1. Understanding Periodontal Disease, Gingivitis And Their Treatment

Have you ever been told that you have or may get peri­odon­tal dis­ease, yet did not quite under­stand what peri­odon­tal dis­ease is? Ever won­der what the dif­fer­ence is between peri­odon­tal dis­ease and another com­monly used term of gin­givi­tis? The answers to those ques­tions will increase your aware­ness of two of the most com­monly found con­di­tions in man.

Peri­odon­tal dis­ease is gum and bone dis­ease around teeth. It is loss of bone and gum attach­ment around the teeth. The gums may or may not be inflamed once this loss of bone and gum attach­ment occurs. Gen­er­ally this bone and attach­ment loss is irre­versible. Gin­givi­tis is gum inflam­ma­tion around teeth with no attach­ment loss and no bone loss. Gin­givi­tis is reversible if prop­erly treated. Both peri­odon­tal dis­ease and gin­givi­tis are caused by bac­te­r­ial plaque under the gums. Ini­tially soft bac­te­r­ial plaque, if not removed, even­tu­ally hard­ens to form cal­cu­lus, which can irri­tate the gums. Many fac­tors con­tribute to the bone and attach­ment loss seen in peri­odon­tal dis­ease even though these con­tribut­ing fac­tors are not the pri­mary cause of this disease.

There are also dif­fer­ent types of peri­odon­tal dis­ease. The most com­mon form is the chronic type, which can go on for many years and give no pain. A less com­mon type is the aggres­sive form which can occur at a younger age and progress more rapidly than the chronic form. Peri­odon­tal dis­ease can be local­ized to one or more teeth, or be gen­er­al­ized to involve all or most of the teeth. Also the dis­ease may be mild, mod­er­ate or advanced at one tooth or a num­ber of teeth. More than one degree may be present, mean­ing that some areas may have a mild peri­odon­tal dis­ease and other areas may have advanced peri­odon­tal disease.

There is a space around each tooth, between the gums and the tooth root. The top of the space is the top of the gums and the bot­tom of the space is the attach­ment of the gums to the tooth root, which in a healthy case, is on aver­age at least 2 mil­lime­ters above the bone level in that area. This space, when deep, is often referred to as a “pocket” in den­tal offices. When bone is lost around teeth, deep spaces or pock­ets may develop around the teeth. Or in other cases the gums may recede with the bone loss, keep­ing the spaces below the gums shal­low and expos­ing the roots.

Peri­odon­tal dis­ease and gin­givi­tis can be treated at your den­tal office. Depend­ing on it’s sever­ity and your gen­eral den­tist, it may be treated at your gen­eral den­tist office, a specialist’s ( peri­odon­tist ) office or at both offices. In topic #2, we will dis­cuss the treat­ment of peri­odon­tal dis­ease and gingivitis.

Basic gum treat­ment involves removal of den­tal cal­cu­lus and plaque above and below the gums. Below the gums means remov­ing the cal­cu­lus and plaque from the pock­ets or spaces around the teeth. The depth of the pocket deter­mines the access avail­able to remove the cal­cu­lus and plaque and there­fore deter­mines the opti­mum treat­ment needed to remove the cal­cu­lus and plaque.

Nor­mal clean­ings are designed to remove cal­cu­lus and plaque above the gum line and in shal­low pock­ets or spaces under the gums. A lim­i­ta­tion of nor­mal clean­ings is that this pro­ce­dure does not remove all the plaque and cal­cu­lus in the mod­er­ate or deep pock­ets (spaces) under the gum line. In these areas, the sur­face of the gums may improve for a short time, how­ever the per­son is still at a high risk of los­ing more bone and gum attach­ment deep under the gums in areas where the plaque and cal­cu­lus still remains.

For areas of mod­er­ate spaces, a pro­ce­dure called scal­ing and root plan­ning is needed. For deep spaces, gums are lifted for access and vis­i­bil­ity and then put back in place for heal­ing and reat­tach­ment to occur. This pro­ce­dure is peri­odon­tal surgery.

Once the cal­cu­lus and plaque is removed under the gums, a main­te­nance sched­ule of nor­mal clean­ings an aver­age of every 3 to 6 months is required to pre­vent the plaque and cal­cu­lus from form­ing deep under the gums and hard­en­ing there. If the main­te­nance sched­ule is not fol­lowed, then the ben­e­fits of the ini­tial gum treat­ment are lost after a few years. Whether main­te­nance sched­ule should be every 3 or 4 or 5 or 6 months depends on the level of oral hygiene a per­son has and the resis­tance a per­son has to gum and bone (peri­odon­tal) disease.

The ben­e­fits of gum treat­ment are to reduce the risk of fur­ther bone and gum attach­ment loss around teeth and in some cases regain gum attach­ment and bone lev­els around teeth with cer­tain types of gum or bone defects. If enough gum attach­ment and bone loss occurs around a tooth, the tooth becomes loose and can be lost in the future. Gum treat­ment in a timely man­ner can pre­vent or reduce the risk of tooth loos­en­ing and tooth loss. In cases where the ini­tial bone loss is severe around the teeth, gum treat­ment may pro­long the time that the teeth remains in the mouth com­pared to those teeth receiv­ing no treat­ment at all.

Gum attach­ment and bone sup­port around teeth are the foun­da­tions for the sup­port of the teeth in the mouth. With­out enough of this foun­da­tion of tooth sup­port, all den­tal treat­ment that relies on ade­quate tooth sup­port can fail pre­ma­turely. Exam­ples of den­tal treat­ment that rely on ade­quate tooth sup­port include crowns, bridges, par­tial den­tures and fill­ings. Even implants rely on good bone lev­els around them. Also unless the gums are healthy around the teeth, regard­less at which lev­els they are at, future qual­ity of den­tal treat­ment is com­pro­mised and the aver­age dura­tion of the den­tal treat­ment is reduced. In other words, it is not pos­si­ble for any den­tist to do good qual­ity crowns, bridges or fill­ings in areas where the gums bleed eas­ily and have cal­cu­lus above and below the gum line in those areas.