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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 of us, our ethnicity is not easily seen from outward appearances. As generations go by, the different ethnic backgrounds have been mixed to produce a large variety of people in the world. Recent research has shown that the diverse oral bacteria in our mouths is actually as powerful as a fingerprint. It turns out the bacteria deep within our gums can give clues to our unique ethnic origins.

Ethnicity Study And Oral Bacteria

Research completed at the Ohio State University periodontology department studied the oral bacteria found in different ethnic groups . The researchers identified about 400 species of oral bacteria in the mouths of 100 subjects. The study consisted of 4 ethnic groups: white, non-Hispanic blacks, Chinese, and Latinos.

More than 60 percent of oral bacteria in the human mouth have never been classified, named or studied. The reason being, that  many oral bacteria will not grow in a laboratory culture dish. To get around this problem, the researchers found a different way to identify the different oral bacteria. The solution was to identify different species by utilizing DNA sequencing.

The study found that only a small percentage ( 2%) of the oral bacteria were found in every one of the research subjects. Bacteria were found in different concentrations based upon the subjects ethnicity. The researchers found that each ethnic group was represented by their own unique signature of oral bacteria.

Another research of ethnicity and oral bacteria found that African Americans and Latinos are more susceptible to periodontal disease.

What Does This Mean?

-Some oral bacteria leave us highly susceptible to tooth decay, some to periodontal disease. Knowing who is more prone to which specific oral diseases can make it easier to monitor and prevent.

-Knowing which bacteria you have allows for specific antibiotic regimens to be customized to target your particular bad oral bacteria, and allows you to decrease your odds of succumbing to oral disease.

-Understanding the genetic basis of bacteria allows researchers to study particularly harmful bacteria, and find new ways to battle it.

-Knowledge of your ethnic background may help you understand why you are genetically prone to certain bacteria related diseases and what you can do to improve your overall oral health.

What Your Dentist Can Do For You

-Test your particular oral bacteria via saliva samples sent to MyPerioPath.

-Help you understand your risk factors.

-Custom design an antibiotic regimen to substantially reduce the dangerous oral bacteria present in your mouth.

-Oral hygiene regimen and instruction.

-Monitoring the mouth for disease progression.

 Effects Of Oral Bacteria On Dental Health

Bacteria are present throughout our body. Some bacteria are sticky and form biofilm. A thin grouping of oral bacteria, plaque biofilm, lives on gum tissue and teeth. Plaque is constantly forming on your teeth. The oral bacteria in the biofilm release acids that attack the enamel of our teeth, and break down tissue attachments in the gums. The plaque bacteria can cause tooth decay and periodontal disease. Knowing which bacteria you have present in your oral environment allows you to know what you are up against.

Conclusions From Research Study

Understanding the genetic basis to bacteria not only helps scientists study them and find cures, but can help you fight oral disease.  Being aware of your particular harmful bacteria and potential issues they may cause, could and should lead to a more personalized approach to dental and medical care.

The ultimate goal of periodontal disease treatment is to allow for re formation of and re attachment of the tissues. The best way (and least invasive) is via regeneration(regrowth). There have been many products over the years that have been considered the next big thing in regenerative therapy. Very few have ever seen the results of emdogain. Emdogain is made up of various biological proteins and growth factors that have been scientifically proven (thru research and trials) to regrow gum tissue,connective tissue and bone. Emdogain has been shown stable and predictable Periodontal  regeneration of lost periodontal tissues.

How Does It Work?

Emdogain achieves its results by tricking the body into forming new bone, cementum, and attachment fibers. The emdogain’s secret weapon is in its enamel matrix proteins (also called amelogenins) taken from developing teeth in pigs. Humans do not recognize these proteins as foreign, as they are similarly found in all mammals. There is also a zero chance of transmission of any disease by the proteins. During tooth development these proteins are secreted onto the root surface that is developing preceding the formation of tooth attachment. Luckily for us, this also occurs when the proteins are placed on the root surface of a tooth that has lost bone and attachment from periodontal disease.

Periodontal regeneration

Emdogain

By reintroducing enamel matrix proteins, you are triggering a biologic response from the body to do what it did naturally during your earliest of development. Enamel matrix proteins are only in the body for a short window of time during human development.When applied to the root surface of teeth, these proteins group and form into an insoluble matrix layer that promotes the attachment of mesenchymal cells. These cells produce new matrix components and growth factors that participate in the regain of tooth attachment. Epithelial cell growth is also inhibited by emdogain. This allows for proper tissue and bone reformation to take place without interference.

Treatment

Periodontal regeneration

Radiograph showing bone level before and after emdogain.

Once your dentist has diagnosed, the presence of periodontal disease. Emdogain will be discussed as the least invasive and most effective way to restore the area back to its natural cosmetic appearance. The area in question is generally referred to as a defect. That term is used because there is a periodontal pocket present where the bone and soft tissue has moved away from attaching to the tooth. This is caused by the periodontal disease process. After the defect has been  exposed so the dentist has full visualization of the area. The area is cleaned and debrided of any inflamed, diseased tissue or hard tartar deposits. Emdogain is used to help the tissues repair themselves. Emdogain comes as a premixed gel in a syringe. The material is inserted into the defect area. The area is closed and patient can then go about their normal lives. Obviously, the area might be a little tender and patient should avoid flossing and chewing on that side for a few days to allow proper healing time and no disturbance of emdogain as it does its work.

Post Treatment

In the following two weeks, approximately 75% of the tooth surface where the defect was present will be covered withPeriodontal Regneration the newly developing tooth tissues. The attachment and supporting  structures begin to reattach to the tooth to aid in keeping the tooth stable and healthy. These new tissues will take about one year to complete the maturation process. For this reason, the area where Emodgain is used, should not be periodontally probed (by your dentist or hygienist) for a period of about 6 months. Emdogain can also be used with soft tissue defects.

Emdogain is not ideal for every defect. Your dentist will be able to describe to you if emdogain is right for your particular case.

 

A gingival graft is the name given for any of a number of surgical periodontal procedures whose goal is to cover an area of exposed tooth root surface with grafted oral tissue from another source. Other names for this procedure are gum graft or periodontal cosmetic surgery. Gum recession is a process in which the margin of gingival tissue that surrounds the teeth wears away in a direction toward the end of the root, exposing more of the tooth. This can cause damage to supporting bone. It is a common dental problem (Studies have shown about 75% of americans have some form of periodontal disease) that often goes unnoticed until it becomes more severe.

Most people are not even aware that their gum tissue has receded since it is such a slow,gradual process. However, over time, an exposed tooth root can not only look ugly, but it can also cause tooth sensitivity. Tooth loss can occur eventually if the gingival tissue is not restored. To repair the damage and prevent further dental problems, a gingival graft may be needed. There are a few goals the dentist and patient are looking for when recommending or performing this surgery. They include:

1)Prevention of further root exposure.

2)To decrease or eliminate tooth sensitivity by covering the root area that was previously uncovered.

Gingival Graft

Gingival Graft – Before and After

3)Decrease the possible incidence of root caries as the root is no longer exposed.

4)Improved aesthetics. This is especially true of teeth that are shown during smiling.

A gingival graft is very effective in solving the problem at hand but there is no guarantee that gum problems won’t develop again. However, with regular dental checkups and careful at home maintenance, serious damage requiring further surgery can be prevented. Other ways to prevent periodontal disease include:

*Brush your teeth twice a day with a fluoride toothpaste. I recommend an electric toothbrush like the Rotadent.

*Floss daily.

*Maintain the schedule recommended by your dentist in regards to hygiene appointments. Usually a 6month recall schedule is the norm but it can more often depending on your situation. Ask your dentist what the best schedule is for you.

*Eat a well balanced and healthy diet.

*Do not smoke.