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Dealing with Periodontal Disease

Periodontal disease is the most common cause of tooth loss in adults.  It results from an interaction between your own immune system and the bacteria that normally inhabit your mouth.  Your susceptibility has a lot to do with who your parents are, too (genetic stuff).

The abbreviated explanation for what happens is that waste products from the bacteria living in the small gap between your teeth and gums seep into your tissue.  Your body, thinking there are germs invading, sends the white blood cells to the area to protect you.  Just as when you get a sliver in your finger, the gum tissue turns red and swells up.  Normally, the inflammation helps the white blood cells pass through the tissues to get to the germs that enter your body.  These germs, however, are outside the tissue and in endless supply,  so the inflammation becomes chronic and the attachment of the gums to the root of the tooth gets weaker.  Over time, it may get so weak that the collagen fibers securing the gums to the root cannot hang on and the attachment recedes, forcing the bone supporting the teeth to move away rather than be exposed to the outside world.

When we “probe” during your examination, we are looking for two things:  How strong are the attachments of the gums to the root, and how deep are the “pockets” between your teeth and gums.  It is easy to know when the attachment is loosening up because when we touch the blunt probe to the weakened connective tissue attachment to the tooth, it simply pierces the tissue and bleeding starts. HEALTHY TISSUE DOES NOT BLEED WHEN YOU TOUCH IT. 

Often times when the attachment of the gums recedes, the visible tissue does not move down the root.  The bottom of the pocket just moves deeper.  This, coupled with the swelling associated with the inflammation, makes it even harder to keep the pocket clean, so the disease tends to pick up speed as it progresses.  Your toothbrush bristles can only reach about 3 millimeters into the pocket, and your floss can only get about 5 millimeters down between teeth at most before it starts to cut into the tissue adjacent to the spot you are trying to clean.  THAT YOU DO NOT BLEED WHEN BRUSHING IS NOT PROOF OF HEALTH. YOU WILL ONLY BLEED IF YOUR BRISTLES GET TO THE BOTTOM OF THE POCKETS, AND DEEP POCKETS ARE USUALLY OUT OF REACH.

Just like “high blood pressure” or “low blood sugar”, the problem of periodontal disease is never really cured.  It is simply managed.  Since we have not yet developed a medication that will help for the long term, the only way to keep the disease in check is to limit the amount and type of bacterial waste coming in contact with the tissue.

Our goal in doing the periodontal scaling and root planing is to get the swelling of the gum tissue associated with the inflammation to go down such that the pocket becomes shallow enough for you to keep clean.  The most frequent reason to send you to a periodontist is to basically trim back the gums and eliminate the pockets of folks that cannot for one reason or another keep them clean.  A “gum-ectomy” if you will.

Now, the hardest part of dealing with this disease is the fact that nothing happens very fast.  Sort of like “one piece of chocolate cake never makes you fat”. It is easy to ignore for even years at a time.  When things get so bad that they start to hurt or your teeth start to get a little wiggly, it is often too late to treat without desperate measures, considerable discomfort, and substantial cost.   Even if you only have a tiny bit of bone loss – say a mere 2/10ths of a millimeter per year, when you hit age 60, you have lost over half the bone around your teeth, and face tooth loss or a major reconstruction costing more that a new car.  I personally plan on being around well past then, and I hope to drive that red Austin Healy, not put it in my mouth. 

Along with that, having exposed roots later in life can be a major problem.  They are very susceptible to decay, especially as our saliva flow diminishes as we get older and we start taking medicines to control blood pressure and such that tend to dry our mouths further.   There also comes a time when we are not as capable of caring for ourselves, and I don’t know about you, but I certainly don’t want to be dealing with a “car’s worth of dentistry” or weekly dental appointments when I am 80. 

For most folks to avoid the worst of this disease they simply have to take a little better care of themselves at home and visit with the dental hygienist a little more frequently.  The good news is that if you do this, you will likely have many fewer dental problems in general to go with your healthy gums.  The savings in fillings, crowns, and such will likely far exceed the cost of prevention.  That is why dental insurance companies pay such a high percentage for prevention visits – they know they will save in the long run.

There tend to be two phases to treatment.  There is an active phase at the start where we basically catch up with what should have been happening all along to prevent the disease – getting the pockets cleaned out and the bacteria under control.  Often this takes several visits and can be quite involved.  It may often require seemingly unrelated things such as replacing old, rough fillings or poor fitting crowns that allow bacteria to hide out and avoid our cleaning and your floss.  Some folks need their teeth straightened because the roots are too close together to actually clean between with the dental instruments, or there are gaps that constantly trap food debris and cause bacterial population explosions. 

This in most cases is followed by a maintenance phase where you get a regular periodontal cleaning and hopefully, over time, you are better able to keep things clean yourself without so much help from us.  Periodically, there may be a repeat of the active treatment, usually abbreviated in form.

Should we not be able together to stop the disease progression, we will recommend referral to a specialist called a periodontist.  There may also be related problems, such as correcting an “odd” gum-line in your smile, or providing a dental implant to replace a missing tooth, that we may seek the specialist’s advice or treatment. 

I hope this information is of some value.  Please feel free to talk further or in more detail about your individual situation.  We look forward to serving you, your family, and your friends in the future.

- Dr. Bob Knudson