Gum Disease (Gingivitis and Periodontitis)
Gingivitis is the medical term for early gum disease, which can lead to periodontitis. Many times, a patient does not see or feel anything as the disease progresses; it is often a silent disease.
This progression is cumulative, and it is almost always avoidable. Gingivitis and periodontitis have a stigma lately because of the increase in recommendations for deep cleanings, which are time-consuming and more expensive.
Here are the basics:
- Any food or debris which remains on the teeth becomes plaque (the sticky, fuzzy feeling when you haven’t cleaned your teeth for a few hours). Plaque can still be brushed or cleaned off the teeth by you.
- Once plaque remains on the teeth for 24 hours or more, it hardens and becomes calculus, or tartar. Calculus is actually a small colony of bacteria living in your mouth. You cannot remove this substance with a brush, floss or a waterpick. A normal dental cleaning can remove calculus that not under the gums. Most calculus at this early stage is above the gums.
- After this happens, you still form more plaque. Now it forms on top of the colonies of calculus. Though you cannot remove the calculus, you can remove newly forming plaque. If plaque is removed, the colonies do not grow larger. If the new plaque remains long enough to form calculus, the colonies become larger.
- If not cleaned, the gum tissues become irritated; this is like having asphalt stuck in your knee after a fall, and not removing it. This is gingivitis. These tissues become irritated, and peel away from the teeth allowing the bacterial colonies to invade the areas under the gums. Now it becomes more difficult to clean.
- On top of this, where the tissue peels away, the bone dissolves as the colonies invade its space. This is where it becomes periodontal disease. The tissue peeling away forms periodontal pockets.
- Without anything stopping it, the colonies will continue to creep down the tooth or teeth until there is no more bone around the teeth.
- Bone is what hold your teeth in your mouth; if you lose the bone, the teeth become mobile and will be lost.
How is this progression prevented?
- If you get the plaque off with regular cleaning at home and normal dental visits, you can generally avoid this progression.
- Even if you progress to gingivitis, a regular dental cleaning will almost always resolve the problem, and you will have no permanent damage. Sometimes an antibacterial rinse is used to help keep the bacteria from invading the tissue further.
- Once the colonies enter the pockets, and bone dissolves, there is permanent damage, BUT you can stop it from progressing by getting rid of these deeper colonies. This is called scaling and root planning, or deep cleaning. It cleans the colonies, the calculus and the plaque off your teeth.
- Now you have a clean slate. If plaque is allowed to start the same process again, this entire pattern will be repeated.
- This pattern can be avoided. Because of the permanent damage which has occurred, however, your teeth should be checked more often. Bacteria can build back up in about three months, so it is shrewd to check in after about 6 weeks for healing, and removal of any minor plaque and calculus build up. This is also a good time to note any areas you may not realize you are missing when you are cleaning BEFORE the calculus invades again.
- At 3 months, the accumulation of bacteria is checked again. The amount of accumulation helps to make an intelligent decision about when you should return for cleanings. Some people start to come back every six months after one year; some people come back every 3-4 months forever.
Other important facts about periodontal disease:
- If colonies invade farther than a deep cleaning can reach (usually 6 millimeters into the pocket), laser therapy or surgery may be required to remove the bacteria and save the teeth.
- If the periodontal disease has progressed so far that the tooth cannot be saved, it should be removed.
- A tooth with periodontal disease which is not removed can spread the disease to neighboring teeth, is linked to serious cardiovascular problems, is linked to diabetes, and is linked to pre-term, low birth rate babies.
- If there is a single stubborn spot or two having trouble healing after all cleaning is complete, there are powders of antibiotics which can be placed next to the infected gums to rid the area of the last minute remains of the bacteria.
Although gum disease is the major cause of tooth loss in adults, in many cases it is avoidable.
Pregnancy has also been known to cause a form of gingivitis. This has been linked to hormonal changes in the woman’s body that promote plaque production.
If periodontitis exist when an implant is placed, the same bacteria can invade the area around the implant and decrease its success.