Gum Disease 2018-04-09T11:06:54+00:00

Gum Disease

Definition of Gingivitis

An inflammation of the gums characterized by a change in color from normal pink to red, with swelling, bleeding, and often sensitivity and tenderness. These changes result when a layer of bacteria accumulates along the gum line and triggers the body’s inflammatory response.  The pocketing or probing depths of tissues are less than or equal to 4mm with bleeding upon probing.

Gingivitis Symptoms

  • Swollen gums
  • Bright red or red-purple appearance to gums
  • Shiny appearance to gums
  • Bleeding gums (blood on toothbrush or floss even with gentle brushing and flossing)
  • Gums that are tender when touched, but otherwise painless
  • Persistent bad breath or bad taste in mouth
  • Bacteria, plaque and tartar accumulation

Risk Factors for Gingivitis

  • Poor oral hygiene (lack of flossing, brushing, rinsing)
  • Certain medications, such as steroids, some anti-epilepsy and cancer therapy drugs, some calcium channel blockers,  oral contraceptives
  • Systemic diseases, such as diabetes, leukemia, autoimmune diseases
  • Tobacco use
  • Pregnancy
  • Poor nutrition
  • Defective or rough dental restorations

Gingivitis Treatment Options

Gingivitis therapy aims to remove the irritating plaque and prevent its return. To help avoid the occurrence of gingivitis or to reverse gingivitis, you should:

  • Brush twice a day for a minimum of 2 minutes with fluoride toothpaste that contains an antibacterial and anti-inflammatory ingredient. Brush with a soft-bristled toothbrush held at a 45° angle to the line where your teeth and gums meet. Move the brush in small circular movements along the gum line and chewing surfaces of your teeth. A power toothbrush may make brushing easier and more efficient.
  • Floss daily. Hold the floss tight. Gently bring it down between the teeth. Do not pop the floss against the gum. Curve the floss around the tooth and gently rub up and down. Adjust the floss so you use a fresh section for each tooth, including the back side of the last teeth. Alternate flossing methods are available for patients who have difficulty flossing or who cannot floss.
  • Rinse with an antiplaque, anti-gingivitis mouthwash that contains either cetylpyridinium chloride or essential oils. Listerine and Colgate Advance Proshield are popular brands of antiseptic rinses.
  • Visit your dentist or dental hygienist every 3 to 6 months, depending on the severity of the gingivitis. Your dental professional will be able to help you manage gingivitis by reviewing your risk factors and oral hygiene habits in order to create a home-care regimen that works for you. They can get to areas in your mouth that you are not able to properly access at home even with good home care.

Definition of Gum Recession

The process through which the gum tissue surrounding the tooth wears away – or pulls back – thereby exposing the tooth’s root.  Gum recession is a common dental problem, and due to its gradual progression, one patients aren’t often aware they have.

Causes of Recession

  • Periodontal disease – With insufficient dental care, bacteria from sugars and acids build up on teeth and cause gum inflammation. This inflammation will eventually eat away at the bone surrounding the teeth, causing loss of both bone and tissue support.
  • Genetics – Some people may be more susceptible to gum disease.  Specifically, some people have thin or weak connective tissue and/or bone that will easily be worn away.
  • Aggressive tooth brushing – If you brush your teeth too hard or with poor technique, it can cause the gums to recede. We prefer extra-soft bristled brushes or an electric toothbrush and sensitivity toothpaste.
  • Grinding and clenching your teeth – These actions put too much force on the teeth, contributing to bone loss and gum recession.
  • Crooked teeth or a misaligned bite – When teeth do not come together evenly, too much force can be placed on the specific areas of the teeth and bone, allowing for bone loss and gum recession.
  • Orthodontic Treatment – If teeth are moved too fast, the bone does not have sufficient time to recycle and can be lost.  Lack of sufficient bone leads to deficient tissue and gum recession.

Risks of Recession

  • Exposure of the tooth root to the sugars, acids, and abrasion of normal diet and function
  • Increased sensitivity to temperature and sweets due to the exposure of the delicate root, which provides access to the nerve
  • Notching or loss of the root surface over time –  when left untreated, this can lead to nerve exposure or tooth fracture

Treatment Options

  • Unfortunately, once we experience recession or lose connective tissue, we cannot get it back naturally.  Our best treatment for recession is prevention with ideal home care.  Ideal home care includes:
  • Use of a Sonicare toothbrush at the most gentle setting with Sensitivity/Non-Abrasive toothpaste
  • Daily flossing
  • Antiseptic mouth rinse at least once a day

If the recession is being caused by a misaligned bite, our recommendation would be orthodontic treatment to eliminate the bite interference.

If orthodontics is not an option, we will recommend a night guard to protect the overloaded teeth during night-time grinding or clenching.
If the recession becomes so significant that we completely run out of protective, connective tissue, the now unprotected bone that supports the tooth is at high risk of rapid tissue and bone loss.  At this point, we recommend seeing our periodontist (tissue-specialist) to have a connective tissue graft completed to prevent future tooth loss.  This involves transplanting a flap of skin and subepithelial connective tissue from the roof of your mouth (palate) and then stitching that tissue around the exposed root.

Active Periodontitis Definition

A bacterial infection of the supporting tissues of the teeth, characterized by a rapid destruction of the periodontal ligament and supporting bone that may lead to tooth loss if not arrested.

Symptoms of Active Periodontitis

  • Gums that are red, swollen, receding, bleeding, painful
  • Bad Breath
  • Dry Mouth
  • Teeth that are sensitive, mobile
  • Pain during chewing, brushing or flossing

Periodontitis Risk Factors

  • Systemic diseases, including severe or undiagnosed Diabetes, Downs Syndrome, AIDS or Rheumatoid Arthritis
  • Immune Dysfunction
  • Poor oral hygiene (lack of flossing, brushing, rinsing)
  • Irregular dental visits
  • Tobacco use
  • Pregnancy
  • Poor nutrition
  • Defective or rough dental restorations

Treatment Options

  • In-office
    • Scaling and Root Planing (SRP): the area being treated is numbed, and dental scalers are used – with the aid of water and sonic vibration – to remove the bacterial plaque and tartar from the tooth surface above and below the gum line.
    • Tissues are treated by quadrant of your mouth (upper right, lower right, etc.) and half the mouth is usually done in one visit. Visits are typically 7-10 days apart to give our hygienist the chance to revisit the area that was initially treated and remove any bacteria that has since accumulated.
    • Periodontal Maintenance and Evaluation: 4-6 weeks after your SRP, our hygienist will evaluate how your tissues have responded and get everything cleaned up again. At this visit we will establish your recommended recall interval, typically 3-4 months.
  • At-home, following in-office active therapy
    • Brush twice a day for a minimum of 2 minutes with fluoride toothpaste that contains an antibacterial and anti-inflammatory ingredient. Brush with a soft-bristled toothbrush held at a 45° angle to the line where your teeth and gums meet. Move the brush in small circular movements along the gum line and chewing surfaces of your teeth. A power toothbrush may make brushing easier and more efficient.
    • Floss daily. Hold the floss tight. Gently bring it down between the teeth. Do not pop the floss against the gum. Curve the floss around the tooth and gently rub up and down. Adjust the floss so you use a fresh section for each tooth, including the back side of the last teeth. Alternate flossing methods are available for patients who have difficulty flossing or who cannot floss.
    • Rinse with an antiplaque, anti-gingivitis mouthwash that contains either cetylpyridinium chloride or essential oils. Listerine and Colgate Advance Proshield are popular brands of antiseptic rinses.
    • Visit your dentist or dental hygienist every 3 to 4 months, depending upon the severity of the periodontitis. Your dental professional will be able to help you manage periodontitis by reviewing your risk factors and oral hygiene habits in order to create a home-care regimen that works for you. They can get to areas in your mouth that you are not able to properly access at home even with good home care.

If the SRP is unsuccessful, other treatment options include

  • Placement of antibiotics under the tissues that haven’t responded to SRP
  • Referral to our periodontist (gum tissue and bone specialist) for evaluation and potential surgery to augment the existing bone and tissue

Treatment Goals

  • Remove factors that provoke inflammation (plaque, Calculus and endotoxins) from the root surface
  • Eliminate Bleeding and swelling
  • Achieve ideal home care techniques with proper patient education
  • Prevent recurrence of disease through regular periodontal maintenance visits following active therapy

Stable Periodontitis Definition

Stable periodontitis is defined as having had an active periodontal disease that has been treated clinically and is now considered stable. The loss of bone remains, but no active infection is present. Indications that the condition is stable include:

  • Lack of tissue inflammation and redness
  • Lack of moderate to heavy bleeding upon probing
  • Lack of suppuration (pus)
  • Presence of light plaque and tartar

Potential Continuing Symptoms

  • Irreversible but stable bone loss visible on x-rays
  • Visible gum recession and root exposure
  • Slight tooth mobility

Risk Factors

  • There is a proven correlation between periodontitis and systemic diseases such as diabetes mellitus, heart disease & HIV – leaving this infection unchecked increases your risk of more serious infections.
  • Environmental factors such as smoking, emotional stress, age, lack of proper oral hygiene and genetics will all increase your risk of periodontal infection.

Treatment Options

  • In office treatment:
    • Once any necessary active therapy is complete and your periodontitis is stable, your condition is kept in check through Phase IV therapy, which includes regular periodontal maintenance sessions with oral examinations. Your gingival condition, mobility, occlusion and any presence of caries will be thoroughly assessed at each 3-4 month visit. Since periodontitis is a condition that cannot be cured, it must be controlled by these visits for the remainder of the patient’s life.
  • At home treatment:
    • Brushing at least two times a day, for a FULL two minutes. We recommend an electric Sonicare toothbrush for ideal plaque removal and to prevent the progression of bone loss.
    • Flossing daily and/or after every meal with proper technique.
    • Daily use of an antiseptic/anti-gingivitis mouth rinses (alcohol rinses are not recommended for patients with dry mouth symptoms) twice a day for 30-60 seconds.
    • Use of interdental aids such as proxy brushes, rubber tip stimulators, floss threaders, tufted brushes, super floss, etc.

Treatment Goals

  • Prevent the new occurrence of active infection
  • Control bacterial plaque to prevent worsening of a stable condition
  • Long-term outcomes depend on the patient’s compliance with home care and periodontal maintenance at the recommended 3 or 4-month interval.

What Makes Gum Tissue Healthy?

Pink, firm, stippled gum tissue completely filling spaces between the teeth.  It has probing depths generally no more than 3mm and is without bleeding or pain.

Symptoms

  • Healthy tissues should not be red, puffy, sensitive, or bleed.

How can you keep your gums healthy and prevent gingivitis?

  • Brush twice a day for 2 minutes with fluoride toothpaste that contains an antibacterial and anti-inflammatory ingredient. Brush with a soft-bristled toothbrush held at a 45° angle to the line where your teeth and gums meet. Move the brush in small circular movements along the gum line and chewing surfaces of your teeth. A power toothbrush may make brushing easier and more efficient.
  • Floss daily. Hold the floss tight. Gently bring it down between the teeth. Do not pop the floss against the gum. Curve the floss around the tooth and gently rub up and down. Adjust the floss so you use a fresh section for each tooth, including the back side of the last teeth. Alternate flossing methods are available for patients who have difficulty flossing or who cannot floss.
  • Rinse with an antiplaque, anti-gingivitis mouthwash that contains either cetylpyridinium chloride or essential oils. Listerine and Colgate Advance Proshield are popular brands of antiseptic rinses.
  • Visit your dentist or dental hygienist every 6 months. Your dental professional can get to areas in your mouth that you are not able to properly access at home even with good home care. This will help to clear unwanted bacteria and keep the tissue in its current healthy state.