Periodontal Gum & Treating Gum Disease

It's important to understand that you can have periodontal disease with no obvious symptoms, especially if you are a smoker (nicotine reduces blood supply preventing bleeding and swelling of the gum tissues). Still, there are some important things to look for:

• Bleeding gums — Some people think that when their gums bleed, it simply means they're brushing too hard. While brushing too hard is bad for the gums, it should not cause bleeding. Any bleeding of the gums should be considered a warning sign of gum disease.
• Bad breath — It's very easy for plaque to collect in the spaces between the teeth, creating the perfect living conditions for bacteria that produce odorous, sulfur-containing compounds, resulting in bad breath.
• Redness or swelling of the gums — Inflammation of the gums is usually the first visible sign of periodontal disease.
• Receding gums — If you notice that your teeth look longer than they used to, it may be that your gum tissue has receded (away from the enamel), exposing some of your tooth roots.
• Sensitivity — If there is gum recession, the exposed roots may become sensitive to hot or cold.
• Periodontal abscess — Bacteria can become enclosed in a periodontal pocket and the area will fill with pus, becoming swollen and painful.
• Loose teeth — When periodontal disease results in bone loss, teeth can become loose or migrate. Tooth loss can result and may be accelerated if you are applying excessive biting forces from clenching or grinding your teeth.

Treatment Options

All periodontal therapy starts with the evaluation of your oral hygiene techniques and instruction for improving them, followed by the mechanical removal of plaque and any calcified deposits (tartar or calculus) that are present on the root surfaces. This is accomplished with a cleaning technique known as scaling, root planing or debridement using hand instruments and/or ultrasonic (high frequency vibrational) instruments. Locally applied antimicrobial products or antibiotics might also be recommended during various parts of periodontal treatment to assist in healing and pocket-depth reduction, hopefully eliminating the need for periodontal surgery. Sometimes surgical procedures may be necessary to remove the deep pockets that form between inflamed gum tissue and teeth. There are many different types of surgery to handle a variety of problems. And many times, combinations of procedures are used to attempt to reduce the number of surgeries as well as the cost of treatment.

The best way to prevent periodontal disease is to brush and floss your teeth effectively every day. In fact, regular dental checkups and professional cleanings every 3 or 4 or 6 months are also an important part of maintaining periodontal health; we can reach into areas that your toothbrush and floss can't.

We can also detect early forms of gum disease by evaluating your gingival (gum) tissues, both visually and by examining their attachment levels to the teeth. And we can assess the health of your tooth-supporting bone by taking dental radiographs (x-rays pictures).

There are other steps you can take: Eating right, reducing stress in your life, and giving up unhealthy habits like smoking will also help ensure that you keep your teeth for a lifetime.

Scaling and Root Planing.

An important goal in the treatment of gum disease is to rid the teeth and gums of pathogenic bacteria and the toxins they produce, which may become incorporated into the root surface of the teeth. We do this with a deep-cleaning procedure called scaling and root planing (or root debridement). Scaling involves removing plaque and hard deposits (calculus or tartar) from the surface of the teeth, both above and below the gum line. Root planing is the smoothing of the tooth-root surfaces, making them more difficult for bacteria to adhere to.

Antibiotics/Antimicrobials.

As gum disease progresses, periodontal pockets and bone loss can result in the formation of tiny, hard to reach areas that are difficult to clean with handheld instruments. Sometimes it's best to try to disinfect these relatively inaccessible places with a prescription antimicrobial rinse (usually containing chlorhexidine), or even a topical antibiotic (such as tetracycline or doxycyline) applied directly to the affected areas. These are used only on a short-term basis, because we don't want to suppress beneficial types of oral bacteria.

Bite Adjustment.

If some of your teeth are loose, we may want to protect them from the stresses of biting and chewing — particularly if you have teeth-grinding or clenching habits. For example, we may carefully reshape minute amounts of tooth surface enamel to change the way upper and lower teeth contact each other, thus lessening the force, reducing their mobility. We also might join your teeth together with a small metal or plastic brace so that they can support each other, and/or make you a bite guard to wear when you are most likely to grind or clench you teeth.

Oral Hygiene.

Since dental plaque is the main cause of periodontal disease, it's essential to remove it on a daily basis. That means you will play a large role in keeping your mouth disease-free. We will instruct you in the most effective brushing and flossing techniques, and recommend products that you should use at home. Then we'll encourage you to keep up the routine daily. Becoming an active participant in your own care is the best way to ensure your periodontal treatment succeeds. And while you're focusing on your oral health, remember that giving up smoking helps not just your mouth, but your whole body.

Often, nonsurgical treatment is enough to control a periodontal infection, restore oral tissues to good health, and tighten loose teeth. At that point, keeping up your oral hygiene routine at home and having regular checkups and cleanings here at the dental office will give you the best chance to remain disease-free.