Periodontal treatment is necessary when various conditions affect the health of your gums and the regions of your jaw bone that hold your teeth in place. Retaining your teeth is directly dependent on proper periodontal care and maintenance. Healthy gums enhance the appearance of your teeth, like a frame around a beautiful painting. When your gums become unhealthy, they can either recede or become swollen and red. In later stages, the supporting bone is destroyed and your teeth will shift, loosen, or fall out. These changes not only affect your ability to chew and speak. They also spoil your smile.
Periodontal diseases are ongoing infections of the gums that gradually destroy the support of your natural teeth. Periodontal disease affects one or more of the periodontal tissues: alveolar bone, periodontal ligament, cementum, or gingiva. While there are many diseases which affect the tooth-supporting structures, plaque-induced inflammatory lesions make up the majority of periodontal issues, and are divided into two categories: gingivitis and periodontitis. While gingivitis, the less serious of the diseases, may never progress into periodontitis, it always precedes periodontitis.
Dental plaque is the primary cause of gingivitis in genetically-susceptible individuals. Plaque is a sticky colorless film, composed primarily of food particles and various types of bacteria, which adhere to your teeth at and below the gum line. Plaque constantly forms on your teeth, even minutes after cleaning. Bacteria found in plaque produce toxins or poisons that irritate the gums. Gums may become inflamed, red, swollen, and bleed easily. If this irritation is prolonged, the gums separate from the teeth causing pockets (spaces) to form. If daily brushing and flossing is neglected, plaque can also harden into a rough, porous substance known as calculus (or tartar). This can occur both above and below the gum line.
If gingivitis progresses into periodontitis, the supporting gum tissue and bone that holds teeth in place deteriorates. The progressive loss of this bone, the alveolar, can lead to loosening and subsequent loss of teeth. Periodontitis is affected by bacteria that adhere to the tooth’s surface, along with an overly aggressive immune response to these bacteria.
Periodontal disease is dangerous in that it is often painless and symptomless. 80% of Americans will be afflicted with periodontal disease by age 45, and 4 out of 5 patients with the disease are unaware they have it. It is important to maintain proper home oral care and regular dentist visits to reduce the risk of obtaining this disease.
The Mouth-Body Connection
Research has recently proven what dentists have long suspected: that there is a strong connection between periodontal disease and other chronic conditions such as diabetes, heart disease and osteoporosis.
Periodontal disease is characterized by inflammation of the gum tissue, presence of disease-causing bacteria, and infection below the gum line. Infections and bacteria in the mouth can spread throughout the body and lead to a host of problematic health issues. Therefore, maintaining excellent oral hygiene and reducing the progression of periodontal disease through treatment will have benefits beyond preventing gum disease and bone loss. It can also save you from the chance of developing another serious condition.
Periodontal Disease and Diabetes
Diabetes is a serious, incurable disease that is characterized by too much glucose, or sugar, in the blood. Type II diabetes occurs when the body is unable to regulate insulin levels, meaning too much glucose stays in the blood. Type I diabetics cannot produce any insulin at all. Diabetes affects between 12 and 14 million Americans, and can lead to a variety of health issues, such as heart disease and stroke.
Research has shown people with diabetes are more likely to develop periodontal disease than non-diabetics. Diabetics with insufficient blood sugar control also develop periodontal disease more frequently and severely than those who have good management over their diabetes.
The connection between diabetes and periodontal disease results from a variety of factors. Diabetes sufferers are more susceptible to all types of infections, including periodontal infections, due to the fact diabetes slows circulation, allowing bacteria to colonize. Diabetes also reduces the body’s overall resistance to infection, which increases the probability of the gums becoming infected.
Moderate to severe cases of periodontal disease elevate sugar levels in the body, increasing the amount of time the body has to function with high blood sugar. Diabetics with periodontitis are most likely to suffer from increased levels, making it difficult to keep control of their blood sugar. Further, high glucose levels in saliva promote growth of gum disease-causing bacteria.
Blood vessel thickening is another concern for diabetics. Blood vessels function by providing nutrients and removing waste products from the body. When they become thickened by diabetes, these exchanges are unable to occur. As a result, harmful waste is left in the mouth and can weaken the resistance of gum tissue, leading to infection and disease.
Smoking and tobacco use is detrimental to anyone’s oral and overall health, but it is particularly harmful to diabetics. Diabetic smokers 45 and older are in fact 20 times more likely to develop periodontal disease than those who do no smoke.
It is very important for everyone to brush teeth effectively, floss daily, and visit the dentist regularly, but it is especially essential that diabetics practice these measures. When teeth are left un-brushed, harmful bacteria can ingest the excess sugar and colonize beneath the gum line.
Periodontal Disease, Heart Disease and Stroke
Coronary heart disease occurs when fatty proteins and a substance called plaque build up on the walls of your arteries. This causes the arteries to narrow, constricting blood flow. Oxygen is restricted from traveling to the heart which results in shortness of breath, chest pain, and even heart attack.
The link between periodontal disease and heart disease is so apparent that patients with oral conditions are nearly twice as likely to suffer from coronary artery disease than those with healthy mouths. Periodontal disease has also been proven to exacerbate existing heart conditions. Additionally, patients with periodontal disease have been known to be more susceptible to strokes. A stroke occurs when the blood flow to the brain is suddenly stopped. This may occur, for example, when a blood clot prevents blood from reaching the brain.
One of the causes of the connection between periodontal disease and heart disease is oral bacteria entering the bloodstream. There are many strands of periodontal bacteria. Some strands enter the bloodstream and attach to the fatty plaques in the coronary arteries. This attachment leads to clot formation and increased risk to a variety of issues including heart attack.
Inflammation caused by periodontal disease creates an increase in white blood cells and C-reactive proteins (CRP). CRP is a protein that has long-been associated with heart disease. When levels are increased in the body, it amplifies the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, causing the liver to produce extra CRP, which then leads to inflamed arteries and possibly blood clots. Inflamed arteries can lead to blockage, which can cause heart attacks or strokes.
Coronary heart disease is the leading cause of death in the United States for both men and women. Enacting positive oral hygiene practices and obtaining treatment for periodontal problems can help prevent the risk of developing this unfortunate condition.
Periodontal Disease and Pregnancy
Pregnant women with periodontal disease expose their unborn children to a variety of risks and possible complications. Pregnancy causes many hormonal changes in women, which increase the likelihood of developing periodontal disease such as gingivitis, or gum inflammation. These oral problems have been linked to preeclampsia, or low birth weight of the baby, as well as premature birth. Fortunately, halting the progression of periodontal disease through practicing high standards of oral hygiene and treating existing problems can help reduce the risk of periodontal disease-related complications by up to 50%.
There are several factors that contribute to why periodontal disease may affect the mother and her unborn child. One is an increase in prostaglandin in mothers with advanced stages of periodontal disease, particularly periodontitis. Prostaglandin is a labor-inducing compound found in the oral bacteria associated with periodontitis. Because periodontitis increases the levels of prostaglandin, the mother may go into labor prematurely and deliver a baby with a low birth weight.
Another compound that has recently been linked to premature birth and low birth weights is C-reactive protein (CRP). CRP is a protein that has long-been associated with heart disease. Periodontal disease increases CRP levels in the body, which then amplify the body’s natural inflammatory response. Bacteria from periodontal disease may enter the bloodstream, causing the liver to produce extra CRP, which then leads to inflamed arteries and possibly blood clots. Inflamed arteries can lead to blockage, which can cause heart attacks or strokes. Although it is not completely understood why elevated CRP also causes preeclampsia, studies have overwhelmingly proven that an extremely high rates of CRP in early pregnancy definitely increases the risk.
Finally, the bacteria that invade and live in the gum sockets in a diseased mouth can travel through the bloodstream and affect other parts of the body. For pregnant women, research has shown that these bacteria may colonize in the internal mammary glands and coronary arteries.
If you are pregnant, it is important to practice effective home care for preventing gum disease. can help assess your level of oral health and develop preventative measures and treatment plans to best protect you and your baby.
Periodontal Disease and Respiratory Disease
Respiratory disease occurs when fine droplets are inhaled from the mouth and throat into the lungs. These droplets contain germs that can spread and multiply within the lungs to impair breathing. Recent research had also proven that bacteria found in the mouth and throat can be drawn into the lower respiratory tract and cause infection or worsen existing lung conditions.
Bacteria that grow in the oral cavity and travels into the lungs can cause respiratory problems such as pneumonia. This occurs mostly in patients with periodontal disease. Periodontal disease has also been proven to have a role in the contraction of bronchitis and emphysema. Chronic obstructive pulmonary disease (COPD), a respiratory condition characterized by blockage of the airways, and caused mostly by smoking, has also been proven to worsen if the patient also has periodontal disease.
One of the reasons for the connection between respiratory problems and periodontal disease is low immunity. Patients who experience respiratory problems generally have low immunity, meaning bacteria can easily grow above and below the gum lines without being confronted by the body’s immune system. Once periodontal disease is contracted in this way, it will only progress and worsen respiratory issues.
Inflammation of the oral tissue has also been linked to respiratory problems. Oral bacteria causing the irritation can travel to the lungs, and contribute to the inflammation of the lung lining. This creates respiratory problems because it limits the amount of air that can be passed freely through the lungs.
If you are diagnosed with respiratory disease or periodontal disease, it is possible will work with your physician to plan how to best treat both conditions and eliminate further complications.
Periodontal Disease and Osteoporosis
Osteoporosis is a condition common in older patients, and particularly women, that is characterized by the thinning of bone tissue and loss of bone density over time. Osteoporosis occurs when the body fails to form enough new bone, or when the body absorbs too much old bone. The leading cause of osteoporosis is a drop in estrogen in menopausal women, or a drop in testosterone among men. Sufferers of osteoporosis must take extra care in daily activities, as they are at increased risk for bone fractures.
Because periodontal disease can also lead to bone loss, the two diseases have been studied for possible connections. Research found that women with periodontal bacteria in their mouths were more likely to have bone loss in the oral cavity and jaw, which can lead to tooth loss. Studies conducted over a period of 10 years also discovered that osteoporosis patients could significantly reduce tooth loss by controlling periodontal disease. Further, it was found that post-menopausal women who suffer from osteoporosis are 86% more likely to also develop periodontal disease.
One of the reasons for the connection between osteoporosis and periodontal disease is an estrogen deficiency. Estrogen deficiency speeds up the progression of both oral bone loss and other bone loss. It also accelerates the rate of loss of fibers and tissues which keep the teeth stable. Tooth loss occurs when these fibers are destroyed.
Low mineral bone density is one of the several causes of osteoporosis. The inflammation from periodontal disease weakens bones more prone to break down. This is why periodontitis can be particularly detrimental and progressive to patients with osteoporosis.
If you are diagnosed with osteoporosis, it is extremely important to take preventative measures against periodontal disease to protect your teeth and oral bones.
Women and Periodontal Health
Throughout a woman’s life, hormonal changes affect tissue throughout the body. Fluctuations in hormonal levels occur during puberty, pregnancy and menopause. At these times, the chance of periodontal disease may increase, requiring special care of your oral region.
Puberty
During puberty, there is increased production of sex hormones. These higher hormone levels increase gum sensitivity and lead to greater irritation from plaque and food particles. The gums can become swollen, turn red, and feel tender.
Menstruation
Similar symptoms occasionally appear several days before menstruation. Bleeding of the gums, bright red swelling between the teeth and gum, or sores on the inside of the cheek may occur. These symptoms generally clear up once the period has started.
Pregnancy
Your gums and teeth are also affected during pregnancy. Between the second and eighth month, gums may also swell, bleed, and become red or tender. Large lumps may appear as a reaction to local irritants. However, these growths are generally painless and not cancerous. They may require professional removal, but usually disappear sometime after delivery. Periodontal health practices should be part of your prenatal care. Any infections during pregnancy, including periodontal infections, can place a baby’s health at risk. For more information, see the section of our website labeled “Pregnancy and Periodontal Disease” under the “Mouth-Body Connection” tab.
Oral Contraceptives
Swelling, bleeding, and tenderness of the gums may also occur when you are taking oral contraceptives, which are synthetic hormones.
You should always mention any prescriptions you are taking, including oral contraceptives, prior to medical or dental treatment. This will help eliminate the risk of drug interactions, such as antibiotics with oral contraceptives, which lessens the effectiveness of the contraceptive.
Menopause
Changes in the look and feel of your mouth may occur if you are menopausal or post-menopausal. They include: feeling pain and burning in your gum tissue and salty, peppery, sour tastes, and “dry mouth.” Careful oral hygiene at home and professional cleaning may relieve these symptoms. There are also saliva substitutes to treat the effects of dry mouth.
Preventing Gum Disease
Adults over the age of 35 lose more teeth to gum diseases than from cavities. At least three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal diseases is by daily thorough tooth brushing and flossing techniques and regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people can still develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.
Other important factors that can negatively affect the health of your gums include: tobacco usage, stress, clenching and grinding teeth, some medications, and poor nutrition.
While brushing the outside surfaces of your teeth, position the brush at a 45-degree angle where your gums and teeth meet. Gently move the brush in a circular motion several times using small, gentle strokes. Use some pressure while putting the bristles between the teeth, but not so much pressure that you feel any discomfort. When you are done cleaning the outside surfaces of all your teeth, follow the same directions while cleaning the inside of the back teeth.
To clean the inside surfaces of the upper and lower front teeth, hold the brush vertically. Make several gentle back-and-forth strokes over each tooth. Don’t forget to gently brush the surrounding gum tissue.
Next you will clean the biting surfaces of your teeth. To do this, use short, gentle strokes. Change the position of the brush as often as necessary to reach and clean all surfaces. Try to watch yourself in the mirror to make sure you clean each surface. After you are done, rinse vigorously to remove any plaque you might have loosened while brushing.
If you have any pain while brushing or have any questions about how to brush properly, please be sure to call the office.
Adults over the age of 35 lose more teeth to gum diseases than from cavities. At least three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal diseases is by daily thorough tooth brushing and flossing techniques and regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people can still develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.
Other important factors that can negatively affect the health of your gums include: tobacco usage, stress, clenching and grinding teeth, some medications, and poor nutrition.
How to Floss
Periodontal disease usually appears between the teeth where your toothbrush cannot reach. Flossing is a very effective way to remove plaque from those surfaces. However, it is important to develop the proper technique. The following instructions will help you, but remember it takes time and practice.
Start with a piece of floss (waxed is easier) about 18″ long. Lightly wrap most of the floss around the middle finger of one hand. Wrap the rest of the floss around the middle finger of the other hand.
To clean the upper teeth, hold the floss tightly between the thumb and forefinger of each hand. Gently insert the floss tightly between the teeth using a back-and-forth motion. Do not force the floss or try to snap it in to place. Bring the floss to the gum line then curve it into a C-shape against one tooth. Slide it into the space between the gum and the tooth until you feel light resistance. Move the floss up and down on the side of one tooth. Remember there are two tooth surfaces that need to be cleaned in each space. Continue to floss each side of all the upper teeth. Be careful not to cut the gum tissue between the teeth. As the floss becomes soiled, turn from one finger to the other to get a fresh section.
To clean between the bottom teeth, guide the floss using the forefinger of both hands. Do not forget the back side of the last tooth on both sides, upper and lower.
When you are done, rinse vigorously with water to remove plaque and food particles. Do not be alarmed if during the first week of flossing your gums bleed or are a little sore. If your gums hurt while flossing you could be doing it too hard or pinching the gum. As you floss daily and remove the plaque your gums will heal and the bleeding should stop.
Caring For Sensitive Teeth
Sometimes after dental treatment, teeth are sensitive to hot and cold. If the mouth is kept clean, this sensation should not last long. However, if the mouth is not kept clean, the sensitivity will remain and could become more severe. If your teeth are especially sensitive, consult with Dr. Bernstein, Dr. Lock, Dr. Singh, Dr. Sterio, Dr. Hanratty, and . A medicated toothpaste or mouth rinse made especially for sensitive teeth may be recommended.
Choosing Oral Hygiene Products
There are so many products on the market that choosing the right one can be difficult. Here are some suggestions for selecting dental care products that will work for most patients:
Automatic and “high-tech” electronic toothbrushes are safe and effective for the majority of users. Oral irrigators (water spraying devices) will rinse your mouth thoroughly, but will not remove plaque. You need to brush and floss in conjunction with the irrigator. We see excellent results with the electric toothbrushes “Sonicare or Oral B”
Some toothbrushes have a rubber tip on the handle that is used to massage the gums after brushing. There are also tiny brushes (interproximal toothbrushes) that clean between your teeth. If these are used improperly you could injure the gums, so be sure to discuss proper use with Bernstein, Lock, Singh, Sterio, Hanratty, and Wise.
If used in conjunction with brushing and flossing, fluoride toothpastes and mouth rinses can reduce tooth decay by as much as 40 percent. Remember, these rinses are not recommended for children under six years of age.
Tartar control toothpastes will reduce tartar above the gum line, but because gum disease starts below the gum line, these products have not been proven to reduce the early stage of gum disease.
Anti-plaque rinses, approved by the American Dental Association, contain agents that may help control signs of early gum disease. Use these in conjunction with brushing and flossing.
When to See a Periodontist
Periodontal treatment may be sought in several ways. Your general dentist or a hygienist may recommend a consultation with a periodontist if they find signs of periodontal disease through the course of a checkup or other dental care appointment. You may also decide to see a periodontist on your own as a referral is not necessary to be seen at our office.
In fact, if you experience any of these symptoms, we encourage you to schedule an appointment at our office without delay:
Bleeding while brushing or eating normal foods. Unexplained bleeding while performing regular cleaning or consuming food is the most common sign of a periodontal infection.
Bad breath. Ongoing halitosis (bad breath), which continues despite rigorous oral cleaning, can point to periodontitis, gingivitis or the beginnings of a gum infection.
Loose teeth and gum recession. Longer-looking and loose-feeling teeth can indicate recession of the gums and/or bone loss as a result of periodontal disease.
Related health concerns. Patients with heart disease, diabetes, osteopenia or osteoporosis are often diagnosed with correlating periodontal infections. The bacterial infection can spread through the blood stream, affecting other areas of the body.
The inside of the mouth is normally lined with a special type of skin (mucosa) that is smooth and coral pink in color. Any alteration in this appearance could be a warning sign for a pathological process. The most serious of these is oral cancer. The following are common signs of a pathologic process or cancerous growth:
- Reddish patches (erythroplasia) or whitish patches (leukoplakia) in the mouth.
- A sore that fails to heal, and bleeds easily.
- A lump or thickening on the skin lining the inside of the mouth.
- Chronic sore throat or hoarseness.
- Difficulty chewing or swallowing.
These changes can be detected on the lips, cheeks, palate, and gum tissue around the teeth, tongue, face, and/or neck. Pain does not always occur with pathology and, curiously, is not often associated with oral cancer. However, any patient with facial and/or oral pain without an obvious cause or reason may also be at risk for oral cancer. We recommend performing an oral cancer self-examination monthly.
Remember that your mouth is one of your body’s most important warning systems. Do not ignore suspicious lumps or sores. Please contact us so we may help.
