleaned and treated with antibiotics as necessary to help alleviate the infection.  A prescription mouthwash may be incorporated into daily cleaning routines.

  • Tissue regeneration – When the bone and gum tissues have been destroyed, regrowth can be actively encouraged using grafting procedures.  A membrane may be inserted into the affected areas to assist in the regeneration process.

 

  • Pocket elimination surgery – Pocket elimination surgery (also known as flap surgery) is a surgical treatment which can be performed to reduce the pocket size between the teeth and gums.  Surgery on the jawbone is another option which serves to eliminate indentations in the bone which foster the colonization of bacteria.​​

  • Dental implants – When teeth have been lost due to periodontal disease, the aesthetics and functionality of the mouth can be restored by implanting prosthetic teeth into the jawbone.  Tissue regeneration procedures may be required prior to the placement of a dental implant in order to strengthen the

  • Laser treatment – This can be used to reduce the size of the pockets between the teeth and the gums.

  • Tissue & bone grafting – Where a considerable amount of bone or gum tissue has been destroyed, the dentist may elect to graft new tissue by inserting a membrane to stimulate tissue growth.

  • Pocket elimination surgery – The dentist may choose to perform “flap surgery” to directly reduce the size of the gum pockets.

Periodontal treatment methods depend upon the type and severity of the disease. Your dentist and dental hygienist will evaluate for periodontal disease and recommend the appropriate treatment. Periodontists specialize in the treatment of gum disease and the placement of dental implants.  A periodontist can perform effective cleaning procedures in deep pockets such as scaling and root planing; they can also prescribe antibiotic and antifungal medications to treat infection and halt the progression of the disease.

Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues.  When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!

Early Stages

If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended.  You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.

Moderate Stages

In the case of moderate periodontal disease, the pockets (under the gumline) of the teeth will be completely cleared of debris using a procedure called scaling and root planing.  The pockets may be filled with antibiotics to promote good healing and kill any bacteria that remain.

Advanced Stages 

If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended.  It is usually done one quadrant of the mouth at a time while the area is numb.  In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing).  This procedure helps gum tissue to heal and pockets to shrink.  Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.

If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. Your dentist may also recommend that you see a periodontist (specialist of the gums and supporting bone).

In the case of tooth loss, the periodontist is able to perform tissue grafts to promote natural tissue regeneration, and insert dental implants if a tooth or several teeth are missing.  Where gum recession causes a “toothy” looking smile, the periodontist can recontour the gingival tissue to create an even and aesthetically pleasing appearance.

Maintenance

It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)!  Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.

Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year.  At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy.  Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.

In addition to your periodontal cleaning and evaluation, your appointment will usually include:

  • Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.

  • Examination of existing restorations: Check current fillings, crowns, etc.

  • Examination of tooth decay: Check all tooth surfaces for decay.

  • Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.

  • Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)

  • Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.

Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!

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