VARIABLES TO PERIODONTAL THERAPY

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Variables that may compromise periodontal therapy or have an effect on you may include:

Systemic Health
Nutritional Intake
Ability to Absorb Nutrients
Alcohol
Caffeine
Smoking
Medications or Drugs
Stress Levels
Hormonal Therapy
Trauma from Malocclusion
Faulty Dentistry
Food Impaction
Mouth Breathing
Calculus
Body Chemistry

Periodontal Disease Facts and Reminders

Periodontal Disease Facts and Reminders
1. Plaque forms 20 seconds after eating and 20 minutes after brushing. It hardens into tartar in 24 hours and stays on your teeth.
2. Healthy gums DO NOT BLEED. If you have bleeding gums, pay more attention to your home care instructions. Salt water rinses can help sensitive and swollen gums (1 tsp. salt dissolved into one cup water). If your gums continue to bleed after a thorough home care routine, please contact our office. Go to www.lajolladental.com
3. Experiencing a bad taste or odor is a sign of gum disease/infection.
4. Mouthwashes have no effect on periodontitis. Some mouthwashes can reduce gingivitis.
5. When subgingival plaque reaches a certain threshold level, it produces periodontal disease. Periodontal Disease, therefore, occurs in episodes of activity and quiescenece. That is why daily removal of the bacteria in your mouth is important in reducing your risk of periodontal disease.

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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Risk Factors for Periodontal Disease

The risk factors that increase the chance of developing Periodontal Disease (PD) are many. Some of the major ones are:

**Genetics – Some people have a greater genetic predisposition to developing a more aggressive, severe type of Periodontal Disease. People with a family history of tooth loss and dentures should be diligent in their efforts to control PD.

**Tobacco – People that chew or smoke tobacco have a greater chance to develop PD, and the effects are usually greater – deeper gum pockets due to increased amounts of plaque and tartar; more loss of bone and soft tissue that support the teeth.

**Medical Conditions – Systemic (the whole body) diseases such as diabetes, cancer, HIV, blood cell disorders, and AIDS, and the treatment for some of these, can lower one’s resistance to infections, making PD more severe.

**Stress – Stress reduces the body’s natural defenses, including the ability to fight off infection. Thus, when under stress, you have an increased chance of developing PD.

**Medications – An increasing number of drugs (antidepressants, steroids, blood pressure drugs, cancer therapy drugs, some heart medications, some anti-epilepsy drugs) can decrease the saliva flow creating a drier mouth than normal. Saliva has a cleansing and protective effect on the gums and teeth. A lack of saliva allows plaque to accumulate on the teeth and gums and cause inflammation and decay.

**Hormonal Changes in Females – Puberty, pregnancy and oral contraceptives change the body’s hormone levels. These changes cause the gums to become hypersensitive to the slightest levels of plaque and tartar.

**Ill-fitting Dentistry – Old fillings, crowns, and bridges may harbor more plaque and increase the liklihood of developing periodontal disease.

**Crowded Teeth – The tongue rubbing on the back side of the teeth, and the cheeks and lips rubbing on the front side of the teeth, have a self-cleansing effect on the teeth. When the teeth are crowded and overlapped, this self-cleansing doesn’t happen very well, and there is an increased chance of decay and gum problems due to plaque retention.

**Insurance Dependency – People that count on their insurance for all the answers are often the patients with the most problems – gum problems, decay problems, and missing teeth problems. The insurance companies write the rule on whether they will have to pay out some of your premium dollars to help get you healthier. If you need to have your teeth cleaned 4 times a year and your insurance only pays for 2 times a year, it does NOT mean you can only get your teeth cleaned twice a year. DON’T be insurance dependent. In today’s market you want to maximize your insurance. But, insurance allowance is a help in covering some of the cost of treatment, not a pay-all.

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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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 Cancer in Men

Following up on my previous blog, gum disease also has a link to cancer in men. From the June issue of The Lancet Oncology, men with a history of gum disease are 14% more likely to develop cancer than men with healthy gums. The report states that men with periodontal disease may be 30% more likely to develop blood cancers, 49% more likely to develop kidney cancer, and 54% more likely to develop pancreatic cancer. Gum disease cannot be cured, but certainly can be controlled by daily brushing and flossing, and routine visits for professional cleaning as a minimum.

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!