Update on gum diseases

Over the past several years, the field of dentistry dealing with gum problems, periodontontics, has witnessed remarkable changes in the understanding of gum and bone disease processes and their relationship to the body as a whole. The focus on gum and bone problems in the mouth has shifted to include significant associations with the health of other body systems.

Gum diseases start as increased redness with swelling and bleeding of the gum tissues. The bleeding may or may not be obvious. For instance, in some cases, the patient may notice bleeding during brushing or flossing. In other cases, the bleeding may not be obvious unless the gum tissues are evaluated with probing by the dentist.

Gingivitis is the term used to describe the inflammation of gum tissues due to bacterial and plaque that grows and accumulates on the teeth.

Gingivitis can elevate to a more advanced state when the inflammation or reddening progresses into the ligaments that hold the tooth into the bone and eventually into the bone itself. This is called periodontitis.

Periodontitis is the main cause of the loss of the bone around the teeth and is the leading cause of tooth loss in adults. It is characterised by decreased bone levels and deep holes in the gum tissues around the teeth. Untreated gingivitis and periodontitis eventually lead to loose teeth.

The rate of bone loss in patients with periodontitis (inflammation around the tooth that infects the bone) varies over time and is considered episodic in nature. Some folks lose a lot of bone in a short period of time and then bone loss slows dramatically. In other cases, the bone loss is gradual and unceasing and over several years the teeth are lost a few at a time.

After a period of time that varies between different people, the teeth will get so loose that they cannot be saved and must be extracted. In many cases, the bone loss due to periodontal disease is so great that there is not enough bone left to use implants to replace missing teeth. Also, if the teeth are lost due to severe bone degeneration, there may not be enough bone left to allow the patient to successfully wear dentures.

So, it is very important to know what the bone levels are around your teeth and get checked for bone loss at least once per year if you are over 30 years of age.

A study published recently in the New England Journal of Medicine shows that roughly 80% of adults over age 30 years showed periodontal bone loss and fifty percent of adults over 60 years have advanced periodontitis with several loose teeth due to severe bone loss. Periodontal disease does not hurt in the large majority of cases. It is insidious and there is no way that the victim can self diagnose the problem. It takes special x-rays and an examination by Dr. Ron to evaluate for the holes or pockets in the gums around the teeth.

In the not so distant past, gum disease and tooth loss was considered to be an inevitable result of aging. We now know specific risk factors for gum and bone loss disease. The risk factors for periodontal disease varies based on the age of the patient, tobacco use, heredity, diabetes, failure to brush and floss the teeth appropriately, and others. The known risks can be ameliorated to prevent the disease and limit disease that has already developed.

Tissue inflammation is the chief causation of periodontal disease. Periodontal disease is a direct result of bacterial infections with organisms that specifically attack the connective tissues (the jaw bone and ligaments) that hold the teeth in place in the jaw. The bacteria that cause the infection to the gum and bone tissues work in two ways: 1) bacterial invasion of the tooth support tissues that causes release of bacterial toxins that cause cellular inflammation, necrosis and cell death, 2) bacterial inflammation that elicits a host response, kind of like an allergy to your own gum tissues that results in tissue destruction by your own body.

There are several levels of prevention and treatment of periodontal disease depending on the causative factors for each particular individual. The main strategies include: 1) efforts to slow the progression of disease process, 2) efforts to increase the regeneration of tooth support bone and soft gum tissues, and 3) prevention of relapse after successful management of the main casuative factors.

Elimination of gingival inflammation is the most important step in reducing the risk for periodontal disease. This is accomplished by removing the bacterial colonies (bacterial plaque) with frequent brushing and flossing and professional cleanings. No bacterial plaque, no inflammation, no gum disease!

The importance of removing the bacterial plaque with a tooth brush, floss and fluoridated tooth paste cannot be overstated. The very first line of defense is to remove the bacteria that are causing the periodontal disease. Effective tooth brushing and cleaning can dramatically reduce the incidence of gum tissue inflammation problems. Dr. Ron and his staff can show you the best ways to brush and clean your teeth to prevent gum disease inflammation problems.

A second line of defense is antimicrobial agents in the form of mouth rinses. Dr. Ron has available fluoricated and other kinds of mouth rinses that not only help remove the bacterial plaque on the teeth, they also dramatically cut down on the amount of tooth decay when used as directed. These adult level cleaning agents use homeopathic levels of fluoride to strengthen the teeth and help remove the bacteria that cause decay and gum diseases.

Another approach that helps a large number of patients with difficult periodontal disease are agents that block inflammation pathways when the body over reacts to the bacterial plaque; host modulation strategies. The use of the oral medication Periostat has been shown to be extremely efficacious in greatly reducing the amount of inflammation in difficult gum disease cases. It has been shown to markedly reduce gum inflammation as well as reduce the rate of bone loss in controlled studies. Dr. Ron has several years experience with Periostat to control inflammation due to gum disease. it is almost a silver bullet when used as directed in spefic cases.

For centuries, it has been recognized that systemic diseases can contribute to weakened immunity that directly contributes to gum disease problems. For instance, diabetes, leukemia, pregnancy and puberty are all associated with an increase in the incidence of periodontal disease.

Recent studies have proven that there is a relationship between gum disease problems and worsened systemic disease. Studies have documented a strong effect between gum and bone diseases in the mouth and heart disease, strokes, osteoporosis, various lung infections, and acceleration of the progression of diabetes. The general mechanism is inflammaion of gum and tooth support bone tissues overloading the body’s immune system allowing all manner of autoimmune disease and degenerative diseases to become worse.

Recent research has shown that inflammation of the gum and tooth support bone tissues are important in the progression of diseases of the gum tissues. This inflammation is also important as a risk factor for general systemic immune and degenerative diseases.

Gingivitis and gum inflammation can no longer be considered only as a precursor to periodontal bone inflammation and breeakdown. We need to understand that oral inflammatory diseases need to be controlled and eliminated to maintain good general health.

It is now proven that treatment protocols that manage and control gum tissue inflammation disease has a beneficial effect on oral and general health! Dr. Ron can perform an examination and help you find a protocol to save your teeth without gum surgery in may cases.

If you have questions about your periodontal tissues or need an examination, you can contact Dr. Ron Levandoski at 702-310-5970. He has a board certified periodontist (gum disease specialist) in his office. There are several non surgical alternatives to manage gum disease that you need to know about!