Over the last few weeks, we have been talking about a road map to oral and dental wellness and getting a great smile.  Last week, we discussed starting with a good check-up to see if there are any dental issues that require immediate attention.

This week, we'll discuss one of the more common issues that face many--gum tissue problems--which fall under the category of periodontics.

Here is what you need to know:

Periodontal (Gum) Disease is a “silent” disease – and surprisingly, research has shown that more than 75% of all adults have some form of gum disease.  Yet, until their teeth become loose and fall out, most people do not know they even have it, or how serious it is. But in fact, it is the #1 reason adults lose their teeth.

More importantly, recent Dental/Medical research has shown a direct correlation to periodontal disease and systemic health. People with periodontal disease have an increased risk of stroke, heart attack, diabetic complications, and serious problems with pregnancy.

However, regular checkups with professional cleanings will help keep gum tissue in good health.

What are the Signs?

• Do your gums bleed when you brush, floss or use a toothpick?
• Are your gums red, swollen and painful?
• Do you have pus coming from between your gums and teeth if you push on your gums?
• Are your gums pulling away from your teeth?
• Has there been a change in the way your teeth come together when you bite or chew on food?
• Do your teeth look longer because of receding gums?
• Are your teeth loose?
• Do you have bad breath?
• If you wear a partial denture, does it still fit the same?

If any of these statements are true, then you may have a problem with your gums and may need more than just a routine cleaning of your teeth to get your gums healthy again. A thorough evaluation of your gums and your overall dental health includes a comprehensive examination, a complete set of x-rays, and periodontal probing. If there is bone loss and deep pocketing you may need non-surgical periodontal or surgical periodontal care.

What occurs during a Periodontal exam?

Periodontal exams will use a periodontal probe instrument to examine if the gums are tightly connected to the teeth.  Typically, the probe should only go a short distance into the gum line, but in case of gum disease, the probe will go further.  Your dentist will also look for the signs mentioned above through both a patient history and direct examination.

The depth the probe is able to enter will tell the dentist a great deal about the health of your gums.  During early stages, the gums may be puffy and red, and the disease can be reversed with proper treatment.  If the probe goes deeper and food and plaque are found under the gums, then there is already damage that will require more aggressive treatment.  If the gums are pulling away from the teeth and plaque and tartar cover the teeth and the roots, then you are in the most advanced stage of gum disease, and your teeth can become loose and can shift--causing your bite to change.  At this stage, you are at risk for losing your teeth.

What are the treatments for gum disease problems?

Depending on the degree of gum disease, your dentist has a number of procedures available for treatment.

The simplest procedure that is used for healthy gums is good hygiene procedures at home coupled with regular professional cleanings (every six months).  

The next level used for gums in the earliest stage of decay is non-surgical periodontal treatment, including scaling and root planing. This treatment involves a careful cleaning of the root surfaces to remove plaque and calculus (tartar) that has formed under the gum - in the area known as the pocket, and smoothing the root surfaces.  Local anesthesia is typically used to assure comfort during treatment. The area is then treated with medication such as antibiotics or antibacterial agents.  The goal of non-surgical periodontal treatment is to bring the gums back to good health by shrinking or eliminating the pockets around the teeth that are the site of infection, without having to have gum surgery.

For the majority of patients, non-surgical therapy is sufficient to reverse the effects of gum disease.  Coupled with a more frequent follow-up schedule (every 3 months), the gum tissue can be restored to health.  

However, there are instances where the disease has progressed too far for non-surgical treatment ot be effective.  If you're diagnosed with advanced periodontal disease, your dentist may recommend periodontal surgery--which is necessary when the tissue around your teeth is unhealthy and cannot be repaired with non-surgical treatment. Following are the four types of surgical treatments most commonly prescribed:

• Pocket Depth Reduction--During this procedure, your dentist folds back the gum tissue and removes the disease-causing bacteria--found in pockets below the gum line--before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.  With the removal of the pockets where plaque and food can hide, bacteria is prevented from further eroding the gums, bone, and teeth.
• Regeneration--This procedure regenerates lost bone and tissue supporting your teeth, and can reverse some of the damage caused by periodontal disease.  During this procedure, your dentist folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue-stimulating proteins can then be used to encourage your body's natural ability to regenerate bone and tissue.
• Crown Lengthening--This procedure is used to correct an issue referred to as a "gummy smile"--one where the teeth are normal in length, but covered with too much gum tissue.  In the procedure, the dentist reshapes the gum line to expose more of the natural tooth.  By removing excessive gum tissue, the dentist can both increase the beauty of the smile as well as remove potential areas for pockets of bacteria to form.
• Soft Tissue Grafts--A soft tissue graft is used to rebuild gum tissue that has been eroded away.  In some cases, it can cover exposed roots to protect them from decay.  During the procedure, your dentist will take gum tissue from your palate or another donor source, and use it to cover areas where the original gum tissue is gone.

Summary

The proper care of your gum tissue should be high on your list of important tasks to maintain your health and smile.  The best treatment remains prevention through a proper daily dental care regime, and semi-annual cleanings and check-ups.  Should disease be present, make sure to work quickly with your dentist to address the issues before they become more serious and damaging.

Have any suggestions for what you'd like to see us write about?  Place your comments and suggestions in the comments section.