Periodontal Disease is a Silent Disease

Knowing all that we know about Periodontal Disease (PD), how is it that 75-80% of us are affected by it?
Periodontal Disease is a silent disease in that it does not hurt (until advanced stages) and can go undetected in its earliest stage. Too often, people don’t go to the dentist regularly and start to build up plaque between their teeth. If the person is not a flosser, the plaque starts to accumulate more and more between their teeth. The once healthy gums, pink and firm around each tooth, now start to become inflamed between the back teeth where the plaque is building up. With gingivitis now established, the bacteria residing in the plaque produce toxins that start to break down the attachment of the gums to the teeth. The body’s inflammatory response is to bring increased amounts of blood to those areas to fight off the toxins. The gums become puffy, tender and swollen, and can bleed easily with brushing and flossing (not likely any flossing is occurring in this person).
A cleaning at the dental office at this point could start to turn things around. Flossing and brushing would go a long way toward health. Of course, this person doesn’t have any pain, and is unaware of this situation.
Periodontitis sets in as the plaque by-products, the toxins, destroy the tissues that hold the teeth in the bone. The attachment of the gum to the root surfaces start to be destroyed and pockets develop between the gum and the teeth. The gums pull away from the teeth and recede. More plaque is now accumulating below the gum line in these pockets. Some of the plaque on the root surfaces is hardening into tartar. Like the barnacles forming on the piers at the ocean, the tartar is rough and more plaque sticks to the rough surfaces and become hardened. As the disease progresses, bone under the gums that anchors the teeth begins to dissolve away. The person may notice an unpleasant odor coming from their mouth – bad breath. The gums may bleed when brushing. At this point, with less bone anchoring the teeth and less gum tissue covering the roots, the teeth appear longer and are sensitive to cold and are more susceptible to decay.
In advanced periodontitis, the toxins deep in the pockets continue to destroy the periodontal ligaments and bone, causing the teeth to lose more support. Unless treated, the affected teeth become more mobile and may fall out.
The key, is to not let this all get started. Should you find yourself progressing down the path described above, work hard on brushing and flossing and get into the dental office for evaluation and necessary treatment. You do not have to lose teeth to periodontal disease!

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Periodontal Disease Symptoms

Periodontal Disease (PD) does not usually show up until people are in their 30s. Certainly the milder form, gingivitis, can occur even in teenagers who don’t do much brushing, or who have braces that trap and harbor the plaque and food particles.

Periodontal Disease is a silent disease – it doesn’t hurt until it is in an advanced stage. But there are ways to detect it. My favorite is to visit the dentist for check-up and periodontal evaluation. Ways that you may detect it at home are:

* Gums that are red and/or swollen and tender

* Gums that bleed when brushing or flossing

* Spaces opening up between your teeth – as if they were moving

* Loose teeth

* Breath that no longer feels fresh – you constantly want to rinse with a mouthwash

* Gums that have pulled away from the teeth

* Pus between the gums and teeth

* Your bite no longer feels solid – you feel as though your bite has changed

Any or all of these indicate some level of gum inflammation/infection. Don’t delay in calling for a dental evaluation, because it won’t get better on its own.

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Gingivitis

Gingivitis is inflammation of the gums caused by the prolonged presence of plaque and tartar on the teeth. The gums become red, puffy and swollen. Gingivitis is a mild form of gum disease that can be reversed with professional dental cleanings by our hygienist and daily brushing and flossing. The gums may bleed during the cleaning and initially when flossing. Gingivitis can be reversed (the inflammation eliminated) because it does not involve bone loss or gum recession.
When the gums are not treated (the person may be brushing but not flossing) the inflammation increases to a point in becomes periodontitis. Here, the plaque builds up below the gums forming pockets. The body’s natural immune system creates enzymes that fight the bacterial toxins within the pockets, but mechanical removal of the plaque and tartar are essential. Left untreated, with time the pockets become deeper, bone loss around the teeth occurs, and the gums recede. Sooner or later the teeth become loose.

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Periodontal Disease

We talked previously about periodontal disease and its effect on our overall health. Let’s take some time to explain what is periodontal disease (PD). Periodontal Disease ranges from simple gum inflammation (gingivitis), to serious disease that results in major damage to the soft tissue and bone that support the teeth (periodontitis). An estimated 75-80% of adults in America have some level of PD (epidemic proportions). Because there is no pain until the condition is at a very advanced stage, most people are not aware they are infected with PD. Our mouths are full of bacteria, which along with mucus and other particles (tissue particles, food particles), constantly form a sticky, colorless “plaque” on our teeth. Brushing and flossing help get rid of plaque which, if not removed, can harden into bacteria-harboring “tartar”. The tartar cannot be brushed away. It must be removed by a professional dental cleaning (Thank goodness for dental hygienists!)

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Periodontal Disease and Alzheimer’s Disease

Periodontal Disease (gum inflammation, infection, bone and attachment loss) and Alzheimer’s Disease (AD)-
Is there a link? The exact mechanisms responsible for the cause and development of AD have yet to be identified, but inflammation within the brain is believed to play a key role. As reported in Alzheimer’s Dement, July 2008, peripheral infection/inflammation may affect the inflammatory state of the central nervous system. Chronic Periodontal Disease is a prevalent peripheral infection that has been associated recently with several systematic diseases (see previous blogs) including AD. These studies suggest that chronic periodontal disease may potentially contribute to the clinical onset and progression of Alheimer’s Disease. As chronic periodontal disease is a treatable and controllable infection (not curable), it may well be a readily modifiable risk factor for Alzheimer’s Disease. Establishing and maintaining healthy gums now, could lessen your risk of developing this awful disease.

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Periodontal Disease and your General Health

We recently welcomed a new patient who came to see us about upgrading his smile. He had a mouth-full of porcelain crowns and veneers done in the past that he was no longer happy with. My concern, when we saw him, was the bright redness of his gums right around each of his restorations. The margins of the restorations are breaking down, retaining plaque, and causing this gum inflammation. I told him his tissue is the first issue, then we can improve the appearance of his smile. He agreed with my concern, and we scheduled his first hygiene visit this week. I sent him home with the abstracts of several articles relating to periodontal disease in his mouth (the redness, puffiness, and recession of his gums) to his general health. Periodontal disease has been linked to tooth loss, subclinical atherosclerosis, and future stroke. Gum disease, also, may affect the development and course of systemic diseases such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight. Now, he can’t get started quick enough!