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What causes periodontal disease? Periodontal disease comes in different stages. The earliest stage of periodontal disease is gingivitis. This stage is reversible with proper treatment. If caught and treated before progression there will be no long term affects. If it advances to the next stage, periodontitis, there will be long term effects to your smile. These effects can include gum tissue recession and bone loss surrounding your teeth. Below we will discuss what causes periodontal disease as well as how to bring it under control for good dental health.

What Causes Periodontal Disease?

What causes periodontal disease? Bacteria and Plaque. Periodontal disease is a chronic dental infection of the periodontal tissues surrounding our teeth. This disease can result in the breakdown of the tissue as well as the loss of bone that surrounds and supports our teeth. Periodontal disease begins when bacteria and plaque form a sticky film on your teeth. This film acts as an irritant to the  surrounding tissues and causes inflammation of the periodontal tissue.  Periodontal disease will continue and progress and become more advanced over time What Causes Periodontal Disease Las Vegas Marielaina Perrone DDSwithout dental intervention. Periodontal disease is the #1 cause of loss of teeth in adults. According to the Centers For Disease Control (CDC), it is estimated that 65 million American adults, have mild, moderate or severe periodontitis (advanced form of periodontal disease)In our senior population aged 65 and older, prevalence rates increase to over 70%.

Bacteria That Causes Periodontal Disease

Periodontal disease and tooth decay are triggered by different types of bacteria and are considered to be two separate and distinct disease conditions. However, they work hand in hand to break down our teeth and gum tissues if left unchecked. Swollen and receding gums allow the more vulnerable areas of the tooth (root areas) to be exposed to cause an increased incidence of tooth decay.  On the other side, patients with extensive tooth decay, the broken down teeth allow for food trap areas which keep periodontal tissue chronically inflamed.

Stages Of Periodontal Disease

-Gingivitis – This is the earliest stage of what causes periodontal disease. Ginigivitis is simply the inflammation of the periodontal tissues surrounding the teeth. Gingivitis is the mildest form of periodontal disease and is wholly reversible with professional care and a good at home dental hygiene regimen. Symptoms of Gingivitis Include red, swollen gum tissue with inflammation as well as gum tissues bleeding easily upon brushing, flossing, or even eating. Often these symptoms are unnoticed by patients. Bad breath may be another sign of advancing periodontal disease.

There are only a few signs at this stage and most are painless. This is what makes periodontal disease so common and so concerning. It is silent until it is not. Periodontal disease does not typically break its “silence” until the fourth and final stage. Beginning signs to watch out for include bad breath on occasion, swelling and redness of the gums, and bleeding when brushing or flossing. Good overall dental hygiene and regular professional examinations can treat and reverse gingivitis as well as stop it from progressing further.

This is a critical period for the patient, as gingivitis can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been adversely affected) at this point if it is recognized, diagnosed, and properly treated by a dental professional. Gingivitis can commonly be seen during puberty, pregnancy (also called pregnancy gingivitis), times of high stress, and menopause. As for the rest of the population, poor dental hygiene is generally the most common cause, followed by medication and certain medical conditions (like diabetes).

-Periodontitis – If left untreated the next phase is early periodontitis. Once it enters this stage, the disease can be difficult to control. In this stage, the bone surrounding the teeth is now being affected. The bacteria will invade between the tooth and gums causing a separation of connective fibers. The result is what is called a periodontal pocket (normal pocket depth should be about 3mm without inflammation). These pockets will now approach 4-5mm in depth and can get filled with bacteria, plaque, and food. This will in turn begin to breakdown the bone below the gum line. Simple at home dental hygiene will not be the answer to bring back to a healthy state. Periodntitis signs include increased swelling or redness of the gums, increasingly bad breath, bleeding upon brushing or flossing, and pocket depths that are between four and five millimeters.

-Advanced Periodontitis – This is where the real destruction lies. At least 50 % of bone support is lost if not more. Teeth will begin to loosen and shift if they have not already. Deep periodontal cleanings and possibly surgical intervention are necessary to salvage teeth. This professional cleanings may occur using a periodontal microscope, (Perioscope), grafting of gum tissue or bone, placement of growth factors (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open periodontal flap surgery, and, possibly even removal of teeth.

How To Treat What Causes Periodontal Disease?

Luckily, the earliest stages of periodontal disease are easily treated. Following a good at home dental hygiene program (including brushing, flossing, and antibacterial mouthwash) along with regular visits to a dentist we can halt gingivitis in its tracks. Failing to to do the above steps will allow periodontal disease to advance unchecked leading to loss of teeth as well as systemic health issues.

Treatment For Periodontal Disease Can Include Any Of The Following:

Pocket Reduction SurgeryA surgical procedure to reduce the size of the periodontal pockets around your teeth. This will ensure the ability to keep the areas clean at home. The surgery is made up of tiny incisions in your gum tissues so that a section of gum tissue can be lifted back, exposing the roots for more effective teeth cleaning. Because periodontitis often causes bone loss, the supporting bone tissue may be recontoured before the gum tissue is sutured back in place. This surgery can take from 1-3 hours and is performed under local anesthesia.

-Periodontal Tissue Grafts. Periodontal or Gum tissue is often lost due to periodontal disease. When the gums recede your teeth will appear longer than normal as root surfaces are exposed. You may need to have damaged tissue replaced for cosmetic as well as functional reasons. It is important to note that root surfaces are not protected by enamel. This can cause extreme tooth sensitivity. This grafting procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetic lift.

Bone graft. The addition of the bone graft helps prevent tooth loss by increasing support structure around our teeth. It also serves as a building block for the regrowth of natural bone.

-Antibiotics and Antibacterial Medications – These medications will aid in healing and removal of bad bacteria from around our teeth. These include:

-Peridex – Prescription antibacterial rinse.

-Periostat – Oral antibiotic. Another type of antibiotic used is called minocycline.

Arestin – placed directly into the periodontal pocket to help aid in healing.

Chlorhexidine – A prescription anti bacterial mouthwash. This is used to control bacteria when treating periodontal disease and after surgery. Patients use it as they would a regular mouthwash.

-Guided Tissue Regeneration. This periodontal procedure helps to regrow destroyed bone. Your dentist or periodontist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back in a stable environment. The goal is to regenerate periodontal tissue and repair defects that have resulted from the development of periodontitis.

-Enamel Matrix Derivative Application. Another technique involves the application of a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue. An example of this is the use of emdogain.

What Causes Periodontal Disease? Conclusion

Periodontal disease if left untreated can cause aggressive destruction of your smile. Regular dental visits can prevent periodontal disease from developing. A good way of looking at this is that it is far cheaper and less painful to go to your dentist every 6 months than it is to wait for periodontal disease to develop and chase after your health. Visit your dentist regularly for a happy, healthy smile.



Periodontal disease is a progressive disease of the structures (bone and gingival tissues) surrounding our teeth. It is believed that about 65 million americans have some form of periodontitis. Periodontitis is the advanced form of periodontal disease. Once the disease state reaches periodontitis it means there have been some form of permanent loss of bone or gingival tissues to the disease. In those 65 and over this number jumps to 70% of that population. These numbers are startling. Luckily, there has been extensive research into periodontal disease and new treatment modes have been developed. One such method is treating periodontal disease with Arestin.

What Is Arestin?

Arestin (minocycline hydrochloride) is an antibiotic that comes in the form of micrspheres. These microspheres are placed locally into areas of concern. Periodontal disease generally hits certain areas over others initially. This gives us a chance to localize treatment of periodontal disease with arestin.

Treating Periodontal Disease With Arestin

Periodontal disease if left untreated will develop deeper and deeper “periodontal pockets” around out teeth. The normal space between our teeth, gums and bone is approximately 3 mm. When periodontal disease begins to damage these areas these pockets can widen and deepen as bone is lost and gum tissues lose their connections to our teeth. As the periodontal disease develops and progresses it is not unheard of to have periodontal pocketing in the 6-8 mm range. That is a doubling over normal pocket size. This allows food and bacteria to penetrate these areas and create even more damage to gingival tissues and bone. Once these support structures become damage they can cause our teeth to become loose and eventually lost them.

The standard course of treatment for periodontitis is scaling and root planing (S&RP). This treatment is highly effective for treatment of periodontal disease.

-Periodontal scaling of teeth with instruments involves manually removing all the plaque, tartar, and food from on and around our teeth.

-Periodontal planing can smooth out rough areas on our teeth’s roots where bacteria and plaque can attach.

Scaling and root planing has been our #1 treatment for periodontal disease for decades. Where does treating periodontal disease with Arestin come in? Combining the use of Arestin with the traditional scaling and root planing gives dentists and periodontists a real chance to reduce the periodontal pocketing around our teeth. In routine scaling and root planing, depending on depth of pockets, it may be difficult to reach to the entire depths of those pockets. Everyone’s anatomy is different so some areas are easy to reach while others might be more difficult based on root structures and how the periodontal pockets form. None are uniform. Using microspheres of Arestin allows your dentist to reach the bottom of those pockets and destroy harmful bacteria before further destruction of tissues can occur.

Treating Periodontal Disease With Arestin Procedure

The following is what to expect if you are undergoing treatment of periodontal disease with Arestin.

Diagnosis of Periodontal Disease. In its earliest form (Gingivitis) there is no damage to bone or gingival tissues and can be reversed thru professional cleaning and increased at home dental hygiene care. In periodontitis, destruction has begun. A simple professional cleaning is no longer as effective. Diagnosis of periodontal disease is achieved thru x-rays and use of a periodontal probe. This dental instrument allows your dentist or hygienist to measure around the teeth and see what areas might be affected by periodontal disease. A normal reading of 3 mm means tissues are healthy. Anything over that raises a red flag and leads to a diagnosis of periodontal disease.

-Treatment Plan To Fight Periodontal Disease. Your dentist will explain these results to you and discuss treatment necessary. The first line of defense is always a scaling and root planing (also called a deep cleaning). Your dentist may now offer Arestin in conjunction with this type of cleaning to give you a better chance of stopping this problem from developing further and also repairing tissues around our teeth.

-Treatment With Scaling And Root Planing.

-Arestin Application Following Scaling And Root Planing. The arestin is in the form of a microsphere. This allows the arestin to release the antibiotic gradually over time to fight the bacteria in the deepest depths of those periodontal pockets. It is able to target areas scaling and root planing instruments just cannot reach.

Is Arestin Effective?

Yes! Studies have shown that is more effective in treating pocket reduction when paired with Scaling and Root Planing Vs S&RP alone. In fact clinical trials have shown significant pocket reductions in as little as 1-3 months and maintenance for at least 9 months. It has also shown significant reductions in our more difficult to treat patients. Those include the smoker’s, ones with a history of heart disease, and those over age 50. The chart below shows those statistics.

Periodontal Disease With Arestin Marielaina Perrone DDS

Is Arestin A Miracle Drug? Conclusion

Arestin is not a miracle drug. But it will help controlling a very difficult progressive disease. Periodontal disease is difficult to control because it relies on many factors. The biggest one is at home dental hygiene. Patients need to understand their dental care does not begin and end inside the walls of their dental office. Fighting periodontal disease is a daily battle. Periodontal disease treatment with Arestin can help reverse some of those issues but it will not be a cure for it.

 

 


Periodontal Disease– is a group of diseases that affect the tissues that support and anchor the teeth. If untreated, periodontal disease results in the destruction of the gums, alveolar bone (the part of the jaws where the teeth arise), and the outer layer of the tooth root. The earliest form of periodontal disease is called gingivitis. Gingivitis is reversible with proper treatment.

Once a patient is diagnosed with advanced periodontal disease (also called periodontitis), their dentist will recommend procedures above and beyond that of a normal professional cleaning to properly treat and manage the periodontal disease. In the initial stages, most treatment revolves around non surgical intervention but as the periodontal disease progresses surgical treatment is often recommended and required.

Periodontal Disease Treatment

Non Surgical Procedures

Scaling and root planing. This procedure is a special type of cleaning that removes plaque and tartar from under the gum line and makes the root surfaces smooth. The smoother root surface is thought to promote reattachment of the gum tissue and promote healing. This type of cleaning is the only way to remove tartar from below the gum line. This is usually completed in multiple visits utilizing a numbing anesthetic to make the procedure more comfortable..

-Drug Therapy. In some cases, antibiotics or antimicrobials may be used to supplement the effects of scaling and root planing. In most cases of early periodontal disease, scaling and root planing in addition to continued daily cleaning at home (flossing, brushing , and rinsing) will achieve a satisfactory result of reversing periodontal disease.  A wide array of antibacterial rinses such as Peridex, antibiotics taken in pill form such as  Periostat, or localized placement directly into the affected pockets with an antibiotic such as Arestin, can aide in, and promote healing of the affected gum tissue.

-Periodontal maintenance or supportive periodontal therapy: Following a scaling and root planing, routine specialized  cleanings (every 3-4 months)  to target your periodontal problem area, can minimize the recurrence or progression of periodontal disease.

Surgical Procedures

-Pocket depth reduction procedures: Your dentist or periodontist will open up the affected gum tissue so that periodontal disease causing bacteria and calculus build up can be easily seen and removed. Some cases may require contouring and smoothing of the damaged bone and root surfaces to allow the gum tissue to reattach to healthy bone during the healing phase. The procedure also repositions the gum tissue so that it is easier to keep clean going forward.

Perioscope cleaning: A deep cleaning requiring a microscope to be placed below the gum line to remove tartar, cement, or other debris.

-Regeneration. Your dentist will treat the affected gum tissue in the same way as in pocket depth reduction procedures, with the additional procedure of using membranes, bone grafts or tissue-stimulating proteins to stimulate the body’s natural ability to regenerate healthy bone and gum tissue. A good example of this is a bone and tissue growth factor called Emdogain.

-Soft tissue grafts. Your dentist will take synthetic tissue such as Alloderm, or healthy gum tissue from the roof of the mouth (palate) or other areas of the mouth and use it to repair receding gums and cover exposed root surfaces.

-Hard Tissue Bone Grafts.  This procedure is needed when periodontal disease has destroyed the bone surrounding your tooth. The bone graft helps prevent tooth loss by holding your tooth in place. It also serves as a platform for the regrowth of natural bone. The dentist can use your bone, cadaver bone, cow bone, or a lab created calcium based bone matrix material.

Conclusion

If you have been diagnosed with periodontal disease please take the news very seriously. Periodontal disease is a progressive disease that will continue to get worse without treatment. Periodontal disease  leads to tooth loss and oral infections. Your dentist can help you with diagnosis, prevention, better oral hygiene methods and instruction, and proper treatment for your particular needs.  Studies have shown time and again that there is a link between oral health and your general health. Keeping your mouth healthy will lead to better overall health. As always visit your dentist regularly for dental examinations and regular professional cleanings to stave off the onset of periodontal disease.