Periodontal Disease

Periodontics is the branch of dentistry concerned with the health of the supporting structures of the teeth, gum and jaw bones. “Periodontal” means “around the tooth”. Periodontal disease, or periodontitis (formerly known as pyorrhea), is caused by acids generated by bacteria in the mouth. These bacteria live in a thin, sticky film, known as plaque that coats the surfaces of teeth and the tongue. These bacteria feed on the sugars in foods and convert the sugar into acids. Plaque eventually hardens into tartar around the gum line, a hard mineral shell that erodes healthy gum tissue. Gingivitis is the first stage of the disease. In advanced gum disease, gums recede and pockets form below the gum line, allowing millions of bacteria to occupy the space. Your supporting jaw bone will dissolve leading to loosening of the teeth and eventually loss of the teeth.

The focus of our team is on treatment and prevention of periodontal disease. While a few people are very resistant to periodontal disease, some are highly susceptible. Resistance varies from person to person and it varies in the same person at different times. Dental research teams around the world are searching for answers to explain these variations. For example, it is felt that “stress” may have a “resistance-lowering” effect on the body. Other factors such as smoking and uncontrolled diabetes have been shown to contribute to periodontal disease. No matter what your susceptibility or resistance, periodontal treatment can arrest or slow down this disease. For the vast majority of people, treatment with meticulous, periodic maintenance is highly successful throughout their lifetime.

Preventing Gum Disease

Most people would say they do not have periodontal disease, but 76% of those over 36 years of age have symptoms of it. In an age when cavities are almost a thing of the past, periodontal disease persists. It is not usually painful by itself but it is the leading cause of tooth loss in adults. Several recent studies have even suggested a link between gum disease and heart disease and stroke. This is still under investigation, but it may be the bacteria that cause gum disease can enter the bloodstream and promote blood clots or damage the heart muscle or other vessels. Recently, it has been shown that if a woman develops severe periodontal disease during pregnancy, she is more likely to give birth to a low birth-weight infant.

But periodontal disease is preventable and can be successfully treated. The most important factor is you and how you take care of your teeth and general health. From the point of view of your teeth, your appearance, and your general health, it’s worth being informed about gum disease and taking steps to prevent it.

Although no one really likes to go to the doctor or dentist, we strive to make your visits with us as comfortable and as pleasant as possible. We strongly believe our patients’ comfort is an important part of quality dental care. Our mission is to treat every patient as if they are our only patient.

Drs. Niver, Sobel, and Niver work closely as a team with your referring dentists, but a referral by a dentist is not required for a visit to our office. We welcome referrals from patients and friends of the practice.

Please do not hesitate to e-mail us if you have any questions regarding your care at [email protected] or call us at 818.788.6600. Our fax number is 818.788.2905.

Who gets gum disease?

Some people never do, even though they do not take care of their teeth and never see a dentist. But it’s not worth gambling on being one of those lucky people. About one-third of the population is thought to have a genetic susceptibility to gum disease, and there’s now a test to detect this. But even if your test is negative, you can still develop gum disease and still need to take the same care of your teeth.

While most people are susceptible to gum disease, some people have factors that make them more likely to have gum disease than others:

  • Plaque and tartar some people actually develop plaque and tartar more easily than others. As a consequence they tend to have more gum disease.
  • Heredity we all inherit a degree of resistance, some people are very resistant to gum disease, plaque, and tartar, and others are not.
  • Medications some medications reduce saliva, leaving a dry mouth. Without the cleansing and antibiotic effect of saliva, plaque and calculus can build up more easily. Alcohol may also decrease saliva.
  • Smoking smoking slows the gum’s ability to heal. Smoking causes a decrease in blood supply to the gum and therefore its healing potential is diminished, so the bacteria can do more damage.
  • Pregnancy hormonal changes that occur during pregnancy, make the gum more susceptible to the damaging effects of plaque. In addition due to the hormonal changes, plaque grows easier during pregnancy.
  • Illness during illness there is usually a decrease or weakening of the immune system, therefore one is more prone to infection, which can lead to gum disease.
  • Stress stress has been known to change both the blood flow and the hormonal balance in the gum tissue. These changes make the gum more susceptible to periodontal breakdown. The bone loss, and loss of ligament and tissue that occurs subsequently can lead to destruction even when the person is trying diligently to take very good care of themselves.
  • Your bite your bite can cause micro-movement in the teeth, causing an increased susceptibility to bacteria and tartar getting in the gap between the gum and the tooth. Grinding or clenching your teeth can actually increase the gap around your teeth allowing bacteria to enter the space. This can accelerate the pocket formation.

What symptoms should I watch for?

The first signs of gum disease are gums that bleed when you brush your teeth, and red, swollen gums. This usually indicates gingivitis. If the condition worsens, you may develop chronic bad breath and more bleeding. With severe periodontal disease, teeth may loosen, and you may notice gums pulling away from teeth. Your bite may change, and if you have partial dentures they may no longer fit. You should not wait for such symptoms to develop. Regular dental visits, ideally every six months, should identify periodontal symptoms in the early stages when you can obtain advice and preventive care from a periodontist.

Aside from poor dental hygiene and genetics, what promotes gum disease?

One of the major risk factors is smoking. The chemicals in tobacco smoke and chewing tobacco have harmful effects on the gums and teeth. A poor diet is also a factor; especially a diet high is sugars and other sticky or gummy carbohydrates (as in dried fruit or potato chips). Hormonal changes, particularly in women, can also affect your gums adversely. Oral contraceptives may increase a susceptibility to gum disease. During puberty, pregnancy, menstruation, and menopause, women may find themselves more prone to gingivitis. Constant emotional and psychological stress may wear down your ability to fight infection, or may simply promote poor eating habits or cause you to neglect dental hygiene. Because saliva helps wash away foods as well as bacterial toxins, anything that decreases saliva production such as certain medications and breathing through your mouth at night can make gum disease worse. Diabetes, AIDS, and other chronic diseases lower resistance to infection and can also play a role.

Can periodontal disease be transmitted to my family members?

Periodontal disease may be passed from parent to children and between couples, according to an article in the September 1997 issue of the Journal of the American Dental Association. Research suggests bacteria that cause periodontal disease pass though saliva.

How can I prevent periodontal disease?

In addition to regular dental care, thorough, daily flossing and brushing are crucial.

Which tooth brush is best?

Choose a soft-bristled brush because hard and medium bristles can damage your gums. Your technique matters more than the tool. Our office will show you this in detail.

What’s the best floss?

Any floss you prefer, waxed or unwaxed, flavored or plain. If the spaces between your teeth are tight, you might prefer waxed floss, which is less likely to catch and fray in tight spots. If your teeth are very tight, you might like a brand such as Glide, made of a Teflon-like, shred-proof material.

What’s the best toothpaste? Does tartar-control toothpaste really control tartar?

For the moment, any fluoride paste that carries the seal of the American Dental Association (ADA) is fine. A tartar-control paste may be a good choice, but no paste controls tartar below the gum line. Brushing with any toothpaste (or even without paste) will help control tartar by removing plaque, but you will eventually need a professional cleaning. A baking soda toothpaste is as good as any other as long as it contains fluoride. The same is true of plain baking soda – a good tooth cleaner, but you should probably use a fluoride rinse along with it. Toothpastes with “natural” ingredients are okay, too, as long as they have fluoride and the ADA seal of approval. However, in spite of their claims, they offer no special benefits for dental hygiene.

What about stimulators, rubber-tips, interdental brushes, floss holders, toothpicks holders, irrigators?

You’ll find a huge range of gadgets and appliances for sale to help you with home dental care. If any of these appeal to you, or solve specific problems, or if you have been advised by your dentist to purchase and use any of these items, they are fine. Before using rubber tips and stimulators, or any item that poses a risk of gum injury if improperly used, it’s a good idea to speak with us for instructions. But none of these things can substitute for toothpaste, toothbrush, floss, and elbow grease (effort) – and regular dental care.

What about mouthwash?

No mouthwash can take the place of regular brushing and flossing. If you want one to freshen your breath temporarily or because you like the taste, any mouthwash will do. The only over-the-counter mouthwash with the ADA seal in the battle against plaque and gingivitis is Listerine. If you have one of the periodontal diseases, your dentist may prescribe either Peridex or Perioguard mouthwashes, which contain the antibacterial ingredient chlorhexidine.

Besides prevention what is the best treatment for periodontal disease?

Depending upon the stage of the disease, you may need a prescription mouth rinse, oral irrigation with an antibiotic solution, general antibiotic treatments, more thorough removal of tartar below the gum line, or periodontal surgery. Your regular dentist will probably refer you to us, the periodontists. A wide range of non-surgical and surgical treatments are now available.