Understanding Gum Disease

To better understand periodontal disease and treatment, you need to know the anatomy a tooth's supporting structures.

They include:

• The periodontal ligament which attaches the tooth roots to the interdental bone (socket)
• The gum tissue which attaches to the bone and surrounds the tooth neck like a collar.

The word periodontal literally means "around the tooth". Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. It also has an impact on the overall health of your heart and cardiovascular system.

Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) release toxins causing gum inflammation.

This causes the gums to swell, appear puffy and bleed easily. This early stage of gum inflammation is called gingivitis. There is usually little or no discomfort. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with regular professional treatment and good oral home care.

Untreated gingivitis can advance to periodontitis. The most important difference between gingivitis and periodontitis is that in periodontitis, the bone around the tooth root is lost to varying degrees. With time, plaque on your teeth can harden to form tartar. Toxins produced by the bacteria in tartar stimulate a chronic inflammatory response causing bone resorption. Gums separate from teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Symptoms include bleeding gums, bad taste in the mouth, halitosis (bad mouth odor) and in severe cases abscesses. Eventually, teeth can become loose and may have to be removed.

So how can an infection in my gums have an effect on my overall health?

Once your gums become infected they usually bleed. When this occurs the bacteria that are in your mouth enter into you blood stream. Normally these bugs are only present in the controlled environment of your mouth. However, now that they are able to travel in the blood, they have access to all the organs of your body and slowly contribute to plaque formation in your blood vessels. This plaque is the kind that causes medical complications like heart attacks and strokes. There is an abundant amount of research that has linked people with chronic gum disease to a higher incidence of these cardiovascular illnesses. It can also cause complications in pregnancy and people who suffer from diabetes. There is no question that as the research becomes broader we will learn of more effects that periodontitis can have on our overall health. Having a healthy mouth is critical in leading a healthy life.

Non-Surgical Periodontal Treatment

The first step towards gum health is regular professional cleanings and good home care. Early periodontitis can easily be treated by scaling and root planing. Scaling and root planing is careful cleaning of the root surfaces to remove plaque and tartar from periodontal pockets. We also have a laser that is used in the pockets to disinfect as much bacteria as possible.

After scaling and root planing with laser therapy is complete, many patients do not require any further active treatment. Periodontitis however is something that can return without proper care. Therefore all patients need to make a commitment to ongoing maintenance therapy (professional cleanings) and vigilant home-care to sustain health. Non-surgical therapy does have its limitations, and when it does not achieve periodontal health, surgery may be indicated.

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Surgical Periodontal Treatment

When gum disease has progressed beyond a point where the patient is able to adequately clean their gums (i.e. when the periodontal pocket has become deeper than floss and toothbrush bristles can reach) or when routine scaling and root planing does not help to restore periodontal health, periodontal surgery may be advised. Most common surgical procedures are:

• Pocket reduction procedures
• Regenerative Procedures

Pocket Reduction Surgery:

The goal of pocket reduction surgery is to reduce or completely eliminate the periodontal pockets that have formed to due to bone loss. This is achieved by cleaning out the infected pockets and then repositioning the gums to the new bone level. Often, due to the nature of the gum disease, the bone that was damaged by the bacteria needs to be recontoured to allow the gum tissue to sit properly on bone. It is crucial to understand that while pocket reduction surgery can lead the gums and the body back to health, the potential for gum disease to reoccur will always remain. As a result, a lifetime of good home care and routine dental cleaning visits are mandatory. Otherwise there is a significant chance that the periodontal disease will return.

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Bone Graft and Guided tissue Regeneration

If there is a defect in the bone, often times a bone graft can be placed to stimulate new bone formation. A combination of natural or synthetic bone can be used for regeneration. Sometimes specialized membranes may be used during this procedure to prevent the gum tissue from creeping in between the tooth and the bone. This helps allow regeneration of new bone and periodontal ligament.

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Gum grafting/Cosmetic surgical procedures

Gum recession is a multifactorial phenomenon. It is related primarily to genetics and is increased by external factors such as grinding, and gum disease. The result is teeth that look longer and have exposed roots. Patients with root recession often experience sensitivity to cold. Recession can also create an esthetic defect if the recession is visible because the root of the tooth will show. There are a few reasons that recession should be treated:

• The gum tissue is lost enough that the tooth involved is no longer protected
• The exposed root is causing unpleasant sensitivity to cold
• The recession has caused an unsatisfactory appearance to the patient

In all cases, the treatment modality remains the same. The gum treatment involves using a donor graft and placing it in the site of the lost gum tissue. There are two different sources of gum tissue:

• The patient's own gum tissue (usually from the palate)
• Donor gum tissue (Acellular dermal matrix ie Alloderm)

Both materials have their advantages and disadvantages. We would be happy to discuss all your options.

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Crown Lengthening

Crown lengthening is done when a tooth needs to be restored, but not enough tooth is present to support a crown or a filling. This can happen when a tooth breaks off at the gum line, or a crown or filling falls out of a tooth that has extensive decay underneath. In order to restore the tooth, gum tissue and bone needs to be removed. This allows more tooth structure to be available above the gum line in order to properly restore the tooth.

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