Patient Education
Periodontal Disease
Diagnosis
Treatment
Maintenance
Bad Breath (Halitosis) Click Here
Xerostomia (Dry Mouth) Click Here
The word periodontal means “around the tooth”. Periodontal disease attacks the gums and the bone that support the teeth. Plaque is a sticky film of food debris, bacteria, and saliva. If plaque is not removed, it turns into calculus (tartar). When plaque and calculus are not removed, they begin to destroy the gums and bone. Periodontal disease is characterized by red, swollen, and bleeding gums.
Four out of five people have periodontal disease and don’t know it! Most people are not aware of it because the disease is usually painless in the early stages.
Not only is it the number one reason for tooth loss, research suggests that there may be a link between periodontal disease and other diseases such as, stroke, bacterial pneumonia, diabetes, cardiovascular disease, and increased risk during pregnancy. Smoking also increases the risk of periodontal disease.
Good oral hygiene, a balanced diet, and regular dental visits can help reduce your risk of developing periodontal disease.
Signs and symptoms of periodontal disease:
• Bleeding gums – Gums should never bleed, even when you brush vigorously or use dental floss.
• Loose teeth – Also caused by bone loss or weakened periodontal fibers (fibers that support the tooth to the bone).
• New spacing between teeth – Caused by bone loss.
• Persistent bad breath – Caused by bacteria in the mouth.
• Pus around the teeth and gums – Sign that there is an infection present.
• Receding gums – Loss of gum around a tooth.
• Red and puffy gums – Gums should never be red or swollen.
• Tenderness or Discomfort – Plaque, calculus, and bacteria irritate the gums and teeth.
• Diagnosis
• Treatment
• Maintenance
Diagnosis
Periodontal disease is during a periodontal examination. This type of exam is always part of your regular dental check-up.
A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums. The depth of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper.
We use pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:
Gingivitis
Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.
Periodontitis
Plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth and become filled with bacteria and pus. The gums become very irritated, inflamed, and bleed easily. Slight to moderate bone loss may be present.
Advanced Periodontitis
The teeth loose more support as the gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss may be present.
Treatment
Periodontal treatment methods depend upon the type and severity of the disease. We will evaluate for periodontal disease and recommend the appropriate treatment.
Periodontal disease progresses as the sulcus (pocket or space) between the tooth and gums gets filled with bacteria, plaque, and tartar, causing irritation to the surrounding tissues. When these irritants remain in the pocket space, they can cause damage to the gums and eventually, the bone that supports the teeth!
If the disease is caught in the early stages of gingivitis, and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.
If the disease has progressed to more advanced stages, a special periodontal cleaning called scaling and root planing (deep cleaning) will be recommended. It is usually done one quadrant of the mouth at a time while the area is numb. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planing). This procedure helps gum tissue to heal and pockets to shrink. Medications, special medicated mouth rinses, and an electric tooth brush may be recommended to help control infection and healing.
If the pockets do not heal after scaling and root planing, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. We may also recommend that you see a Periodontist (specialist of the gums and supporting bone).
Maintenance
It only takes twenty four hours for plaque that is not removed from your teeth to turn into calculus (tartar)! Daily home cleaning helps control plaque and tartar formation, but those hard to reach areas will always need special attention.
Once your periodontal treatment has been completed, your dentist and dental hygienist will recommend that you have regular maintenance cleanings (periodontal cleanings), usually four times a year. At these cleaning appointments, the pocket depths will be carefully checked to ensure that they are healthy. Plaque and calculus that is difficult for you to remove on a daily basis will be removed from above and below the gum line.
In addition to your periodontal cleaning and evaluation, your appointment will usually include:
• Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.X-rays also help determine tooth and root positions.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Examination of tooth decay: Check all tooth surfaces for decay.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, cheek tissues, and gums for any signs of oral cancer.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed. (Electric toothbrushes, special periodontal brushes, fluorides, rinses, etc.)
• Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.
Good oral hygiene practices and periodontal cleanings are essential in maintaining dental health and keeping periodontal disease under control!
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Halitosis/ Bad Breath
Bad breath (halitosis) can be an unpleasant and embarrassing condition. Many of us may not realize that we have bad breath, but everyone has it from time to time, especially in the morning.
There are various reasons one may have bad breath, but in healthy people, the major reason is due to microbial deposits on the tongue, especially the back of the tongue. Some studies have shown that simply brushing the tongue reduced bad breath by as much as 70 percent.
What may cause bad breath?
• Morning time – Saliva flow almost stops during sleep and its reduced cleansing action allows bacteria to grow, causing bad breath.
• Certain foods – Garlic, onions, etc. Foods containing odour-causing compounds enter the blood stream; they are transferred to the lungs, where they are exhaled.
• Poor oral hygiene habits – Food particles remaining in the mouth promote bacterial growth.
• Periodontal (gum) disease – Colonies of bacteria and food debris residing under inflamed gums.
• Dental cavities and improperly fitted dental appliances – May also contribute to bad breath.
• Dry mouth (Xerostomia) – May be caused by certain medications, salivary gland problems, or continuous mouth breathing.
• Tobacco products – Dry the mouth, causing bad breath.
• Dieting – Certain chemicals called ketones are released in the breath as the body burns fat.
• Dehydration, hunger, and missed meals – Drinking water and chewing food increases saliva flow and washes bacteria away.
• Certain medical conditions and illnesses – Diabetes, liver and kidney problems, chronic sinus infections, bronchitis, and pneumonia are several conditions that may contribute to bad breath.
What can I do to prevent bad breath?
• Practice good oral hygiene – Brush at least twice a day with an ADA approved fluoride toothpaste and toothbrush. Floss daily to remove food debris and plaque from in between the teeth and under the gumline. Brush or use a tongue scraper to clean the tongue and reach the back areas. Replace your toothbrush every 2 to 3 months. If you wear dentures or removable bridges, clean them thoroughly and place them back in your mouth in the morning.
• See your dentist regularly – Get a check-up and cleaning at least twice a year. If you have or have had periodontal disease, your dentist will recommend more frequent visits.
• Stop smoking/chewing tobacco – Ask your dentist what they recommend to help break the habit.
• Drink water frequently – Water will help keep your mouth moist and wash away bacteria.
• Use mouthwash/rinses – Some over-the-counter products only provide a temporary solution to mask unpleasant mouth odour. Ask your dentist about antiseptic rinses that not only alleviate bad breath, but also kill the germs that cause the problem.
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Xerostomia (Dry Mouth)
Xerostomia, more commonly known as dry mouth, is not a disease in itself. Rather, it is a symptom of many other diseases and conditions. These conditions cause saliva production to decrease or stop.
Saliva moistens your mouth and helps you to swallow and taste food. It helps in fighting cavities by washing away food and plaque from the teeth. It also helps to neutralize acids in the mouth that harm tooth enamel.
If you have less saliva in your mouth, your teeth and gums are at increased risk of tooth decay. People with xerostomia also are more likely to get illnesses that affect the soft tissues of the mouth, such as yeast infections (thrush). In addition, your diet may be affected because you cannot taste food as you normally would. People with complete dentures who develop xerostomia also may notice that their dentures lose some of their suction. They may feel loose in the mouth.
Xerostomia may occur for several reasons. Some common causes include:
• A side effect of medicine — Hundreds of drugs can cause dry mouth. These include pain relievers and medicines for depression, cold symptoms, muscle spasms and allergies. Medicines are the most common cause of xerostomia.
• A complication of diseases and infections — Several diseases are associated with dry mouth. They include diabetes, anemia, cystic fibrosis, rheumatoid arthritis, high blood pressure and HIV infection. Xerostomia also occurs with Sjogren's syndrome. In this disease, the body's antibodies attack the salivary and tear glands. Some viral infections, such as mumps, also affect saliva production and cause xerostomia.
• Dehydration — Any condition that leads to loss of body fluids can also cause xerostomia. These conditions include fever, excessive sweating, vomiting, diarrhea, blood loss or loss of water through the skin after a burn.
• Radiation therapy — Xerostomia is a common side effect of radiation therapy to treat cancers in the head and neck.
• Surgical removal of the salivary glands — If a mass develops in a salivary gland, surgical removal of the gland may be recommended.
Although xerostomia is a symptom, it often occurs along with other symptoms. These may include:
• Frequent thirst
• Burning or tingling sensation, especially on the tongue
• Sores in mouth or at corners of lips
• Difficulty swallowing
• Problems with taste and speech
• Sore throat and hoarseness
• Bad breath
• Dry nasal passages and cracked lips
• Increase in dental problems, such as cavities and periodontal disease
• Difficulty wearing dentures
• Repeated yeast infections in the mouth
The treatment of xerostomia focuses on three areas:
• Preventing tooth decay
• Relieving symptoms
• Increasing the flow of saliva, if possible
We recommend that you practice good dental hygiene. This means that you should brush and floss properly and have regular dental visits. In the office, we may apply fluoride to your teeth if we feel you are at risk of cavities. We may also recommend using an alcohol free mouthrinse.
To relieve your symptoms, try the following:
• Drink water often to keep your mouth moist.
• Chew sugarless gum and suck on sugar-free hard candies or ice chips.
• Use an over-the-counter oral moisturizer or saliva substitute.
• Avoid salty foods, dry foods (crackers, cookies, toast) and foods and beverages with high sugar contents.
• Avoid drinks containing alcohol or caffeine. These increase water loss by triggering frequent urination.
• Avoid smoking.
• To reduce irritation of dry tissues, use a moisturizer on your lips and a soft-bristle toothbrush on your teeth and gums.
Xerostomia treatment has been primarily palliative, namely, increasing salivary flow by increasing water consumption, using surgarless gums and mints, and medications to stimulate salivary production, none of which have been particularly effective.
Recently, investigative studies using acupuncture have shown promising results with improved salivary flow lasting up to three years. It is suggested that accupuncture increases the release of neuropeptides and stimulates the autonomic nervous system. It has also been shown to increase blood flow to the skin overlying the parotid gland. The best acupuncture points are three on each ear and one on each index finger.
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