Periodontal Disease

Periodontal disease, also known as gingivitis or periodontitis, is an infection of the gums that, left untreated, may lead to tooth loss as well as heart attack, stroke, diabetes, respiratory diseases, and premature/underweight babies. An estimated 80 percent of American adults currently have some form of periodontal disease. 

What Causes Periodontal Disease? 

The mouth is full of bacteria. Bacteria, along with mucus and other particles, constantly form a sticky, colorless "plaque" on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form bacteria-harboring "tartar" that brushing doesn't clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar. 

Sore, swollen, red, or bleeding gums as well as tooth pain or sensitivity and bad breath are warning signs of periodontal disease. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed. 

Gingivitis 

The longer plaque and tartar are on teeth, the more harmful they become. In the mildest form of periodontal disease, gingivitis, the gums become red, swell and bleed easily. There is usually little or no discomfort. Gingivitis can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place. 

Periodontitis 

When gingivitis is not treated, it can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. If not treated, the bones, gums, and connective tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed. 

Risk Factors 

How is Periodontal Disease Treated? 

The main goal of treatment is to control the infection. The number and types of treatment will vary, depending on the extent of the gum disease. Any type of treatment requires that the patient keep up good daily care at home. Additionally, modifying certain behaviors, such as quitting tobacco use or improving dietary intake, might also be suggested as a way to improve treatment outcome. 

Deep Cleaning (Scaling and Root Planing)
The dentist, periodontist, or dental hygienist removes plaque through a cleaning method called scaling and root planing. Scaling is the process of scraping off the tartar from above and below the gum line. Root planing gets rid of rough spots on the tooth root where the germs gather, and helps remove bacteria that contribute to the disease. 

Medications
Medications may be used along with scaling and root planing treatment.  Specific drugs used to treat periodontal disease include chlorhexidine and tetracycline (doxycycline, minocycline, etc.).  A dental professional may also recommend a specific nutritional supplement to help ensure the dietary intake of key micronutrients known to help maintain healthy gums.

Surgery
Surgery might be necessary if inflammation and deep pockets remain following treatment with deep cleaning and medications. A dentist/periodontist may perform flap surgery or suggest bone or tissue grafts 

Since each case is different, it is not possible to predict with certainty which treatments will be successful over the long-term. Treatment results depend on many things, including severity of the disease, ability to maintain oral hygiene at home, and certain risk factors, such as smoking, which may lower the chances of success. 

Prevention

Here are some things you can do to help prevent periodontal diseases: 

1. Brush your teeth twice a day  2. Floss every day  3. Visit a dentist routinely for a check-up and      professional cleaning  4. Eat a well balanced diet  5. Don't use tobacco products

Today, with increased awareness of periodontal disease and its potential overall impact on health, many people are taking a proactive approach to maintaining healthy gums. This includes compliant home care, routine visits to a dentist or periodontist, and following a healthy lifestyle. 

Maintaining Periodontal Health

There are additional steps that you can take to help ensure the health of your teeth and gums. Gingival tissues are in a continuous critical period of growth and development known as “turnover”. This rapid turnover time, coupled with the ongoing repair of damaged tissues, demands a higher nutrient requirement than other body tissues. For example, the recommended daily requirement (RDA) for vitamin C is 60mg. Although this daily intake will prevent deficiency, it is not clear whether this dose is adequate for optimal ascorbic acid levels in various tissue levels throughout the body. Because vitamin C is essential for production of collagen, and because collagen within the gingival tissues has a high turnover rate, it has been postulated that optimal ascorbic acid levels of the gingiva may be greater than can be supplied by ingesting the recommended daily allowance. In another example, zinc, needed for protein synthesis, is an important mineral in gingival healing. The large epithelial portion of the gingiva is greater than that of the skin. Epithelial tissues contain about 20% of the body’s entire zinc content. Therefore, even small nutritional deficiencies of zinc can adversely affect oral tissues more readily than other body tissues. 

Recognizing the importance of nutrition in preventive dentistry, a study was performed to evaluate nutrients in the diets of periodontal patients. One hundred men and women (mean age 43.1 and 46.7 years for men and women, respectively) referred to a dental office for periodontal treatment participated in this 5-day evaluation of diet history. Average nutrient intakes were compared to the RDA for men and women. Nutrient intake analysis revealed that about 80% of men received less than the RDA for calcium, about 65% received less than the RDA for thiamin, about 55% for vitamin A and riboflavin, and about 50% for niacin. In women, about 75% did not get enough calcium, about 55% for thiamin, 35% for vitamin A, and about 30% for riboflavin and niacin. It is evident from this study that a significant number of patients failed to maintain an adequate intake of key vitamins and minerals. 

Deficiencies in other nutrients have also been observed. For instance, folic acid deficiency is the most common vitamin deficiency in humans; up to 45% of adults with low incomes are deficient. The average adult American also receives less than the recommended daily intake of zinc and magnesium. Nutritional deficiencies in older persons may be particularly problematic. 

Following a good diet is one of the best ways to keep your teeth and gums healthy. If you are unable to attain the increased nutrient requirements that are in demand during periodontal stress, you should consider supplementing your diet with key micronutrients known to be helpful in maintaining the health of your gums. There is a specific vitamin mineral supplement available for your consideration. 

Remember…for optimal periodontal health…brush, floss, visit your dentist and ensure that you have a healthy, well-balanced diet.