What causes periodontal disease? Bacteria and Plaque. Periodontal disease is a chronic dental infection of the periodontal tissues surrounding our teeth. This disease can result in the breakdown of the tissue as well as the loss of bone that surrounds and supports our teeth. Periodontal disease begins when bacteria and plaque form a sticky film on your teeth. This film acts as an irritant to the surrounding tissues and causes inflammation of the periodontal tissue. Periodontal disease will continue and progress and become more advanced over time without dental intervention. Periodontal disease is the #1 cause of loss of teeth in adults. According to the Centers For Disease Control (CDC), it is estimated that 65 million American adults, have mild, moderate or severe periodontitis (advanced form of periodontal disease). In our senior population aged 65 and older, prevalence rates increase to over 70%.
Bacteria That Causes Periodontal Disease
Periodontal disease and tooth decay are triggered by different types of bacteria and are considered to be two separate and distinct disease conditions. However, they work hand in hand to break down our teeth and gum tissues if left unchecked. Swollen and receding gums allow the more vulnerable areas of the tooth (root areas) to be exposed to cause an increased incidence of tooth decay. On the other side, patients with extensive tooth decay, the broken down teeth allow for food trap areas which keep periodontal tissue chronically inflamed.
Stages Of Periodontal Disease
-Gingivitis – This is the earliest stage of what causes periodontal disease. Ginigivitis is simply the inflammation of the periodontal tissues surrounding the teeth. Gingivitis is the mildest form of periodontal disease and is wholly reversible with professional care and a good at home dental hygiene regimen. Symptoms of Gingivitis Include red, swollen gum tissue with inflammation as well as gum tissues bleeding easily upon brushing, flossing, or even eating. Often these symptoms are unnoticed by patients. Bad breath may be another sign of advancing periodontal disease.
There are only a few signs at this stage and most are painless. This is what makes periodontal disease so common and so concerning. It is silent until it is not. Periodontal disease does not typically break its “silence” until the fourth and final stage. Beginning signs to watch out for include bad breath on occasion, swelling and redness of the gums, and bleeding when brushing or flossing. Good overall dental hygiene and regular professional examinations can treat and reverse gingivitis as well as stop it from progressing further.
This is a critical period for the patient, as gingivitis can be reversed (since the bone and connective tissue that hold the teeth in place have not yet been adversely affected) at this point if it is recognized, diagnosed, and properly treated by a dental professional. Gingivitis can commonly be seen during puberty, pregnancy (also called pregnancy gingivitis), times of high stress, and menopause. As for the rest of the population, poor dental hygiene is generally the most common cause, followed by medication and certain medical conditions (like diabetes).
-Periodontitis – If left untreated the next phase is early periodontitis. Once it enters this stage, the disease can be difficult to control. In this stage, the bone surrounding the teeth is now being affected. The bacteria will invade between the tooth and gums causing a separation of connective fibers. The result is what is called a periodontal pocket (normal pocket depth should be about 3mm without inflammation). These pockets will now approach 4-5mm in depth and can get filled with bacteria, plaque, and food. This will in turn begin to breakdown the bone below the gum line. Simple at home dental hygiene will not be the answer to bring back to a healthy state. Periodntitis signs include increased swelling or redness of the gums, increasingly bad breath, bleeding upon brushing or flossing, and pocket depths that are between four and five millimeters.
-Advanced Periodontitis – This is where the real destruction lies. At least 50 % of bone support is lost if not more. Teeth will begin to loosen and shift if they have not already. Deep periodontal cleanings and possibly surgical intervention are necessary to salvage teeth. This professional cleanings may occur using a periodontal microscope, (Perioscope), grafting of gum tissue or bone, placement of growth factors (Emdogain), periodontal antibiotic regimen (Periostat), placement of antibiotics directly into pockets, (Arestin), open periodontal flap surgery, and, possibly even removal of teeth.
How To Treat What Causes Periodontal Disease?
Luckily, the earliest stages of periodontal disease are easily treated. Following a good at home dental hygiene program (including brushing, flossing, and antibacterial mouthwash) along with regular visits to a dentist we can halt gingivitis in its tracks. Failing to to do the above steps will allow periodontal disease to advance unchecked leading to loss of teeth as well as systemic health issues.
Treatment For Periodontal Disease Can Include Any Of The Following:
–Pocket Reduction Surgery. A surgical procedure to reduce the size of the periodontal pockets around your teeth. This will ensure the ability to keep the areas clean at home. The surgery is made up of tiny incisions in your gum tissues so that a section of gum tissue can be lifted back, exposing the roots for more effective teeth cleaning. Because periodontitis often causes bone loss, the supporting bone tissue may be recontoured before the gum tissue is sutured back in place. This surgery can take from 1-3 hours and is performed under local anesthesia.
-Periodontal Tissue Grafts. Periodontal or Gum tissue is often lost due to periodontal disease. When the gums recede your teeth will appear longer than normal as root surfaces are exposed. You may need to have damaged tissue replaced for cosmetic as well as functional reasons. It is important to note that root surfaces are not protected by enamel. This can cause extreme tooth sensitivity. This grafting procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetic lift.
–Bone graft. The addition of the bone graft helps prevent tooth loss by increasing support structure around our teeth. It also serves as a building block for the regrowth of natural bone.
-Antibiotics and Antibacterial Medications – These medications will aid in healing and removal of bad bacteria from around our teeth. These include:
-Peridex – Prescription antibacterial rinse.
-Periostat – Oral antibiotic. Another type of antibiotic used is called minocycline.
–Arestin – placed directly into the periodontal pocket to help aid in healing.
–Chlorhexidine – A prescription anti bacterial mouthwash. This is used to control bacteria when treating periodontal disease and after surgery. Patients use it as they would a regular mouthwash.
-Guided Tissue Regeneration. This periodontal procedure helps to regrow destroyed bone. Your dentist or periodontist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back in a stable environment. The goal is to regenerate periodontal tissue and repair defects that have resulted from the development of periodontitis.
-Enamel Matrix Derivative Application. Another technique involves the application of a specialized gel to a diseased tooth root. This gel contains the same proteins found in developing tooth enamel and stimulates the growth of healthy bone and tissue. An example of this is the use of emdogain.
What Causes Periodontal Disease? Conclusion
Periodontal disease if left untreated can cause aggressive destruction of your smile. Regular dental visits can prevent periodontal disease from developing. A good way of looking at this is that it is far cheaper and less painful to go to your dentist every 6 months than it is to wait for periodontal disease to develop and chase after your health. Visit your dentist regularly for a happy, healthy smile.
Periodontal disease is a progressive disease of the structures (bone and gingival tissues) surrounding our teeth. It is believed that about 65 million americans have some form of periodontitis. Periodontitis is the advanced form of periodontal disease. Once the disease state reaches periodontitis it means there have been some form of permanent loss of bone or gingival tissues to the disease. In those 65 and over this number jumps to 70% of that population. These numbers are startling. Luckily, there has been extensive research into periodontal disease and new treatment modes have been developed. One such method is treating periodontal disease with Arestin.
What Is Arestin?
Arestin (minocycline hydrochloride) is an antibiotic that comes in the form of micrspheres. These microspheres are placed locally into areas of concern. Periodontal disease generally hits certain areas over others initially. This gives us a chance to localize treatment of periodontal disease with arestin.
Treating Periodontal Disease With Arestin
Periodontal disease if left untreated will develop deeper and deeper “periodontal pockets” around out teeth. The normal space between our teeth, gums and bone is approximately 3 mm. When periodontal disease begins to damage these areas these pockets can widen and deepen as bone is lost and gum tissues lose their connections to our teeth. As the periodontal disease develops and progresses it is not unheard of to have periodontal pocketing in the 6-8 mm range. That is a doubling over normal pocket size. This allows food and bacteria to penetrate these areas and create even more damage to gingival tissues and bone. Once these support structures become damage they can cause our teeth to become loose and eventually lost them.
The standard course of treatment for periodontitis is scaling and root planing (S&RP). This treatment is highly effective for treatment of periodontal disease.
-Periodontal scaling of teeth with instruments involves manually removing all the plaque, tartar, and food from on and around our teeth.
-Periodontal planing can smooth out rough areas on our teeth’s roots where bacteria and plaque can attach.
Scaling and root planing has been our #1 treatment for periodontal disease for decades. Where does treating periodontal disease with Arestin come in? Combining the use of Arestin with the traditional scaling and root planing gives dentists and periodontists a real chance to reduce the periodontal pocketing around our teeth. In routine scaling and root planing, depending on depth of pockets, it may be difficult to reach to the entire depths of those pockets. Everyone’s anatomy is different so some areas are easy to reach while others might be more difficult based on root structures and how the periodontal pockets form. None are uniform. Using microspheres of Arestin allows your dentist to reach the bottom of those pockets and destroy harmful bacteria before further destruction of tissues can occur.
Treating Periodontal Disease With Arestin Procedure
The following is what to expect if you are undergoing treatment of periodontal disease with Arestin.
–Diagnosis of Periodontal Disease. In its earliest form (Gingivitis) there is no damage to bone or gingival tissues and can be reversed thru professional cleaning and increased at home dental hygiene care. In periodontitis, destruction has begun. A simple professional cleaning is no longer as effective. Diagnosis of periodontal disease is achieved thru x-rays and use of a periodontal probe. This dental instrument allows your dentist or hygienist to measure around the teeth and see what areas might be affected by periodontal disease. A normal reading of 3 mm means tissues are healthy. Anything over that raises a red flag and leads to a diagnosis of periodontal disease.
-Treatment Plan To Fight Periodontal Disease. Your dentist will explain these results to you and discuss treatment necessary. The first line of defense is always a scaling and root planing (also called a deep cleaning). Your dentist may now offer Arestin in conjunction with this type of cleaning to give you a better chance of stopping this problem from developing further and also repairing tissues around our teeth.
-Treatment With Scaling And Root Planing.
-Arestin Application Following Scaling And Root Planing. The arestin is in the form of a microsphere. This allows the arestin to release the antibiotic gradually over time to fight the bacteria in the deepest depths of those periodontal pockets. It is able to target areas scaling and root planing instruments just cannot reach.
Is Arestin Effective?
Yes! Studies have shown that is more effective in treating pocket reduction when paired with Scaling and Root Planing Vs S&RP alone. In fact clinical trials have shown significant pocket reductions in as little as 1-3 months and maintenance for at least 9 months. It has also shown significant reductions in our more difficult to treat patients. Those include the smoker’s, ones with a history of heart disease, and those over age 50. The chart below shows those statistics.
Is Arestin A Miracle Drug? Conclusion
Arestin is not a miracle drug. But it will help controlling a very difficult progressive disease. Periodontal disease is difficult to control because it relies on many factors. The biggest one is at home dental hygiene. Patients need to understand their dental care does not begin and end inside the walls of their dental office. Fighting periodontal disease is a daily battle. Periodontal disease treatment with Arestin can help reverse some of those issues but it will not be a cure for it.
Dentistry is not a one size fits all type of medicine. Dentistry is a very personalized treatment for our dental health. This includes treatment and management of periodontal disease. DNA testing is all the craze with companies like 23andMe. But did you know you can use DNA testing for oral diseases as well? The company is called OralDNA and they have developed three separate testing methods. These include early warning and detection for periodontal disease, personalized treatment for periodontal disease, and checking if you have increased risk of developing HPV related oral cancers.
OralDNA Approach To Periodontal Disease
-OralDNA MyPerioPath testing. Oral DNA MyPerioPath is a diagnostic tool for the detection of the type of oral pathogens present in your mouth that can cause periodontal disease. By using this test your dentist can create a personalized care to deal with the pathogens causing the issues in your mouth. There is also evidence that knowing what oral pathogens are present can also determine a patients increased risk of developing Diabetes, cardiovascular disease, alzheimer’s disease, possible stroke, and if pregnant, risk of birth complications. Clinical studies are increasingly linking oral bacteria with systemic disease. For example, inflammation is a major factor in both periodontal disease and heart disease. recent studies have found that a high dose of a common cholesterol medication (atorvastatin) can prevent inflammation from both periodontal inflammation as well as cardiovascular inflammation. Statin family of medicines have other side effects as well not always that good. But this adds to the education that there is a connection between periodontal disease and heart disease.
The Oral DNA MyPerioPath test can determine if the following pathogens are present and in what levels:
- (Aa) Aggregatibacter actinomycetemcomitans
- (Pg) Porphyromonas gingivalis
- (Tf) Tannerella forsythia
- (Td) Treponema denticola
- (En) Eubacterium nodatum
- (Fn) Fusobacterium nucleatum/periodonticum
- (Pi) Prevotella intermedia
- (Cr) Campylobacter rectus
- (Pm) Peptostreptococcus (Micromonas) micros
- (Ec) Eikenella corrodens
- (Cs) Capnocytophaga species (gingavalis, ochracea, sputigena)
The Oral DNA MyPerioPath testing should be done on an annual basis. Once at start of periodontal disease treatment and then one at end of first year to track progress of personalized treatment and if any changes need to be made to improve periodontal disease state. Oral DNA MyPerioPath is a valuable tool that can allow you and your dentist to measure success and track progress for a more personalized periodontal disease therapy.
–Oral DNA MyPerioPath combined With MyPerioID. The Oral DNA MyPerioID test assesses a persons inherited genetic risk to developing periodontal disease as well as other systemic diseases as mentioned above. Combining the 2 tests can give greater control to personalized periodontal disease care and give a fuller picture to you and your dentist. Can also help determine which patients are at increased risk for more severe periodontal disease infections due to an exaggerated immunity response.
–Oral DNA OraRisk HPV Test. This test can determine if there is increased risk for HPV related oral cancer. Human papillomavirus (HPV) is one of the most common virus groups in the world (and is linked to the HPV virus in the mouth). Specific types of oral HPV are now considered to be separate and serious risk factors for developing oral cancers. Early detection and identification of the presence or absence of oral HPV is important, as early oral HPV infections do not typically cause any clinical signs or symptoms.
-Oral DNA OraRisk HPV Complete Genotyping Test. This HPV test gives data to your dentist or doctor to establish if there is increased risk for oral cancer and have the ability to make proper referral for further treatment. Oral DNA OraRisk HPV complete genotyping has the ability to identify a total of 51 different types of oral HPV.
Oral Pathogens Associated With Periodontal Disease
Periodontal researchers have uncovered more than 350 different species of microorganisms that are present in a normal, healthy person’s mouth. Fewer than 5% of these species are linked to periodontal disease. It has also proven that these bacteria that cause periodontal disease, can be shared with your partner or loved ones.
Generally healthy and disease causing bacteria are usually placed into two distinct bacteria categories:
–Gram positive aerobic bacteria. These are harmless or helpful bacteria in the mouth.
–Gram negative anaerobic bacteria. These are the bacteria known to be related to periodontal disease. When periodontal disease develops, the bacterial balance in the mouth shifts over to gram negative anaerobic bacteria. Inflammation and injury cannot develop without these bacteria flourishing in the mouth.
Common bacteria involved in periodontal disease include:
–Actinobacillus actinomycetemcomitans (Ag) and Porphyromonas gingivalis (Pg). These two bacteria appear to be particularly likely to cause aggressive periodontal disease. Both P. gingivalis and A. actinomycetemcomitans, along with multiple deep pockets in the gum, show increased resistance to standard dental treatments for periodontal disease. The presence of P. gingivalis may even have 2x the risk for serious periodontal disease. P. gingivalis produces enzymes, such as one called arginine-specific cysteine proteinase, that has been linked to a disruption of the immune system and lead to subsequent periodontal connective tissue destruction.
–Bacteroides forsythus is also strongly linked to periodontal disease.
Other bacteria associated with periodontal disease are Treponema denticola, T. socranskii, and P. intermedia. These bacteria, together with P. gingivalis, are frequently present at the same sites, and are associated with deep periodontal pockets.
Some bacteria are related just to gingivitis, but not development of plaque. They include various streptococcal species.
As you can see there are a variety of bacteria that are linked to periodontal disease. The MyPerioPath testing can isolate the bacteria causing the issues for you. Your dentist can use antibiotic therapy and rinses to personalize care for your particular case.
How does OralDNA testing help to individualize periodontal disease treatment?
The ability to know the bacteria that is causing the issue allows treatment to target that bacteria. Periodontal disease treatment can include the following:
–Scaling And Root Planing (S&RP). Also called a “deep” cleaning. The initial goal of any periodontal disease treatment must be the removal of plaque and tartar buildup that is causing irritation and inflammation development. The scaling and root planing procedure is done with this in mind as well as to allow for healing and reattachment of gingival fibers to the tooth. This healing can hopefully reduce size of periodontal pocketing (normal about 3mm).
–Antibitoics Application. This can include administering this via a pill orally or placed into local areas that need help. Arestin is an antibiotic that can be placed directly into a periodontal pocket and give local therapy. This is important as it reaches places your dentist cannot but it also does not have the side effects of a systemic pill. The use of antibiotics will help control the overgrowth of the “bad” bacteria that is flourishing due to periodontal disease.
-Dental Hygiene Instructions. This is a staple of any periodontal disease treatment. This disease will be an ongoing problem that needs maintenance to stave it off. This includes proper brushing, flossing, and rinsing. Your dentist may even prescribe a prescription oral rinse to control bacteria or even Periogen. Periogen is an oral rinse that has been shown to help dissolve tartar between visits to the dentist. By lowering amount of tartar in the mouth you are hopefully also lowering the irritatation and inflammatory response.
Periodontal Disease Treatment With Oral DNA Testing Conclusion
DNA testing has been a great tool in many facets of society. It can also be one for dentistry thanks to OralDNA. There is an increased cost for this type of testing but it comes with great benefits in controlling a disease that can be difficult to manage. Any advantage will save you time and discomfort over time during treatment as well as possible tooth loss and systemic health maintenance. Periodontal disease linked to heart disease (as well as other diseases) should be motivation enough to get this under control. See your dentist at the first signs of periodontal disease and get your health back on track.
Periodontal disease is a progressive condition that should be treated immediately. Below you will find some common questions patients ask about periodontal disease.
What Is Periodontal Disease?
Periodontal disease is classified as an infection of the soft and hard tissues supporting your teeth. Periodontal disease is caused when plaque begins to build up on the teeth and eventually hardens (also known as tartar). In the initial stages of periodontal disease, the gum tissues become inflamed and there may be some bleeding upon brushing and flossing. This initial stage of periodontal disease is known as gingivitis. Gingivitis is reversible with professional treatment from your dentist and maintaining a regimented routine of at home dental hygiene. If gingivitis is left untreated, the disease can continue to progress. The next stage is known as periodontitis. In this stage of periodontal disease the plaque and tartar build up below the gumline. Continued irritation and inflammation of the gums occur, this response will create periodontal pockets (increased space between your teeth and gums) that become infected. As periodontitis progresses and worsens, the periodontal pockets get deeper and the bone that supports the teeth begins to be lost. If periodontitis is left untreated, it will eventually lead to loss of teeth.
During your dental visits, your dentist or hygienist will examine the tissues surrounding your teeth visually, using instruments, and thru radiographs. If inflammation is present or the gums bleed easily that will be the first sign of periodontal disease being present. Further examination will occur using an instrument called a periodontal probe. This probe can measure the bone height surrounding your teeth. Normal periodontal pocketing is around 3mm. As bone loss and inflammation occurs this number can rise dramatically. Generally a pocket depth above 4 mm along with bleeding is a hallmark sign of the presence of periodontal disease.
What Are Common Signs Of Periodontal Disease?
Unfortunately for many, periodontal disease can be a silent disease until it becomes quite advanced. Signs and symptoms of periodontal disease include the following
-Inflamed or tender gums that are red in color.
-Bleeding upon brushing, flossing, or when consuming harder to chew foods.
-Teeth appear longer due to receding gum tissues.
-Loose or moving teeth.
-Development of a dental infection in the gum tissues. Usually presents itself as a pimple. Can also be a sign of an infection related to a bad tooth.
-Sores in the mouth
-Unexplained, chronic bad breath
-A change in the way your teeth fit together when you bring them together.
What Are Typical Periodontal Disease Treatments?
Depending on severity of periodontal disease, your dentist may refer you to a periodontist. A periodontist is a dentist that specializes in the gum and bone tissues of the mouth surrounding your teeth. There are a few options available. These include:
1. Scaling And Root Planing (also referred to as a deep cleaning). This dental hygiene cleaning will include the normal removal of plaque and tartar but will also smooth the root surfaces that are exposed or just below the gum line. This will help rid the oral bacteria that contribute to the development and progression of periodontal disease.
2. Periodontal Flap Surgery. This type of surgery opens the gum tissues up giving the dentist greater access to teeth, gum tissues, and bone. They can then debride the areas fully along with planing of roots. The tissues will be replaced and allowed to heal. Your dentist may decide a dental bone graft or gingival tissue graft may be necessary as well. A bone graft will help restore some missing bone to give added support in hopes of saving the affected teeth. A gingival tissue graft will help cover exposed roots to decrease sensitivity as well as give a better cosmetic result following surgery.
What Follows Treatment Of Periodontal Disease?
You will be placed on a maintenance therapy program. This will include oral hygiene instructions for at home along with necessary tools and education. It will also include the possibility of more frequent visits to the dental hygienist for follow up visits to keep the disease state under control. Some patients will require a more frequent schedule. The normal is every 6 months but for many cases it can increase to every 3 months to keep the disease from progressing further.
Can Periodontal Disease Contribute To General Health Issues?
Clinical studies have given us lots of data that periodontal disease does in fact affect our general health. These issues include:
-Cardiovascular Issues (Heart attack or stroke). Both periodontal disease and cardiovascular disease are considered chronic inflammatory diseases. The medical community believes that inflammation is probably the factor that associates the two disease states.
-Low Birth Weight Babies and PreTerm Pregnancies
-Difficulty in Controlling Diabetes
Can Children Develop Periodontal Disease?
It is rare to find periodontal disease in children but it is possible. More so for adolescents and teenagers. This does not mean we should not educate our children on the importance of dental hygiene. Children should be educated and develop a routine to avoid any issues as they get older. The warning signs of periodontal disease include swollen, bleeding gums that are red in color. If your child has these symptoms call your dentist to ensure he/she is cared for swiftly.
What Can Be Done At Home To Prevent Periodontal Disease?
The #1 way to prevent development of periodontal disease is visit your dentist regularly and maintain a diligent schedule of dental hygiene at home. This should include brushing at least 2x per day (recommend after every meal), flossing at least once a day, and using an antibacterial mouth rinse.
Is Periodontal Disease Contagious?
The actual periodontal disease state is not contagious since it is an inflammatory process. However, the bacteria that causes periodontal disease can be spread thru saliva. This is most often common from mother or father to newborn baby prior to full development of immune system. It has also been shown to have a genetic component. It is believed that approximately 30% of the world’s population may have some genetic susceptibility to the development of periodontal disease. Modern DNA testing can shed some light on these factors as well. Once such company is called OralDNA. MyPerioPath is used to test for the detection of oral pathogens that cause periodontal disease. MyPerioPath can help provide early detection of oral pathogens to enable the personalized care in treatment of periodontal disease.
Can I Wait To Get Periodontal Disease Treatment?
The earlier that periodontal disease can be treated the cheaper and easier it will be to manage the outcomes. At the earliest sign of periodontal disease see your dentist and it could just involve a professional cleaning and some dental hygiene instructions. If you wait it could progress to periodontal flap surgery and tooth loss.
What Are The Stages Of Periodontal Disease?
The stages of periodontal disease are as follows: