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What causes periodontal disease? Periodontal disease comes in different stages. The earliest stage of periodontal disease is gingivitis. This stage is reversible with proper treatment. If caught and treated before progression there will be no long term affects. If it advances to the next stage, periodontitis, there will be long term effects to your smile. These effects can include gum tissue recession and bone loss surrounding your teeth. Below we will discuss what causes periodontal disease as well as how to bring it under control for good dental health.

What Causes Periodontal Disease?

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 What Causes Periodontal Disease Las Vegas Marielaina Perrone DDSwithout 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 SurgeryA 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.

Periodontal Disease With Arestin Marielaina Perrone DDS

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.

 

 




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.

Periodontal Disease Las Vegas Marielaina Perrone DDSHow Is Periodontal Disease Diagnosed?

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:

Alzheimer’s Disease

-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 OralDNAMyPerioPath 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:

-Gingivitis

-Periodontitis

-Advanced Periodontitis



Receding gum tissue can be an issue especially as we get older. Normal healthy gum tissue will follow snugly against the conforms of our teeth. Gum recession occurs when the gum tissue recedes or pulls away from teeth exposing the root below. This creates an esthetic issue as well as a functional one. The roots of our teeth do not have a protective layer of enamel. This can make your teeth sensitive to hot and cold as well as increase your risk of tooth decay. Once recession occurs, this tissue cannot grow back to its original state. There are treatments to restore lost gum tissue and bring your smile back to its original healthy state.

What Causes Gum Tissue To Recede?

Several factors can cause our gum tissue to recede including:

Periodontal Disease (ranges from ginigivitis to advanced periodontitis) – Periodontal disease (also called gum disease), refers infections of the structures around the teeth, which include the gums, periodontal ligament and alveolar bone. In the earliest stage of periodontal disease — gingivitis — the infection affects the gums. In more severe forms of the disease, all of the tissues are involved. This inflammation occurs due to an accumulation of bacterial deposits called plaque.

Contributing factors of periodontal disease include:

-poor oral hygiene maintenance

-misaligned or crooked teeth

-damaged or faulty fillings

-bridges or partial dentures that no longer fit

-genetics

-hormonal changes due to pregnancy or oral contraceptives

-medications that cause dry mouth (xerostomia)

-certain immune disorders

-stress

-tobacco use

Periodontal Disease Stages

-Gingivitis causes gum redness, swelling, and sometimes bleeding. If left untreated, gingivitis can progress to periodontitis.

Periodontitis is the advanced stage of periodontal disease and can cause the gums to recede. As the gum and connective tissues pull away from the tooth, a pocket forms between the tooth and gum, which begins to accumulate bacteria. Over time, the bacteria cause further damage and inflammation. If the gums recede too much, it may lead to bone loss, which can cause teeth to loosen or fall out over time.

Is Incorrect Brushing The Cause?

Maintaining a regular brushing and flossing regimen is essential for maintaining good oral hygiene. However, using an incorrect brushing technique could actually contribute to receding gums. The part of the gum that comes into contact with the crown of the tooth is called the gingival margin. Brushing incorrectly or too hard can damage the gingival margin, possibly triggering gum inflammation and recession.

Incorrect brushing techniques can include:

-brushing too forcefully

-using a hard or medium bristled toothbrush

-brushing the teeth in a broad, horizontal motion

Teeth grinding and clenching

Some people grind their teeth together while sleeping. This motion of teeth grinding puts intense pressure on the gums, which can cause them to react by receding over time. Teeth grinding can also cause teeth to become loose in their sockets. Grinding creates deep pockets between the tooth and the gum, where bacteria can collect. These bacteria trigger gum inflammation, which can then worsen gum recession.

Injury

Sustaining direct trauma to the gum tissue may cause the gums to recede in that area. These injuries could include:

-during a fall or other accident

-during dental procedures

-while wearing ill fitting partial dentures

-trauma while playing contact sports

Treatments For Receding Gums

Scaling and root planing

Scaling and root planing is one of the first treatments for receding gums that a dentist will recommend. This procedure will remove plaque and tartar from below the gumline, where routine brushing cannot reach. Root planing removes plaque and tartar specifically from the roots of teeth. Following removal of plaque and tartar your dentist or hygienist will use special instruments to smooth the roots, which helps the gums re-attach to the tooth.

Gum Tissue Grafting

Your dentist may recommend gum graft surgery if your gums have severely receded to the point where surgical intervention is needed. During gum grafting, a surgeon will take a small piece of gum tissue from a different area in the mouth and transplant it to cover the exposed tooth roots. This gum tissue grafting helps prevent bone loss and the gums from receding farther. It can also protect the previously exposed tooth roots from decay and tooth sensitivity

Pinhole Surgical Technique

Pinhole surgical technique is a fairly new treatment for mild to moderate receding gums. Pinhole Surgical Technique is a minimally invasive procedure that requires no incisions and no suturing. It is a quick and effective treatment for gum recession that is virtually pain-free and requires only a very short recovery time. Patients can resume normal activities the same day as their procedure.

Prevention Of Gum Tissue Recession

-Practice good oral hygiene

The following oral hygiene tips can help avoid receding gum tissue:

-flossing between the teeth at least once per day preferably after each meal

-fluoride toothpaste

-brushing your teeth 2x/day using a soft bristled toothbrush

-using an antiseptic mouthwash to reduce bacteria and flush out debris

-choosing a size and shape of toothbrush that allows access to all parts of the mouth

-replacing toothbrushes at least every 2–4 months or as recommended by your dentist

-maintaining a regular schedule of dental appointments

-Wear A Mouthguard

Wearing a mouthguard at night can help prevent gum recession due to teeth grinding. Mouthguards create an even pressure across the jaw and act as a physical barrier to separate the top and bottom teeth. Mouthguards can be bought at your local pharmacy. A dentist can also make a customized mouthguard, which will provide a better fit and be much more comfortable and long lasting

-Replace Dentures That Do Not Fit

Partial dentures that once fit well can become incompatible with the mouth over time. This can happen for several reasons, including:

-the bone and gum ridges shrinking over time

-differences or changes in jaw alignment

-overall wear and tear of the partial dentures over time

Ill fitting partial dentures can rub and irritate the gums, causing the gums to recede around healthy teeth. People can prevent this by replacing partial dentures as needed. If you are concerned have your dentist evaluate your partial dentures at your next visit.

-Maintain Regular Dental Visits

Attending regular dental checkups is vital for detecting the early stages of gum recession. Routine examinations also allow your dentist to identify and replace any failing restorations or ill fitting partial dentures, which can contribute to receding gums.

Gum Recession Conclusion

Unfortunately once the gum tissues have receded, they cannot grow back on their own. With Advancements on treatment your dentist can reattach and restore gum tissue around the teeth. Remember to maintain a good oral hygiene program at home and seeing your dentist regularly can help prevent, slow, or stop gum recession. If you notice changes in your smile speak to your dentist to see what options are right for you.