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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.

Do you have a missing tooth (or teeth) that need to be replaced? Throughout our lives, teeth can be lost for a variety reasons. They can be lost from tooth decay, periodontal disease, nutritional neglect, and accidents. Missing teeth can compromise your eating habits, speech, health, and appearance. The loss of a front tooth can negatively affect the appearance of your smile, your speech, and your self confidence. Losing a tooth in the back of your mouth can lead to a number of issues affecting your ability to chew, your ability to properly clean your teeth, jaw collapse, teeth shifting, and the health of your remaining teeth. Replacing a lost tooth will prevent further destruction and help save your remaining teeth. Replacing lost teeth can save you time, money, keep you healthier,and prevent many other oral difficulties in the future.

The loss of a single tooth can start a devastating chain reaction of events. After a back molar tooth is lost, a series of destructive events occurs including the displacement and tilting of other teeth around it including a supra eruption (when a tooth continues to grow into the mouth because it is not being kept in place by it’s opposing tooth) of the tooth above it, decay, drifting and formation of periodontal pockets. Eventually, bone loss and periodontal disease, to the teeth surrounding the lost tooth, tend to cause further destruction. If you fail to replace a lost back tooth, you may cause the loss of other teeth.

What Can Happen If Lost Teeth Are Not Replaced?

-Shifting of Teeth - When a tooth is lost, for whatever reason, the surrounding teeth will begin to drift into the open space. This includes both adjacent teeth as well as teeth in the other arch. A once straight smile can quickly turn into a crooked one. Replacing a lost tooth sooner, rather than later, can prevent this from happening As the number of lost teeth increases, the further the damage to the overall eveness of the bite  and, making it harder to replace later on. The altered position of teeth causes the forces to be applied incorrectly while chewing, making fractures and bone loss much more likely. The incorrect forces also cause wear which can result in loss of tooth height and subsequent facial changes.

-Temperomandibular Joint Issues (TMJ Disorder) - As your teeth shift out of their normal alignment, bite issues usually develop. When the upper and lower teeth do not meet properly, it can strain and eventually damge the TMJ. This can lead to head, jaw, and ear pain, headaches, dislocations, clicking and popping, as well as permanent damage to the joint.

-Periodontal Disease - When teeth begin to shift, it makes it that much harder to keep your teeth clean. It will be harder to brush and floss certain areas which have, essentially, created a trap for plaque and food debris to build up. When plaque and bacteria are not removed and allowed to build up the result can be tooth decay and periodontal disease. When teeth shift and drift, they oftentimes create a root exposure problem, and allow forces to move them in unnatural ways. This can loosen teeth, and make them very sensitive. Periodontal disease can lead to further tooth loss.

Options For Replacing Missing Teeth

Patients have multiple options when teeth are lost. They can include fixed ( permanent and not removable) or removable options. These procedures can include:

-Removable Dentures - This option has been the longstanding traditional option when multiple teeth are missing. Removable dentures are often the fastest and least expensive alternative in the short term. There are some disadvantages to removable dentures. Removable dentures work by attaching to exisiting teeth. This often leads to these “anchor” teeth becoming loose, worn, decayed, or broken. There can also be bone loss under the denture, which over time will make the denture more and more mobile and uncomfortable. Removable dentures can also be inconvenient to clean after eating especially if out at a restaurant. Lastly, removable dentures have about 1/3 the chewing power and efficiency of natural teeth. This can lead to poor chewing and lack of good nutrition in one’s diet.

Marielaina Perrone DDS Dental Bridges-Fixed Dental Bridge - This entails cutting down surrounding teeth, and fitting them with fused crowns to replace any missing teeth. The most popular type of fixed bridge is called a 3 unit bridge. This means that the two natural teeth adjacent to the missing tooth serve as anchors. This is a very stable option but does also have disadvantages. Disadvantages include:

-Removal of good tooth structure from adjacent teeth.

-Difficulty maintaining good dental hygiene under bridges as normal flossing is not possible

-Long term prognosis of most dental bridges in between 8-10 years before it needs replacing. This is an average. Some bridges can and will last longer.

-Dental Implants – Dental implants are the largest initial investment, but most cost effective long term solution for replacement of missing teeth available today. The main disadvantage to dental implants is the time it takes to be completed. Following placement of the dental implant a 4-6 month healing time is generally needed before the tooth can be restored. Dental implants are the ideal solution for many tooth replacements in dentistry today.

-All on Four Dentures - When many or all  teeth are lost, or if you are rapidly progressing to full mouth breakdown, This dental implant/denture option is an excellent choice. The best thing about this procedure is that you have your entire procedure done and walk out with teeth the same day. There are usually 4 dental implants placed and a titanium bar supported denture placed. It is screwed down, but can be removed if needed. The biggest negatives here are price, and post operative possibility of bruising and discomfort while healing.

Tooth Replacement Conclusion

Tooth loss can happen at any time to anyone. Losing a tooth due to a trauma, dental disease, habits, etc. can be a big problem for a variety of reasons. If teeth are not replaced, they can cause issues for you including bone loss, periodontal disease, and more tooth loss. Replacing lost teeth as soon as possible will save you discomfort and greater expense in the future. Knowing your options, and being informed can help you and your dentist come up with the best treatment options for you. Remember, sooner is better than later, but know that whenever you are ready to move forward with tooth replacements there will always be options!

Birth control is an integral part of many women’s lives. The newer method of receiving a birth control shot (DMPA) every Three (3) months versus taking a pill every day has become a convenient way of  birth control  for many women.

Depo-Provera is the most well known and used DPMA. This contraceptive is injected into a woman’s muscle every three months.

DMPA works to prevent pregnancy in three different ways:

1) Prevents ovaries from releasing eggs.

2) Thickens cervical mucus to act as a barrier preventing sperm from reaching the egg.

3) Changes the lining of the uterus to prevent implantation.

Birth Control Research Study Findings

New studies have shown, that there are some dental health risks involved with the DMPA shot. The study has found a possible link between injectable progesterone contraceptives (Depotmedrooxyprogesterone acetate-DMPA) and periodontal disease.

The researchers examined about 4,500 participants ranging in age from 15 to 44. These patients were confirmed to not be pregnant and all reported receiving DMPA shots in the past or never having received the contraceptive shot.

About 4% of the  research participants were currently using the  Depo Provera shot, and about 12% had used it in the past. All the participants were thoroughly examined by a dentist. The dentist recorded gum tissue health indicators, such as  presence of bleeding gums,  any gingival recession, as well as  periodontal probing to measure bone levels surrounding the teeth.

Bone loss, periodontal pockets, and gingival recession are hallmark signs of periodontal disease.

Birth Control Marielaina Perrone DDSResearchers found that those currently taking DMPA injections were about 73% more likely to have gingivitis,( Gum inflammation and bleeding, without periodontal bone loss). Those women who had previously used DMPA also had a slightly higher incidence of gingivitis but the level of risk was not significant enough to prove an association.The researchers also found that Hispanic and Black women were 30-50% more likely to have some form of periodontal disease. Women of lower economic levels or who had not visited the dentist within the past two years also had a higher rate of periodontal disease.

The researchers believe that the hormones played a major role in the presence of periodontal disease. Women receiving any hormone based contraceptive (like DMPA) injections need to pay extra  attention to their teeth and gums to help prevent periodontal disease. This should include regular dental visits along with professional cleanings every 3-6 months.

Periodontal Disease Impacts your Whole Body

This research has once again shown, a definite link between periodontal disease and your overall health. When your mouth becomes diseased it does not remain contained there. When periodontal disease advances, toxins are released into your bloodstream. These toxins promote inflammation and can have a negative impact on your heart and other organs. This combination of bacteria and inflammation has been linked to a number of chronic diseases. These include:

-Heart Disease. People with periodontal disease are actually almost twice as likely to have heart disease.

-Diabetes. Periodontal disease is considered a definite complication of diabetes. Patients with diabetes are more likely to have periodontal disease than those without. According to the Journal of Periodontology, not only does having diabetes increase the risk of periodontal disease but it also increases blood sugar which will lead to  diabetic complications including problems with healing.

-Rheumatoid Arthritis. Rheumatoid arthritis and periodontal disease are both chronic inflammatory processes. It has been found that treating periodontal disease has reduced the effects of rheumatoid arthritis.

-Cancer. Periodontal disease has been linked to several different cancers including pancreatic, kidney, and blood cancers.

-Other disease links include Alzheimer’s Disease, Kidney Disease, Respiratory Disease, Pregnancy complications (premature birth and low birth weight), and Osteoporosis.

What to Do If You Take a Progesterone Contraceptive?

See your dentist more often, ( every 3-4 months) and amp up your home care. More frequent cleanings, and flossing after meals will help prevent complications and the advancement of periodontal disease. The sooner the problem is detected, the better your chances are at reversing the disease process through professional cleanings and proper oral hygiene. If periodontal disease progresses it can be treated. Most often,  a deeper cleaning called scaling and root planing will start the healing process. In more severe cases,  periodontal disease surgery may be required. Remember to ask your dentist and hygienist for better brushing and flossing techniques, and ask them how often you should be seen for cleanings.