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Periodontal disease can be very difficult to manage once it begins to progress past its initial stage of gingivitis. The treatment requires diligence on the part of the patient to

Periogen Marielaina Perrone DDS

Periogen + Waterpik = Healthier Mouth!

maintain regular hygiene appointments and meticulous home care. Professional cleanings go a long way to preserving your teeth and gums, but once patients leave the office they need to maintain their oral hygiene so it does not progress further. Many patients just need to get into a routine of brushing, flossing, and rinsing regularly. So, how can we make it more effective and efficient for the patient?

How to Improve Dental Hygiene?

Let’s face it, most patients do not like to floss. So what do we do to get patients to maintain their dental hygiene? One of the most effective and most popular products on the market today is the waterpik flosser. The waterpik flosser works by delivering a combination of water pressure and pulsation. This allows the waterpik to remove debris and bacteria lodged between the teeth and below the gum line. It is also able to massage and stimulate the gums to improve blood circulation and help promote healthy gums.

The waterpik has also been extensively studied in clinical trials and shown that it is clinically proven 50% more effective than traditional dental floss.

SO…what can make the waterpik even better? The answer is in a new rinse called Periogen. Periogen is a patented oral rinse that has been proven capable of dissolving tartar buildup between professional cleanings and dentist visits. Periogen works by exploiting a weakness (discovered by the research team at the Periogen Company) in the fundamental structure  of oral tartar, and the way it sticks to our teeth.

Tartar (or calculus as it is sometimes called) can be found above and below the gum line. Tartar above the gum line is referred to as supra gingival tartar and tartar below the gum line is referred to as sub gingival tartar. Dental Tartar is comprised almost entirely of Calcium Phosphate Salt. Calcium Phosphate is also the basic component of tooth material.

Periogen Marielaina Perrone DDS

Periogen Oral Rinse

Calcium phosphate salt differs from calcium phosphate in its electron structure. The calcium phosphate salt has two less electrons than the calcium phosphate which makes it electrically unstable. This process of losing electrons happens in nature all the time. The best comparison is the buildup of lime deposits in water pipes and faucets. Microscopically, tartar is layer upon layer (can be in the tens of thousands layers) of  calcium salts and bacterial debris.

The tartar is a main cause of periodontal disease. Breakdown of gum and bone tissue is caused by toxins released by bacteria in plaque and tartar, and by the body. The toxins cause the body to react by starting the inflammatory process thereby destroying healthy gum tissue and supporting bone structures. Periodontal disease is progressive. Without proper treatment, periodontal disease will lead to tooth loss and infections throughout the mouth.

Periogen is used as an oral rinse 1-2 times per day between professional cleanings to reduce the level of tartar buildup and stain. This will in turn, make for an easier dental visit. It also maintains a healthier state in your mouth for your teeth and gums to heal. Periogen should in no way replace brushing and flossing, or visits to the dentist but just works as an accessory between professional dental cleanings to give you a more effective way to reduce tartar and fight periodontal disease .

Everyone knows the basic structures of the mouth including your teeth and gums. But there is more to your mouth than just those two anatomical parts. This means

Maintain Oral Health - Marielaina Perrone DDS

Anatomical Structures of the Mouth

maintaining good oral hygiene goes beyond just your teeth and gums.  In addition to your teeth and gums, your mouth is made up oral mucosa, the upper (maxilla) and lower (mandibular) jaw, the tongue, salivary glands, the uvula, and the frenulum. All of these structures play an important role when it comes to good oral health and are regularly examined by your dentist when you receive dental care.

Anatomical Structures of the Mouth

- Oral Mucosa. When you look in your mouth everything that is not a tooth is the oral mucosa. The oral mucosa is a protective lining and includes the gum tissues. This lining is very similar to the lining in your nostrils and inner ears. The oral mucosa plays a very large and essential role in maintaining your oral health. It is also important in maintenance of your overall health by defending against germs and other irritants that come into your mouth. The oral mucosa has a tough component called keratin. Keratin (also found in fingernails and hair) helps keep the oral mucosa protected from injury.

-Gums or gingival tissue. Your gums are the pink, attached, colored tissue that envelops and supports your teeth. Also covered by oral mucosa, gums play a critical role in your oral health. Healthy gums are firm, cover the entire root of the tooth, and do not bleed when brushed, flossed, or probed. Diseased gum tissue, or Periodontal disease can ultimately progress to tooth loss. This makes it essential to take care of your gums by flossing daily and brushing regularly.

-Upper (Maxilla) and Lower (Mandible) Jaws. Your jaws are an essential structure of the mouth and face. The jaws give your face its shape and are the structures holding your teeth. They are needed for chewing and speech. The Upper jaw or Maxilla is made up of two bones fused together and then to the rest of the skull. The lower jawbone (mandible) is separate from the rest of the skull which allows it to move up and down, and side to side in your jaw joint (TMJ) when you speak and chew.

-The Tongue.  This is an extremely strong muscle covered in specialized mucosal tissue that also includes the taste buds. The tongue is unique in that it truly plays a dual role in our health. The tongue plays an integral role in the ability to speak. It does this by allowing people to shape the sounds that come from your mouth. It’s other role is being a part of the body’s digestive system. The tongue is responsible for moving food over to your teeth and following chewing, the tongue moves to the back of the throat so it can force it down to continue on its path thru swallowing. In infants the tongue and jaw work as one to allow the infant to breastfeed.

-Salivary Glands. There are three different major salivary glands in your mouth and neck. These are the parotid, sub mandibular, and the sub lingual glands. There are also smaller, or minor salivary glands in your hard palate, soft palate, and inner lip. These glands are responsible for producing saliva. Saliva is critical to maintaining good oral health. It functions in the following ways:

1) Breakdown of food. Saliva contains special enzymes that help break down food. This makes it easier for you to digest your food.

2)Lubrication. Saliva aides in swallowing food by acting as a carrier of foods out of the mouth and into the throat. Saliva also keeps gums and teeth from drying out. This constant lubrication makes it more difficult for bacteria to stick and stay, and helps keep teeth and gums clean.

3) Protection of teeth and gums. Saliva is able to offer protection of teeth and gums by rinsing away food and bacteria. It is also able to neutralize acids or acidic foods that can wear down your teeth causing tooth cavities.

-The Uvula. The uvula is the small flap of tissue which hangs down at the back of your throat. The uvula is made up of muscle fibers as well as connective and glandular tissues. The uvula is covered by oral mucosa. The uvula’s functions are not fully understood as of yet. However, it seems to play some role in speech and in keeping the mouth and throat moist.

-The Frenulum Linguae. The frenulum or frenum, is an attachment of oral mucosa that connects and pulls two areas together. There is one major frenum attachment above your two front teeth connecting your lip to the adjacent gums, another major one is under the tongue attaching it to the floor of the mouth. There can be any number of minor frenum attachments from lip to gum or cheek to gum.  Children can be born with a frenulum that is too short, or not elastic enough, keeping the tongue almost tied down. This can  affect speech as the tongue is not able to protrude as far as necessary. A short frenum can also affect swallowing and feeding in babies.

Take notice the next time you are brushing your teeth, spend a minute looking at the parts of the mouth that lie farther inside the oral cavity. Knowing what these structures do and what they look like can help you to maintain optimal oral health, and notice changes that can occur. Your self awareness can help you point changes out to your dentist, and find out why they have occurred. As always, see your dentist regularly and have an open line of communication to ensure that your mouth is it’s healthiest!

 

The presence of bleeding gums usually when brushing or flossing is usually a sign that you have some form of periodontal disease but it can also mean a greater risk is present. Persistent gingival bleeding can be due to something far more serious. This type of bleeding has been linked to diseases such as leukemia, blood platelet disorders, and even scurvy.

Many people sometimes mistakenly believe that bleeding upon brushing or flossing is normal. They might say that their gums always bleed when brushing and so do some of their other family member’s.

Are bleeding gums normal?……NO! Healthy gums do not bleed from normal brushing and flossing.

Bleeding gums in their earliest form is a sign of ginigivits. Gingivitis is simply inflammation of the gum tissues. It is the earliest stage of periodontal disease and is reversible if treated before it progresses. Periodontal disease is a progressive disease that will advance without proper treatment. Periodontal disease is inflammation and infection that breaks down and destroys the tissues that support the teeth. This  includes the gum tissues, the periodontal ligaments (PDL), and the bone supporting the teeth.

Gingivitis comes from the long term effects of deposits of plaque on your teeth. Plaque is a sticky material made of bacteria, mucus, and food debris that develops on the exposed protein layer,( the pellicle) on the teeth. The pellicle is like a microscopic cuticle which grows out from under the gum tissue and allows bacteria to use it as a scaffold to build upon. This pellicle layer is removed during a professional cleaning, it does not come off with a toothbrush.

Periodontal Disease - Gingivitis

Periodontal Disease – Gingivtis

The accumulated plaque bacteria and the toxins produced cause the gums to become infected, swollen, and tender. The body responds by sending blood cells ( inflammatory cells) to attack the bacteria, and the bleeding begins.

If you watch television at all, you have probably heard of gingivitis. A very big industry has been built with various types of products that are supposed to eliminate gingivitis. The problem is that most of these products do not work on their own to eliminate ginigivitis or advanced periodontal disease. They work to make your teeth “feel” clean and as a helpful aid in between visits to maintain oral hygiene. Nothing replaces visits to the dentist and hygienist for a proper examination and thorough cleaning to remove the pellicle and bacteria film.

If the plaque is not removed, eventually it will stick to a harder substance known as tartar. While the tartar is not formed directly from the plaque it is able to stick more readily to teeth because of the presence of the plaque. The tartar will be hard and will trap food particles, plaque and bacteria below the gum line.

Researchers have long recognized that there are at least 11 different strains of bacteria that can cause periodontal disease. These bacteria thrive in dark, moist areas. This includes the gingival tissues around the teeth. Our immune systems react to the problem by sending out cells to remove the bacteria. Blood to the infected area is also increased to help flush away the invading bacteria. However, if the invading bacteria do not leave, our gingival tissues become filled with blood and our gums can bleed when we brush. This makes it very difficult to maintain oral hygiene for the patient.  This will ultimately advance to more progressive forms of periodontal disease called periodontitis. Periodontal disease at this stage unfortunately is not truly reversible. Modern dentistry has newer techniques to deal with periodontal disease. These include emdogain, a gum and bone growth factor,  and arestin, a tetracyline type antibiotic.

Periogen

Periodontal Disease – Periogen

There is a new product on the market called Periogen. This product is used as an adjunct to professional cleanings to help dissolve some of the tartar, plaque and stains that builds up in the mouth. This product has shown the ability to dissolve subgingival (below the gum line) calculus through an in-home, daily irrigation regimen.  It is recommended to use this product with a waterpik ultra to allow penetration of the product below the gum line. The results of this innovative treatment include a reduction to many gum infections and the reduction of many periodontal  pockets. This product has been shown to be very helpful in the reduction of periodontal disease.

What Raises your Risk for Ginigivitis and Periodontal Disease?

-Certain infections and systemic diseases. There are some very serious reasons for gums that bleed. These can include blood disorders, clotting disorders, liver problems, kidney disorders, artery or capillary diseases, and diabetes and heart problems. Vitamin C and K deficiencies can also result in bleeding gums. Fungal infections are also linked with bleeding tissues, as well as certain medications such as aspirin, high blood pressure medications, (calcium channel blockers) and blood thinners.

-Maintaining poor oral hygiene. If you do not keep your teeth clean with a diligient at home oral hygiene program coupled with regular visits to the dentist you will eventually develop some form of gingivitis as well as increased posssibility of more advanced periodontal disease.

-Pregnancy. Hormonal changes at this time will cause changes to your oral cavity. These changes can increase your chances of developing cavities, gingivitis, and advancement of periodontal disease.

Studies have shown that women with periodontal disease are 7X more likely to have preterm births and low birth weight babies. Preventive dental cleanings and regular dental exams during pregnancy are not only completely safe, but are highly recommended by both dentists and physicians alike.

-Uncontrolled diabetes. Diabetes impairs white blood cells, which are the body’s main defense against bacterial infections.  These bacterial infections can affect everything in the mouth as well as the rest of the body. It has been noted that elevated levels of Periodontal disease also lead to complications in management of blood glucose levels. This disease tends to be more prevalent and more severe in diabetic patients than in the general population. This is mainly due to the fact that diabetics have decreased wound healing and infection fighting ability.

-Misaligned, crooked teeth, rough edges of fillings, and ill-fitting or unclean mouth appliances (braces, dentures, bridges, and crowns). Crowded teeth are much more difficult to maintain and keep clean. This will pose a greater challenge for those patients and mean they need to work a little harder to avoid the pitfalls of periodontal disease.

Many people have some amount of gingivitis. It usually develops during puberty or early adulthood due to hormonal changes. It may persist or recur frequently, depending on the health of your teeth and gums.

Dental and Periodontal Examinations

The dentist will examine your mouth and teeth and make notations if soft, swollen, reddish-purple gums are present. This gum tissue is usually painless or slightly tender at this point. Plaque and tartar will more than likely be present to some degree. A periodontal probe will be used to measure around the teeth to see if your periodontal disease has progressed past just gingivitis. Remember, once bone loss has occurred you now have a more advanced form of periodontal disease.

Following examination, your dentist will recommend a course of treatment for your periodontal disease. This will include a professional cleaning along with extra home care instructions. The goal in treatment is to reduce the inflammation and not allow the periodontal disease to progress. An antibacterial rinse may also be recommended for at home use. A good example of this is Listerine. Your dentist may also recommend repair of misaligned or crooked teeth to aid you in your home care efforts. Also, most people do fine on a 6 month schedule but, everyone accumulates pellicle and plaque at different rates, your dentist may recommend a more frequent schedule for you.

Periodontal Examination

Periodontal Disease Examination

Once the plaque and tartar are removed, bleeding and tenderness of the gums should lessen within 1-2 weeks after professional cleaning and careful oral hygiene. Warm salt water or antibacterial rinses can reduce gum inflammation. Taking an over the counter anti inflammatory medication can also aid in pain and inflammation reduction.

Healthy gums should look pink and firm with no bleeding upon brushing or flossing. Strict oral hygiene must be maintained for your whole life, or periodontal disease will come back and possibly advance past the gingivitis form into advanced periodontal disease (also called periodontitis).

Home Care to prevent periodontal disease should include:

-Regular dental visits. Usually recommended every 3- 6 months for examination and professional cleaning.

-Brushing after every meal and flossing at least once a day.

-Rinsing with antiseptic rinse as recommended by dentist.

Consult your physician if the bleeding is severe or chronic, gums continue to bleed even after dental treatment, or you have other unexplained symptoms along with the bleeding from your gums. These could all be the sign of a more serious condition than periodontal disease and should be checked out as soon as possible.

Periodontal disease in its earliest stages is very treatable and should be stopped in its tracks. Everybody has it in their power to keep periodontal disease from progressing to more advanced stages.

 

 

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