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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 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



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If you have a damaged (from tooth decay or even periodontal disease) or traumatized tooth, extraction is not the only option as there is a chance that you can save your natural tooth. Whenever possible, it is always better to save your teeth rather than lose them, as missing teeth have negative effects on confidence, ability to chew, general health and the alignment of the remaining teeth. Here are the alternative procedures to tooth extraction if you would like to keep a beautiful, natural smile.

Save Your Teeth with Root Canal Procedures

Root canal treatment is the most popular alternative to teeth extraction. Endodontic treatment or a root canal treats the living parts found inside the teeth known as the pulp. The pulp consists of the soft tissue inside the teeth made up of nerves, blood vessels and connective tissues that nourish the root during the development stage. When the teeth develop fully, it is possible to remove the pulp without affecting the teeth since the supporting tissues provide nourishment.

Tooth decay, repeat dental procedures, cracks, chips, trauma caused by accidents and faulty crowns can trigger infections and inflammation of the pulp. Root canal therapy treats the damaged pulp preventing major pain and abscess. Root canal treatment involves the non-surgical removal of the infected or inflamed pulp. The resulting hollow is cleaned, disinfected, shaped, filled and sealed to prevent further infections. A tooth restoration procedure using a crown or filling follows to restore the tooth to its normal function and structure. After root canal treatment, teeth can last for a lifetime without requiring another root canal treatment or dental procedure.

Save Your Teeth with Endodontic Surgery

Another alternative to losing teeth through extraction is to undergo endodontic surgery. One of the most popular surgeries is apicoectomy or root-end resection done when the inflammation or infection continues spreading to the bony tissue even after root canal treatment. An endodontist removes the infected area and sometimes part of the root and then seals the area. This is a safe procedure made comfortable by the use of local anesthesia. There are no serious complications and the bone heals within a few months.

Another sophisticated endodontic surgery procedure to save the teeth is intentional replantation. This involves the removal of the infected teeth for treatment outside the mouth. After treatment, an endodontist plants the tooth back in its socket and it resumes normal operation without the infection. Other surgery options to save the teeth include separating the tooth into two halves, or surgery to fix or remove an injured root.

Endodontic surgery is beneficial in the following situations:

  • For diagnosis and treatment of root infections, minor fractures and tiny canals that do not show on the x-rays; yet there are symptoms of infection.
  • For cleaning, treatment and sealing of too narrow canals that root canal treatment instruments cannot penetrate to reach the roots.
  • For treatment of teeth that fail to heal after a root canal treatment or develop infections after a root canal procedure.
  • For treatment of damaged roots and supporting bone structure of the teeth.

Other Ways to Save Your Damaged or Dying Teeth

Medication

Some people take painkillers to eliminate toothache and other symptoms instead of undergoing a tooth extraction immediately. However, this does not deal with the root problem but only eliminates the symptoms. It is possible to treat some infections using antibiotics, however. Still, it’s best to consult your dentist to find out the best solution for your specific needs.

Early Periodontal Disease Treatment

For people with mild gum disease, tooth loss is inevitable if the mild gum disease goes untreated and develops into chronic periodontal inflammation. Early diagnosis and treatment of gum disease is the best way to prevent tooth loss associated with periodontal disease.

Apart from endodontic procedures, maintaining proper dental hygiene is the best way to save your teeth from extraction or any other restorative dental procedure. Proper dental care involves brushing teeth properly at least twice a day, flossing daily, following a healthy diet and visiting the dentist regularly. This prevents damage to the teeth in the first place, thereby eliminating the need to undergo root canal treatment or teeth extraction. This is also the best way to ensure your teeth stay healthy for a long time and delay tooth loss.

If it is too late or impossible to save the teeth and extraction is inevitable, replacing the extracted teeth with dental implants and other structures is the best way to avoid the negative effects of physically visible tooth loss.

Conclusion

It is important to see your dentist regularly for routine dental care and examinations. This will help prevent the issues listed above. Maintaining good dental health will lead to a lifetime of smiles.




As we age many changes occur in our bodies including our teeth. Our teeth shift and move over time due to many forces that we control and ones we do not. These forces include tongue movements, lips pushing against our teeth, and how our teeth come together. Below we will review some of these forces in greater detail.

Forces Attempting To Move Our Teeth

-Tongue Habits. The most common is an abnormal tongue thrust. Our tongue places pressure on our teeth through eating, swallowing, and talking. We do not even realize how often our tongue presses against our teeth. If you swallow, you will realize that your tongue presses against your upper teeth. For most of us, this is not an issue but for others with a powerful tongue thrust, this can cause tooth movement over time.

-Lip Habits. The forces that your lips apply to your teeth can actually cause your teeth to move.  A good example is tucking your lower lip behind your upper teeth.  This is especially common in younger children and people who bite their lips when they get nervous. The forces over time can cause those teeth to shift outward.

-Frenum Issues. The frena is the attachment between your lips and tongue to the gum tissues attached to the teeth. The one on the inside by your tongue is called a lingual frenum. The other two are on the inside of your lips and called a labial frenum. The lingual frenum generally does not affect the teeth but can affect eating, speech, and swallowing as it can constrict tongue movement. The labial frenum can play a part in moving the front two teeth apart. To alleviate this your dentist or oral surgeon can remove the labial frenum surgically.

-Forces From Our Teeth. Our teeth are in a constant state of pressure from each other.  Normally when you bite together, your teeth touch and rest in a certain position.  This position is known as centric occlusion.  Normally, the top teeth oppose the bottom teeth and keep them in line. However, if you lose a tooth or a tooth becomes badly damaged from trauma or tooth decay space opens up. The teeth on either side of the lost tooth move, as will the tooth that opposes it. For example, if you lost a lower tooth, the tooth on the upper jaw that normally hits it would start to grow down slightly to fill in the space and the adjacent teeth to the lost tooth would start to lean in towards the empty gap.

-Genetics. Our body is hardwired with a set of instructions and our genetics determine if our teeth will be straight or not.

Tooth Decay. If left untreated, your tooth will eventually break down changing its shape and size. This will open space up causing our teeth to shift into that space. Also, a tooth restored improperly can also change the tooth’s relationship to the other teeth causing changes as well.

-Age. As we age, the area between the teeth starts to wear away. When this happens, the enamel begins to thin out. And, because the lower teeth are inherently thinner, they wear out faster. The more wear and tear on the lower teeth, the less able they are to withstand the force of the top teeth when biting down, resulting in shifting.

-Teeth Grinding (Bruxism). Teeth grinding forces the lower jaw forward and puts tension on the upper teeth. The continual thrusting affects the position of the upper arch, pushing it out of alignment.

Conclusion

As you can see, there are many different forces that are constantly acting on your teeth that could cause them to move. It is important to treat those forces that you can control. See your dentist if you feel your teeth are shifting to avoid future issues.