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Periodontal disease is a slow, progressive disease that appears to sneak up on us. Many ignore the warning signs simply because many of them are painless. It is important not to ignore these signs and symptoms as periodontal disease is the leading cause of tooth loss. There are many different types of periodontal disease including aggressive, chronic, necrotizing periodontitis, and periodontitis associated with systemic diseases.  Each of these types of periodontal disease has its own distinct characteristics and symptoms, and all require prompt treatment by a dentist to help halt subsequent bone and gum tissue loss.

Common Periodontal Disease Signs And Symptoms

-Bleeding Upon Brushing, Flossing, Or Eating. This is one of the most common signs that periodontal disease is active. It is often also one of the most overlooked signs. Periodontal disease is an inflammatory disease. As the bacteria and toxins build up in the mouth, the body responds by activating the inflammatory process, rushing our cells to stop the attack. This will cause the gum tissues to become inflamed and red. It is important to note that bleeding gums can also be something more sinister like leukemia and blood platelet disorders.

-Unexplained Pain Or Swelling. This can be caused by a periodontal infection. At this point it is essential that you get to a dentist as soon as possible. If the infection is left unchecked it will cause damage to the gum tissues and the bone supporting your teeth. It can also be carried to other parts of the body through the blood stream.

-Persistent Bad Breath (Halitosis). Bad breath can occur from many things but peristent bad breath can mean progressive periodontal disease . As the gum tissues are destroyed, the areas where the oral bacteria can flourish will increase causing a foul odor in the mouth. There are other causes of chronic halitosis that should also be ruled out.

-Change In Your Smile Or Loose Teeth. As periodontal disease advances, your teeth will loosen and shift out of position. This will effect the way your teeth fit together and even alter your smile.

-Teeth Become Longer In Appearance. As periodontal disease progresses it will lead to destruction of the bone and gum tissues. This will show up as gum recession. Once the gum tissues pull back they expose more of the tooth and root, making them appear longer than before.

-Pus Drainage. This goes along with the periodontal infection mentioned previously. An active periodontal infection will create pus which can ooze out from between the teeth and gums causing a bad taste and malodor.

Avoiding Periodontal Disease

Dental and Periodontal Examinations

Your dentist will complete a thorough examination with x-rays and periodontal charting. Notations about the visual condition of the gum tissue will also be recorded. In its earliest stages the gum tissue is usually red, puffy, and 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 and to what degree. It is important to note that once bone loss has occurred you now have a more advanced form of periodontal disease.

Following the 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 progression of the disease. An antibacterial rinse (example, Listerine) may also be recommended for at home use. Your dentist may also recommend repair of misaligned or crooked teeth to aid you in your home care efforts. Your dentist may also recommend a more frequent schedule(every 4-6 months) to control your periodontal disease.

Following removal of plaque and tartar, bleeding and tenderness of the gums should begin to subside within 1-2 weeks after professional cleaning and careful dental hygiene. Warm salt water or antibacterial rinses can also 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, flossing, or eating. Good 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).

Steps to prevent periodontal disease should include:

-Routine 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 an antiseptic rinse as recommended by your 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 Conclusion

Periodontal Disease in its beginning stage is very treatable and should be easily controlled. Keeping periodontal disease from progressing to more advanced stages should be your goal. It takes a regular effort by both you and your dentist but it can be done. Getting control of periodontal disease will not only help your overall health, but will keep you smiling!

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.

Crooked teeth (also called malocclusion) can affect almost 75% of all American adults. Malocclusion can significantly affect oral health over the course of a lifetime, leaving you with increased chances of developing periodontal disease and increased wear and trauma to teeth.

Types Of Malocclusion

-Crossbite – A crossbite is when the lower teeth overlap or come out even with the upper teeth. In a normal occlusion the upper teeth overlap the lower ones but when a crossbite (can occur on either side or both) is present, the opposite is true. This can lead to premature wear, increased risk of chipping or fracturing your teeth, development of abfraction (small notch in tooth at the gumline), and periodontal disease.

-Excessive Overjet – This occurs when the upper front teeth are too far out in front of the lower teeth. This can lead to increased trauma as well as an increase to chipping or fracturing of teeth (especially the front ones).

-Edge To Edge Bite – This occurs when the teeth touch one another edge to edge (or cusp to cusp). The teeth do not fit together propely allowing the biting surfaces to touch. This will lead to increased risk of chipping and fracturing, Temperomandibular Joint (TMJ) pain, as well as short, worn down teeth.

-Open Bite – This is a common occurence from thumb sucking or can be genetic. It is when there is a space between the front upper teeth and the front lower teeth upon closing. Not only is this an unesthetic option but it can lead to abfraction, is difficult to bite and tear food ,and causes excessive, premature wear of the back teeth.

-Over Bite- This is when the upper front teeth completely cover the lower front teeth. Often, the lower teeth hit into the backs of the upper teeth and sometimes into the roof of the mouth.

-Under Bite- This occurs when the lower jaw has grown more quickly than the upper jaw. The lower front teeth and jaw have grown in front of the upper teeth.

-Tooth Size Arch Length Discrepency- When your teeth are too large for your jaw space and cause extreme crowding or when your teeth are too small for your mouth. Crowding can lead to decay, fracture, and periodontal disease. Small teeth are generally a major cosmetic issue.

The General Health Danger

Gum disease is commonly found along with malocclusion, due to difficulty in maintaining good oral hygiene when teeth are not in proper position.

Periodontal disease has been linked to many systemic diseases through various studies. Some of these diseases include heart disease, diabetes, and alzheimer’s. Periodontal disease generally takes years of neglect to develop. There are various stages of periodontal disease progression, they include:

-Gingivitis – The earliest stage. The only stage that is reversible with proper dental care. This stage is characterized by swollen, red gum tissues, bleeding upon brushing, as well as bad breath (halitosis). If treated before it progresses, it can be reversed back to a normal, healthy, gingival state.

-Periodontitis – This is the stage that develops following ginigvitis. It is not reversible but can be controlled. Damage to teeth, bone, and gums can be limited with proper dental care. During this stage, the supporting tissues around the teeth may break down leading to gum recession and bone loss around the teeth.

-Advanced Periodontitis – This stage increases the bone loss and gum recession leading to loosening of teeth with the real possibility of losing one or more teeth.

How Do Crooked Teeth Affect Our Mouths?

When teeth are crowded and not aligned properly, the plaque and bacteria that forms on our teeth during everyday food consumption  becomes much more difficult to remove. This makes it difficult to  maintain a good state of health. Many times, flossing and brushing areas of overcrowded teeth will become very difficult. These areas are generally called a “plaque trap” for their ability to constantly trap food and debris.  As mentioned earlier, without proper care, plaque traps can lead to bone loss, gum recession, and even tooth loss.

Another cause for concern is wear and trauma to the teeth. Poorly aligned teeth can create unnatural stresses on the teeth and the jaws. Teeth subjected to excessive pressures can develop chipping, fracturing, and abfractions. Premature wear can also lead to lost teeth, loose teeth and even root canal therapy.

Finally, crowded teeth affect your systemic health by allowing bacteria to grow and flourish unabated in these crowded areas. Over time, this can lead to devastating life threatening effects like heart disease and stroke.

What Can Be Done To Combat Crooked Teeth?

Fortunately, in many cases the simple solution is increased visits to the dentist for professional cleanings as well as diligent  home care.  When there is undue stress placed on the teeth that can cause trauma and wear over time, Orthodontics is the answer in most cases. Orthodontics is a type of dentistry dealing with crowded or misaligned teeth. Proper orthodontic treatment can, in many cases, restore your smile and make it easier to maintain it.

Orthodontics Conclusion

Orthodontics is not just for cosmetic reasons. We are not all born with perfectly straight teeth and sometimes we need a little help to get there. The bottom line is to have beautiful teeth and gums that make you feel confident and healthy. Your smile should  last you a lifetime!

Recent studies have shown an increased risk for periodontal disease in women. Why are women more prone to the disease, and what can be done to help decrease the risks? While there are many risk factors, which seem to be more prevalent?

Female hormones seem to be the main risk factor.  The study done at Case Western University has shown a link between female sex hormones and periodontal disease. For women, this means it effects them over the course of their entire lives. Female sex hormone changes occur at puberty, menstruation, during pregnancy, and throughout menopause. The study found that as female sex hormones fluctuate throughout a woman’s life they can change conditions in the mouth that allow bacteria to grow and enter the bloodstream. This development can and usually does intensify certain health issues like bone loss in the body and especially the mouth.

What can women do to prevent Periodontal Disease?

Some preventive steps  are the same for men and for women. These include, maintaining proper oral hygiene, regular dental examinations, and professional cleanings. For women, the steps may need to be brought to the next level.  Women are presented with different challenges in  life that can at different periods increase the risk for periodontal disease and progression. In its earliest stages, periodontal disease (called ginigivitis at this point) is reversible, but if periodontal disease progresses to the stage called periodontitis it is much more difficult to combat. The following are some tips for women to prevent periodontal disease:

-Maintain proper oral hygiene at home. This is doubly important for women especially during the times of their lives when sex hormones are elevated. This includes brushing at least twice a day (after every meal is even better when possible), flossing at least once per day, using an antibacterial mouth rinse, an electric toothbrush and waterpik with periogen, and drinking water. Decrease snacking and try to maintain a healthy diet. You may even want to try oil pulling therapy.

-Regular dental visits and professional cleanings. It is recommended to have a dental exam every 6 months and at least 2 professional cleanings per year. The number of cleanings recommended by your dentist is based on your risk factors. Hormonal fluctuations, advancement of gum disease, and bone loss are reason to increase cleanings to every 3-4 months. It was long believed that women should not seek dental care during pregnancy. The opposite is true,  women who are pregnant need to be diligent to avoid developing periodontal disease. Periodontal disease has been linked to pre term birth as well as low birth weight of children. Women going through hormone fluctuation (menses, pregnancy, menopause) are also at higher risk for tooth decay.

-Be Healthy. Smokers are at an increased risk for periodontal disease as are diabetics. Quitting smoking and changing to a healthy diet can help your body increase it’s healing capability and decrease periodontal disease.

Periodontal Disease Conclusion

All of us need to be diligent with oral hygiene to keep healthy. The fact that women need to be extra diligent in maintaining proper oral hygiene throughout their lives is important to understand. We are only beginning to understand many of the hormonal risk factors for women. The research has made us aware that women need to work harder to maintain their oral health.