What is Periodontal Disease?

Periodontal disease is an infection of the gums and/or bone that surrounds the tooth. Generally, the disease is painless and most patients are not aware they have a problem until examined by a dentist.

With a healthy tooth, the root is set in the jawbone with a strong ligament, which keeps the tooth tightly attached to the bone. Gum covers the bone, and like skin, protects it from bacteria that are constantly present in the mouth. The gum connects to the neck of the tooth with a band of fibers, which insert just above the bone into the root. In a healthy situation, the gum edge is higher than the fiber attachment, forming a space around the tooth. This is similar to having a turtleneck sweater and this sulcus should be 2-3 millimeters in depth.

Everyone has bacteria constantly in their saliva. These bacteria collect on all surfaces forming colorless, sticky colonies called plaque. Unfortunately, this plaque also forms in the space underneath the edge of the gum. If the plaque is not removed (something that takes careful brushing and flossing), then it will start to cause an infection in the gum. Plaque that remains on the tooth for a long period of time absorbs salts from the saliva and becomes hard. This calculus or tartar cannot be removed by brushing and flossing and must be dislodged by a dental professional.

Periodontal disease is a bacterial infection. Bacteria initially accumulate along the gum line in the form of plaque. The body’s immune system sends white blood cells to fight the bacteria, but this response actually encourages the gum tissue to break down in order to make room for the blood vessels. As a result, “pockets” form between the gums and the tooth’s hard surfaces, providing ideal conditions for more bacterial growth. Eventually, the interaction of bacteria with the body’s immune system can result in destruction of bone that supports each tooth.

There are many normal types of bacteria in our mouths and most of them won’t cause any problems for us. However, researchers have identified specific bacteria that are sound in periodontal disease. When these types of bacteria are present, we know the patient is at increased risk for periodontal disease. When the bacteria appear in large numbers, they may signal an acute phase of the disease.

Previously, the only way we could tell was by seeing the destruction caused by bacteria – the deep pockets, the loss of bone, etc. Now we don’t have to wait until after the damage is done.

Using a special microscope and/or culturing, we can tell if you are harboring the bacteria associated with periodontal disease. For Patients who have already been treated for periodontal disease, this evidence can alert us to the possibility that the disease is re-entering an active phase.

If disease-associated microorganisms are present, how do you eliminate them?

This is the major challenge we face. There are several treatment alternatives and we try to determine the plan or combination of plans that best suit each individual condition. Treatment options include:

• Root Planing and scaling, which removes calculus and other toxic material from the tooth’s roots to encourage reattachment of gum tissue.
• Antimicrobial irrigations, in which solutions that target bacteria are irrigated under the gums to reduce the amount of bacteria.
• Antibiotic medications, which are taken orally to fight the infection.
• Laser treatment, which helps to disinfect the gum pockets and encourages pocket shrinkage.
• Daily home care, which helps to maintain healthy gums following in-office treatment.

We can provide a very conservative approach without compromising getting the best results. First, we view a bacterial slide of the patient’s current bacterial levels. We may also take a culture of the bacteria. Then we perform very thorough root planning and scaling in order to remove any trace of calculus and bacteria. We also use antimicrobial irrigation to aid in the fight against bacteria and we prescribe a very specific home care program for the patient. In more advanced cases, the laser can also be used to assist in destroying bacteria and removing infected tissue. Bacterial slides are re-done periodically so that the patient and our staff can monitor the progress of the treatment.

Definitely, and much of that can be attributed to greater patients awareness of gum disease. Our patients tend to be well informed about the risk of gum disease and they are willing to take an active part in the fight against it.