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What is Periodontal Disease?

The word periodontal literally means “around the tooth.” Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease (commonly referred
to as gum disease), is an infection of the tissues and ligaments that hold the teeth in place. Periodontal disease is caused by plaque, a colorless, sticky substance loaded with bacteria that clings to teeth. This plaque typically forms after we have eaten sugars or starchy foods the bacteria thrive on these foods. If the plaque is not removed by daily brushing, it produces toxins that can irritate the gum tissue causing
gingivitis (the mildest form of periodontal disease), cavities and if left untreated, bone loss.

Periodontal disease can get out of control quite easily if you do not have dental checkups at regular intervals. Advanced periodontal disease is a leading cause of tooth loss among adults. The most insidious aspect of periodontal disease is that it is usually painless and can develop either slowly or quite
rapidly. Many patients do not seek treatment for periodontal disease right away because many of the symptoms do not manifest until later stages.

Signs and symptoms of periodontal disease:

Bleeding, red or swollen gums

Persistent bad breath

Receding gums

Painful chewing

Sensitive teeth

Pus between your teeth and gums

New spaces developing between your teeth

Bad taste in your mouth

Periodontal disease is not just a dental problem. Research has shown that there is an association between periodontal disease and other chronic inflammatory conditions, such as diabetes, respiratory disease and cardiovascular disease.

Women may be especially susceptible to periodontal disease. According to Perio.org the following
stages in a women’s life may be of particular concern.

Menstruation

Occasionally, some women experience menstruation gingivitis. Women with this condition may experience bleeding gums, bright red and swollen gums and sores on the inside of the cheek. Menstruation gingivitis typically occurs right before a woman’s period and clears up once her period has started.

Pregnancy

Women may experience increased gingivitis or pregnancy gingivitis beginning in the second or third month of pregnancy that increases in severity throughout the eighth month. During this time, some women may notice swelling, bleeding, redness or tenderness in the gum tissue.

Studies have shown a possible relationship between periodontal disease and pre-term, low-birth-weight babies. Any infection, including periodontal infection, is cause for concern during pregnancy. If you are planning to become pregnant, be sure to include a periodontal evaluation as part of your prenatal care.

Women who use oral contraceptives may be susceptible to the same oral health conditions that affect pregnant women. They may experience red, bleeding and swollen gums. Women who use oral contraceptives should know that taking drugs sometimes used to help treat periodontal disease, such as antibiotics, may lessen the effect of an oral contraceptive.

Menopause and Post-Menopause

Women who are menopausal or post-menopausal may experience changes in their mouths. They may notice discomfort in the mouth, including dry mouth, pain and burning sensations in the gum tissue and altered taste, especially salty, peppery or sour.

Bone loss is associated with both periodontal disease and osteoporosis. Research is being done to determine whether the two are related. Women considering Hormone Replacement Therapy (HRT) to help fight osteoporosis should note that this may help protect their teeth as well as other parts of the body. In short, women suffer from periodontal disease more than men because of hormonal shifts caused by menstruation, pregnancy and menopause.

For more information on women and periodontal disease, please visit http://www.perio.org/

Risk factors for developing periodontal disease:

Smoking

Poor dental hygiene

Obesity

Stress

Aging (periodontal disease risks increase with age)

Poor nutrition

Other key factors to consider:

Women are more likely than men to develop periodontitis because of hormonal changes that women experience throughout their life cycle.

There seems to be a genetic link which can be tested by companies such as OralDNA.

Risk factors for periodontal disease increase if you take medications for certain health conditions. These include birth control pills, antidepressants, heart medications, chemotherapy drugs and immunosuppressant medications.

Other factors contributing to periodontal disease include systemic diseases such as diabetes and autoimmune diseases.

Treatment options:

1. Scaling and root planing (also called deep cleaning) removes subgingival and supragingival calculus (tartar below and above gums). Early to moderate periodontal disease has gum pocket depths at about 5-6mm, while normal healthy gum pockets are at about 3mm. An ultrasonic scaler used with an antibacterial rinse (chlorhexidine) is used to knock off large pieces of calculus followed by hand scaling for detailing. This also disrupts the bacteria colonies (infection). Most of the time we have the patient use the same antibacterial rinse (chlorhexidine) twice a day for up to 2 weeks post treatment. Sometimes an antibiotic pill regimen is also taken to help heal the infected gums. We give a pre-treatment of ibuprofen to reduce inflammation after the procedure which is generally taken for the first 24 hours.

2. At the follow-up cleaning appointments, if the gum pockets are still slightly inflamed, we may incorporate a laser disinfection process to further eliminate the bacteria. This is called laser curettage and is performed at a lower power level than the laser periodontal surgery.

3. For moderate to severe periodontal disease which have gum pocket depths of 6mm and higher, we recommend the laser periodontal surgery. This treatment includes the scaling and root planing, but by using the laser right before scaling the gum pockets, it helps to remove the tartar. The laser light
waves are attracted to inflammation and make the calculus brittle and therefore easier to remove with the ultrasonic scaler. This procedure is FDA approved and is safe for even patients who could not have the traditional periodontal flap surgery because they are on medications such as blood thinners and Fosamax (for bone density).

4. Patients are strongly encouraged to keep their follow-up appointments every 3 months. These periodontal maintenance cleanings are extremely important in order to promote good gum health. In addition, practicing proper oral hygiene at home is essential. Patients may want to consider using an electronic tooth brush such as the Sonicare for more effective cleaning. We also recommend daily flossing and brushing after every meal (including snacks!) as a way to maintain healthy gums and prevent future
problems.