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Periodontal disease is a progressive disorder that if left untreated will worsen over time. Many people simply ignore the warning signs or just do not know them. Educating yourself on the signs and symptoms of periodontal disease is a good first step to taking control of the disease and it’s progression.

What Is Periodontal Disease?

Periodontal disease (or gum disease) is a serious and chronic infection of the gum tissue that can result in the staged breakdown of the tissue and the deterioration of bone that surrounds and supports your teeth. This infection process begins when bacteria and plaque form a sticky bio film on your teeth. Biofilm causes a chronic inflammation of the gum tissue.  Periodontal disease will continue to progress if the biofilm is not reduced or removed.   Maintaining proper dental care and hygiene are the most important steps in prevention and halting of the disease. Periodontal disease is the leading cause of tooth loss in adults. Studies show that somewhere between 75% and 95% of all adults are suffering some stage of periodontal disease.

The stages of periodontal disease include:

-Gingivitis ( inflammation of the gum tissues). This is the initial stage of periodontal disease. This is easily reversible and is the mildest form of periodontal disease. Symptoms include red, swollen (or puffy) and inflamed gums due to plaque-bacteria build-up. The gums may also bleed easily during brushing or eating of hard foods. During this early stage of periodontal disease, the process can be reversed with at home dental hygiene and professional cleanings to remove the biofilm, and tartar. Most of the people with this early form of periodontal disease, do not even know a dental problem exists. This is a crucial period for the patient, as the condition can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been affected) at this point if it is recognized and properly treated. Gingivitis is commonly seen during puberty, pregnancy, times of high stress, and menopause, as hormones can make you more prone to inflammation. As for the rest of the population, poor hygiene is generally the most common cause, followed by medication and certain medical conditions.

-Periodontitis. As the disease state progresses, it is now becoming harder to treat and manage. The difference between gingivitis and periodontitis is that gingivitis only infects the gum tissue that surrounds the teeth while the periodontal disease process also invades the bone that provides support and stability for the teeth. The bacteria eventually invades past the initial the gum line area and destruction begins to the point that gums may begin to separate or pull away from the teeth (taking away support and connective fibers with it). What results are called periodontal pockets. These pockets allow for bacteria to invade below the gum line.  They eventually become loaded with toxic plaque and bacteria that moves and works its way deeper. It begins to erode the bone and connective fibers below the gum line. A patient’s bite will be affected (as the teeth shift or loosen) by the lost support which then affects chewing and other functions.

-Advanced Periodontitis. As the periodontal disease process advances further, the fibers and bone that provide support for the teeth are destroyed. At least half of the bone support (if not more) will have broken down at this late stage of periodontal disease. It does not grow back naturally. Teeth may begin to loosen. Deep root cleanings and surgical intervention are typical at this stage. This may include cleaning with a periodontal microscope, (Perioscope), grafting of tissue, bone, placement of growth factors, (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open flap surgery, and, possibly tooth removal.

Periodontal Disease Warning Signs

-Puffy, Swollen Gum Tissue. This is a hallmark sign of gingivitis and periodontal disease in general. Your body’s natural response is to fight off this infection caused by excessive untreated debris. It does this by bringing healing components to the area through the blood vessels. The gums will remain this way until the irritant is removed namely the plaque and bacteria building up on your teeth and below the gum line.

-Bleeding Gums. Once the tissues are puffy and receiving extra blood flow to fight off the disease process. This leads to inflamed gum tissue that will bleed easily upon brushing or even eating.

-Presence Of Periodontal Pockets. As the disease process progresses and the bacteria and plaque build up the gum tissue will begin to separate from the teeth creating ever larger pockets where bone will be lost. These pockets become very difficult to clean on your own and necessitate further professional help.

-Infection And Pus. Once there has been significant advancement of pockets, bleeding ends, and infection begins. Pressing on the gums, flossing or probing by the hygienist tends to release pus into the mouth.

-Long Looking Teeth. As we lose bone support, the gum tissue falls back and exposes the root of the tooth. This gives the appearance of longer teeth.

-Persistent Bad Breath. While this can be a sign of other more serious medical conditions it is a hallmark of periodontal disease progression. Much of the odor has to do with the infection process, and tartar.

-Loose Or Drifting Teeth. Once periodontal disease has advanced, the support tissues are diminished. The further the advancement, the looser the teeth become.

Periodontal Disease Conclusion

Periodontal disease is a progressive disease. There are many signs and stages to help you to be aware of  it’s progression. The disease process involved in periodontal disease can be quite aggressive making it harder and harder to control and treat. It is best to stay ahead of that process by being diligent with at home dental hygiene and maintaining a regular schedule of professional cleanings.

For many people, eating disorders are part of every day life. These  abnormal eating habits may involve either insufficient or excessive food intake to the detriment of an individual’s physical and psychological health. The resulting effects of the dietary issues involved directly and indirectly relate to oral health problems.

Common Types Of Eating Disorders

-Anorexia Nervosa (commonly called,  ”anorexia”) -  This eating disorder is characterized by a refusal to maintain a healthy body weight, an obsessive fear of weight gain, and an unrealistic perception of current body weight. Anorexia can cause menstruation to stop, and often leads to bone loss, loss of skin integrity. It is a big stressor on the heart, there is an increase in the risk of heart attacks and related heart problems. This disorder also presents with an increased risk of death. Peer pressures play a role in an individuals’ obsession with their outer appearances. Recent research suggests it is not only about a person’s outward perception but genetics may play a role in the disease process.

-Bulimia Nervosa (commonly called, “bulimia”) – This eating disorder is characterized by recurrent binge eating followed by purging. The purging can include self induced vomiting, excessive use of laxatives/diuretics, or excessive exercise. Fasting may also be used as a method of purging (self inflicted vomiting) following a binge.

-Compulsive over-eating- This eating disorder is characterized by eating large quantities of food even when not feeling hunger. The food is generally consumed quickly and often with little to no regard for proper nutrition.

Dental Issues That Arise From An Eating Disorder

Tooth Enamel Erosion and Tooth Decay – It is quite common to see an increased incidence of tooth decay in all forms of eating disorder. It is also not unusual to see very extensive decay that leads to tooth loss. For bulimic and over-eaters, high calorie, high carbohydrate foods put the enamel at risk due to increased sugar levels in the mouth. Vomiting (either self inflicted or from eating an enormous amount of food) exacerbates the problem by incorporating stomach acid into the oral environment. Anorexics are also prone to regurgitation of stomach acid due to lack of food in the stomach.

It is quite common in patients with an eating disorder to need extensive dental work over and over again. This is especially true to the backs of the teeth, (facing the tongue) since these surfaces would be exposed the most to the stomach acids released from vomiting. The gum lines of teeth are also prone to decay when habits of snacking through the night and not brushing occur frequently.

Soft Tissue Damage – The force of repeated vomiting also takes a toll on the soft tissues in the mouth. This can result in swelling of the tonsils and the uvula in the back of the throat. Another indicator of an eating disorder may be a red and swollen tongue or a lacerated palate caused by vomiting induced by placing a finger into the back of your throat (fingernails and other implements will damage the palate).

Other Eating Disorder Dental Issues Include:

-Gum pain

-Chronic sore throat

-Inflamed esophagus

-Palatal hemorrhages

-Decreased saliva production - leading to dry mouth (xerostomia)

-Enlarged Parotid glands

-Problems swallowing

-Jaw alignment abnormalities

Dental Treatment Options

An eating disorder is a major health issue and create all kinds of problems both to our dental health and systemic health. Communication is important to not only get help to overcome the disease but also to get proper dental treatment.

Dental hygiene becomes extra important in patients with an eating disorder because some of the damage from stomach acids in the mouth can be minimized if patients brush, floss, and rinse following vomiting. This can lessen the effect of the acids on the teeth. Damage will still be done if the habits remain for long or short periods of time.

Standard dental treatment for an eating disorder can include:

-Dental Fillings

-Root Canal Therapy

-Tooth Extractions

-Periodontal Surgery

Eating Disorder Conclusion

An eating disorder is a very difficult disease to diagnose and treat. Dentists need to know the warning signs to be able to get patients in need to seek proper help. Eating disorders can ultimately kill and should not be taken lightly. The dentist should be able to speak openly about oral symptoms of eating disorders if signs are present. This is a difficult topic to discuss for most but is nevertheless important. The patient must feel comfortable enough with their dentist to tell them they think they have an eating disorder. The dentist should  be clear about everything, portray empathy and care at every opportunity. Body language is very important. Trust between the dentist and patient is very important to establish before moving on.

Once habits are addressed, treatment and restoration of healthy teeth and smile go hand in hand.. The power of a beautiful, healthy smile can do wonders do our emotional well being. A positive self-image and self-esteem are critical for recovery from bulimia and a restored, healthy smile is evidence of those feelings. Does having a new smile help that process? Absolutely. It has been shown time and again to be life changing. Even more important is restoration of the teeth to a healthy state so that the patient can eat without pain and regain health.

Tooth sensitivity is tooth discomfort in one or more teeth that is triggered by hot, cold, sweet, or sour foods and drinks, or even by breathing cold air. The pain can be sharp, sudden, and shoot deep into the nerve endings of your teeth.

Sensitive teeth is a very common issue for many adults in America. Sensitive teeth occur when the layer under the enamel (the dentin), or cementum (root area) of your teeth becomes exposed as a result of receding gum tissue. These unprotected surfaces, which are not covered by hard protective enamel, contain thousands of tiny tubules leading to the tooth’s nerve center (also called the pulp). These dentinal tubules allow the hot, cold, or sweet food to reach the nerve in your tooth, which results in the pain you feel.

Sensitive Teeth Home Remedies

If you develop tooth sensitivity in one or more teeth, first see your dentist for an examination to determine the cause. Then, if your sensitivity is caused by simple enamel abrasion or by gum recession, try the following home remedies for relief:

-Desensitizing Toothpaste. Unfortunately, tooth sensitivity over a wide area due to enamel abrasion or recession at the gum line usually cannot always be treated with dental fillings. Instead, it may be recommended that you try brushing with a desensitizing toothpaste. These toothpastes are available at your local drug store. These toothpastes contain ingredients that reduce tooth sensitivity by filling in the tubules in the dentin. Another good tip is to put some of the toothpaste on your finger and spread it over the sensitive spots in your mouth before you go to bed. You can spit out excess but do not rinse otherwise you will wash it off. The tooth sensitivity should be reduced over the course of a few weeks. A good toothpaste for sensitivity is Colgate sensitive Pro-relief.

-Fluoride Rinse. Stannous Fluoride rinses can help decrease sensitivity, especially for people plagued with decay issues. There are certain instances where patients need a stronger fluoride rinse than available at the local drugstore. During some periodontal disease treatment, teeth can become more sensitive than usual until the gum tissue heals. Dentists will then prescribe a higher concentration fluoride rinse to use.

-Maintain Good Dental Hygiene. Keep your teeth clean through brushing, flossing, and rinsing. Plaque, the white substance that forms on and around teeth, produces an acid that irritates teeth, especially if your teeth are naturally sensitive. It is recommended that you brush your teeth at least twice a day (preferably after eating and definitely before bed) and flossing at least once per day.

-Use a Soft Bristled Toothbrush or a Mechanical Toothbrush. Using a tooth brush that is too hard or being too aggressive while brushing can actually damage your teeth’s enamel. When the gum line recedes, the exposed dentin along the root becomes even more vulnerable to abrasion. Using a brush with soft bristles along with a gentle touch works far better in the long run. A good option is the Rotadent electric toothbrush. The Rotadent has very soft bristles and the action of the brush does all work effectively cleaning your teeth without doing any unnecessary harm.

-Decrease Acids in Your Diet. Carbonated beverages, citrus fruits, and vinegar can increase sensitivity. If you combine acids with sugar as in sour gummies, you can cause yourself hours of aching teeth.

-Be Careful of Temperature. Extreme hot or cold should be limited. If cold, use a straw. If too hot, let it cool down a bit before consumption. Never follow one temperature extreme with the other. Drinking hot coffee after ice cream is sure to increase your sensitivity dramatically.

Sensitive Teeth Conclusion

These at home remedies are to be utilized after seeing your dentist to get a full evaluation as to why your teeth are sensitive. Figuring that out should always be the first step to ensure the sensitivity is not from a tooth fracture or tooth decay. The remedies above will help resolve limited tooth sensitivity so it is not as big an issue for you and you can resume eating and drinking your favorite items.

Peri-implantitis - is a destructive  process affecting the gums and bone surrounding dental implants. The various periodontal bacteria found surrounding failing dental implants (those affected by peri-implantitis) are very similar to those found in association with various forms of periodontal disease.

Peri-implantitis is a unique complication when dealing with dental implants. Dental implants have a very high success rate but do fail for various reasons. These can include failure to integrate with bone, poor oral hygiene by patient, rejection by the body, trauma, or peri-implantitis. Peri-implantitis becomes a factor in patients with poor oral hygiene, diabetes, smoking, and when there is residual cement stuck to the implant surface.  Peri-implantitis will cause the destruction of bone and gum tissue exposing part of the dental implant to the outside. This will cause the possibility for the dental implant to become less stable and cause the patient to lose the implant and restoration if not treated in a timely manner.

How Is It Diagnosed?

A dentist will use x-rays and measuring instruments to determine the level of the bone surrounding the dental implant. If it is found there is some level of bone loss beyond normal surrounding the dental implant, then the diagnosis becomes that of peri-implantitis. It is normal to see some minor bone loss 1-2 years out following placement of the dental implants. It should be no more than 1-1.5 mm in the first year and no more than 0.2 mm in each subsequent year. As stated earlier peri-implantitis of a  dental implant that goes undiagnosed will lead to complete failure and have to be removed.

Peri-implantitis can be diagnosed early or once clear clinical evidence has developed. The most common signs and symptoms are:

- Color changes of the gum tissue around the implant.

- Bleeding during brushing, probing or measuring.

- Increased pocket depth around the implant.

- Pus drainage from around the dental implant.

- Thinning of the tissue causing transparency around the implant..

- Progressive loss of bone height around the implant.

-X-rays showing loss of bone around the implant.

Peri-Implantitis Treatment Options

The course and success of treatment revolves around when the peri-implantitis is diagnosed. If the initial bone loss is limited there will be a higher chance of success in saving the dental implant. However, the later treatment begins the lower the chance of saving the dental implants. There are various methods used to treat peri-implantitis. All have varying degrees of success. These include the following:

-Mechanical Debridement (professional cleaning using instruments). A patient with dental implants must follow normal treatment schedules to maintain his/her dental implants. This includes regular dental visits. At these visits radiographs will be taken to ensure the dental implant and surrounding tissues are in a  healthy state. At these visits the patient will also undergo a professional cleaning for the dental implants and/or natural teeth. Dental implants require special tools for cleanings. The standard dental implant instruments used for cleaning include plastic, graphite, or gold tipped instruments. Ultrasonic tips may be used. The goal in cleaning the implant is to remove debris and bacteria without damaging the exterior coating of the dental implant.

-Perioscope. A microscope guided cleaning deep below the tissues to remove debris and otherwise  undetectable cement residue.

-Localized Drug Delivery. Since dental implants by nature have rough surfaces (to allow better integration with surrounding bone), removing infection tends to be quite a challenge using just hand instruments. It is recommended that a chemical anti microbial agent be used along side hand instrumentation. Recent studies have shown the combination of hand instruments and chemical agents have proven effective in eliminating peri-implantitis in its earliest stages. Drugs used can include chlorhexidine rinse, oral antibiotics such as tetracycline, minocycline, doxycycline hyclate, or Arestin, an antibiotic placed directly into the pocket.

-Bone regrowth factors. Emdogain can be placed along with bone grafting material to help stimulate new bone growth.

Conclusion

The primary goal once peri-implantitis has been diagnosed is to stop the disease process from progressing. If untreated, it will ultimately lead to loss of the dental implants. The #1 goal should be to see your dentist regularly to avoid the complication of peri-implantitis. It is important to note any signs that may be occurring so you can be proactive about your dental health.