Periodontal (gum) disease is an insidious
infection that affects virtually everyone with teeth. This
group of diseases originates with bacteria that grow
in a sticky matrix commonly called plaque, which grows back and should be removed daily using toothbrushing and flossing. Mechanical removal
of plaque can accomplish just so much, however, since the
oral bacteria responsible for periodontal disease are natural
residents of the mouth that reattach to teeth immediately
after plaque is removed. Some people are more susceptible
to periodontal disease than others. Factors such as heredity
(where a family has a history of periodontal disease) and
lifestyle (such as tobacco and alcohol use) can influence
the overgrowth of certain oral bacteria. This
overgrowth can damage soft and hard tissues unless
it is brought under control and the tissues are allowed to
heal. As the gum tissue is damaged, it begins to detach from
the tooth exposing the roots. In more advanced stages, this
recession results in "pockets" being formed. This
detached gum tissue is an ideal living space for the bacteria
that cause periodontal disease - and it allows the disease
to destroy the underlying bone to which your
teeth are anchored.
The first bacteria to attach and overgrow on
teeth and gums are facilitators; they allow the attachment
of more aggressive, or virulent, forms of bacteria. As more
and more aggressive forms attach in succeeding layers, they
overgrow and disrupt a natural balance in the mouth known
as homeostasis. It is at that point that they begin to damage
gingival (gum) tissue. This early infection, called gingivitis,
is typically characterized by slight bleeding or tenderness
of the gum tissues, yet many people fail to notice these somewhat
subtle warning signs. Fortunately, gingivitis is reversible
via the mechanical disruption of the bacterial plaque, since
it has not yet moved below the gum line and formed harder
to reach spaces (periodontal pockets). Bacterial plaque forms
all around the tooth and so, all sides of a tooth and its
gum line must be thoroughly cleaned to remove as much bacteria
as possible. Normally, this means careful oral hygiene at
home, i.e. brushing and flossing or another method of interdental
(between the teeth) cleaning. When there is no gum recession,
or damage, between the teeth, dental floss is recommended.
In cases where the gum has receded between the teeth, specially
designed brushes that fit between the teeth are often helpful.
Over-the-counter mouthwashes are a way to temporarily cover
up bad breath that can be caused by periodontal disease, but
do nothing to solve the root problem. In effect, you are simply
ignoring the warning symptoms by masking them.
If gingivitis goes untreated, oral bacteria
will continue to overgrow and may reach the supporting structures
of the teeth in individuals who are susceptible. One of those
structures, a muscle-like ligament that anchors the tooth
to the bone, can be destroyed by the action of the bacteria
and the body's response to harmful byproducts released by
the bacteria. Once the ligament is destroyed the bacteria
can more easily reach the bone itself. For most of us, this
destruction is painless, which leads many people to notice
the damage only when a tooth actually becomes loose. Unfortunately,
that tooth movement usually represents severe periodontal
disease - and it presages the loss of the tooth. Early detection
of periodontal disease can literally save teeth, but the process
can be performed only by a dental professional who employs
techniques that can measure the depth of the separation of
gum and tooth with an instrument called a periodontal probe.
This measurement should always be part of your routine cleaning
and check-up at your dentist's office. Detected in early stages,
periodontal disease is easily treatable, but later stages
of the disease require more advanced forms of therapy.
We now understand that gum infections can have negative effects on other parts of the body. Individuals with chronic infections, including gum infections, can have more cardiovascular and diabetic problems than people who do not have gum disease.
Preventative Solutions For Gum Disease
The best way to fight gum disease is to stop
it before it destroys gum and bone tissues. Brush and floss
daily and have regular checkups done at least once a year
by your dentist.
If your dentist finds that you have gingivitis,
you may need your teeth professionally cleaned.
Tartar (calculus) is often found on your teeth
when you have gingivitis. This hardened plaque should be removed
by a dental professional since it can harbor plaque and irritate
the gums. Patients who have gingivitis should have their teeth
cleaned, on average, twice a year.
Professional treatment in areas of bone loss
is aimed at cleaning the exposed tooth root surface so that
the surrounding soft tissues can reattach. Two types of treatment
can facilitate restoring health, repair and regrowing bone.
Treating Bone loss (periodontal
Minimally Invasive Periodontal Therapy - Nonsurgical
Repairing the damage using the Dental Endoscope
Most people, over time, build up tartar around
their teeth at the gum line. Some people naturally form more
tartar than others, but everyone has it. Effective daily oral
hygiene can minimize that buildup by removing the bacterial
plaque that influences tartar formation, since tartar is an
encrustation on the teeth formed by salivary secretions, food
residue, and various minerals ( such as calcium carbonate
or phosphate). This hard mineral substance, which cannot be
effectively removed at home once it forms, makes it far easier
for disease-causing bacteria, and the food debris they feed
on, to attach and remain impervious to brushing and flossing.
Tartar below the gum has
been removed by scraping the root surface without
seeing seeing the deposit. Today, we understand that this
"blind" approach can leave bacteria and tartar at
the tooth, which in turn can prevent the gum from reattaching
to the tooth and lead to re-infection.
An endoscope, which enables the dentist
to see the tooth surface and gum line under great magnification allows
more of the bacteria and tartar to be removed. The device
magnifies surfaces up to 50 times, allowing the visualization
of deposits invisible to the naked eye. For the patient this
means a cleaner tooth, better gum repair and, in many cases,
no need for surgical intervention.
Re-growing lost bone
In cases where we choose to regenerate (regrow) bone
that has been lost to periodontal disease, the endoscope makes
it possible to make openings in the gums that are
much smaller than in the past - and minimize
post-operative problems. When combined with the application
of biomaterials that encourage the regeneration of soft and
hard oral tissues, such as enamel matrix derivatives (see below),
the surgical result is more predictable and more comfortable,
usually with far less gum recession.
Enamel Matrix Derivatives (Emdogain)
Enamel matrix derivatives (EMD's) are naturally occurring
proteins found in all humans that help regulate the formation
of our teeth. Like a multitude of proteins throughout our
bodies, EMD's are building blocks within the body cells.
Similar proteins are found around the developing teeth of
all mammals. First isolated in the 1980s, EMD's have also been
found to generate new bone around teeth and a new periodontal
ligament that attaches the bone to the teeth. Those regenerative
properties have made EMD's quite valuable in the restoration
of health around teeth ravaged by periodontal disease.
The EMD's used in periodontal treatment have
a porcine origin. They are isolated, processed, and prepared
for "on-time" delivery during the therapy itself.
Their use for treating periodontitis (bone loss from gum disease)
and gum recession has been approved by the U.S. Food and Drug
Before EMD's can be applied, the affected teeth
are given a through cleansing to remove tartar and bacterial
plaque using the endoscope. The tooth root surface is then cleaned with a preparatory
material and the proteins are placed.
These proteins quickly form an interactive yet invisible layer
on the teeth which, in our experience, has significantly augmented
healing following treatment of gum disease and implant placement.
FAQs about gum disease
1. If periodontal diseases
are caused by bacteria, why can't I simply take antibiotics
to cure the infection?
There are many types of bacteria, acting alone
or in concert with other types, that lead to periodontal
disease. The simple answer is that no one antibiotic can
affect all the types of bacteria that may be involved in
2. Are there diets or
dietary supplements that will help reduce the damage from
Bacteria feed on virtually any food that is
trapped in the mouth. While diet can play a role in oral
health, it is oral hygiene and the frequency of eating that
are most important. It is important to thoroughly clean
the teeth at least twice a day, preferably soon after eating.
This removes the food debris on which bacteria feed and
makes it harder for them to overgrow. Another important
diet-related factor is the frequency of eating. Even daily
toothbrushing might not be able to keep up with frequent
eating occasions throughout the day. Each instance "feeds"
the oral bacteria. Avoiding frequent snacking on foods containing
refined sugars and starches will help
reduce the growth of plaque that can cause gum disease and
3. Does it take longer to do a deep cleaning
using the endoscope?
Yes. Because your therapist can now actually
see microscopic deposits of tartar that would have been
missed with the naked eye, it will take longer to remove