Periodontal Therapy
Periodontal Diseases
What is Gingivitis? Although many cases may present with no symptoms, some indications for treatment can include prolonged temperature sensitivity, spontaneous pain, tooth discoloration, tenderness of the tooth or surrounding gum tissue and swelling.
On a daily basis, our mouths are consistently harbouring bacteria. These bacteria form onto the surfaces of teeth and gums, and forms a sticky, furry layer. Brushing and flossing daily can remove plaque. However, once the bacteria remains on our teeth for a long time, bad bacteria begin to release toxins which cause the inflammation of the gums, known as gingivitis.
Fortunately, gingivitis is a mild form of gum disease which is completely reversible with daily cleaning. A professional clean can help to reduce bacteria further in areas which are inaccessible to home hygiene. This form of gum disease does not result in any loss of gum or bone tissue.
What is Periodontitis? Although most people brush regularly, bacteria may remain sheltered from the toothbrush. This may commonly occur at hard to reach areas such as the molars, and especially the areas in between teeth. Over time, the plaque that is not removed, mineralizes and hardens into ‘tartar’. The bacterial deposits in its hardened form becomes more toxic and then causes irreversible damage to the gums and surrounding bone. If left untreated, teeth may eventually loosen and may require removal by this stage. Only professional cleaning from the dentist will remove tartar. Symptoms of periodontitis include:
- Bleeding gums
- Receding gums
- Gum abscess
- Loosening teeth
- Food constantly caught between teeth
- Usually painless until it becomes advanced
However, not every person is equally susceptible to gum disease. Smoking, stress, family inheritance, diabetes, nutrition, genetic conditions and certain medications may cause increased risk of gum disease in an individual.
Periodontal Disease and Other Health Conditions
Periodontal disease (gum disease) results in the progressive destruction of supporting structures of teeth, causing significant negative impacts on the health, function and appearance of the mouth. It occurs when there is buildup of plaque bacteria that irritate the gums and cause an inflammatory response resulting in red, swollen and bleeding tissue. If left untreated, there is destruction of the supporting tissues of the teeth, causing gum recession, gaps between the teeth and gums, loosening and shifting of teeth, and eventual tooth loss.
Your periodontal health has been shown to have effects on your overall health and vice versa. Research findings show that periodontal disease is associated with a number of other conditions, including heart disease, diabetes and even cancer. Taking care of your gums with the help of a periodontist is thus an important part of ensuring your wellbeing beyond the mouth.
Diabetes
Periodontal disease is often thought to be a complication of diabetes, a condition where the body is unable to produce insulin or properly use insulin to convert sugar into energy. People with diabetes are two to four times more likely to develop periodontal disease. Research has found that people with both diabetes and periodontal disease tend to experience more severe levels of bone loss and more aggressive periodontal disease advancement, which can ultimately lead to tooth loss. In addition, it found that diabetic patients with periodontal disease had poorer control of their blood sugar levels. This could be for a variety of reasons, such as periodontal disease increasing systemic inflammatory signals, which increase blood sugar, and tooth loss due to gum disease making chewing and digesting food difficult, so proper nutrition is difficult to maintain.
As such, treating periodontal disease should be kept in mind when trying to achieve optimal control of diabetes.
Cardiovascular disease and stroke
People with periodontal disease are almost twice as likely to develop cardiovascular disease. Many researchers believe oral bacteria to be the cause of this association. These bacteria can enter the bloodstream and travel to other parts of the body, causing an inflammatory response and the development of plaque that narrows and hardens arteries. These slow progressing obstructions can eventually lead to a heart attack or stroke.
Cancer
Research has found a connection between gum disease and various types of cancer, such as pancreatic cancer and lung cancer. One particular study found that men with a history of periodontal disease were 14% more likely to develop cancer than men with healthy gums. While a direct cause and effect relationship between periodontal disease and cancer has yet to be established, it is important to recognize that the two conditions share similar risk factors such as tobacco use, genetics and age.
Other conditions
Periodontal disease shares documented connections with Alzheimer’s disease, respiratory disease, osteoporosis, rheumatoid arthritis, kidney disease and pregnancy complications. You should notify your periodontist if you are being treated for these conditions.
Extractions
Teeth are now extracted less frequently because retaining teeth is nearly always better than extraction. However, there are instances where extraction is the best treatment option.
The aim is always to achieve the best long-term outcome for you, while providing the most satisfactory functional and aesthetic outcome possible. Your periodontist is in the best position to evaluate your circumstances.
Teeth may have to be removed for several reasons:
Extensive damage – If a tooth is badly decayed or damaged due to trauma, extraction may be necessary.
Gum disease – Poor oral hygiene leads to build up of plaque and calculus on teeth. This can cause inflammation and infection of the gums. If not treated in a timely manner, gum disease causes destruction of the underlying bone and supporting tissues around the tooth. This can cause the tooth to become loose. If severe enough, saving the tooth may not be possible despite treatment.
Prevention of complications – If severely diseased teeth are not extracted, complications such as infection or abscesses, spreading of infection to other parts of the body may occur. This can affect the general health of the patient.
Improving appearance – Extractions may be necessary as a part of orthodontic treatment to improve the appearance of your teeth.
Non-functional teeth – A tooth with no opposing partner to grind and chew against may be better removed.
Cracks in tooth roots – A root may fracture or split completely. If repair is not possible, extraction is necessary.
Extraction of a tooth/teeth is only done after careful consideration and discussion with your dentist. The utmost effort is made to try and retain teeth as they function better than artificial replacements such as dentures, bridges or implants. Root canal treatment may be recommended to try and save a tooth, however, it is not suitable in every case and is recommended when successful outcomes are likely.
A missing tooth can result in tilting of neighboring teeth into the gap. This can make chewing and biting difficult. It may also cause decay and gum disease around these teeth, as thorough cleaning can be difficult. To prevent this shifting of adjacent teeth into the space, a bridge, denture or implant may be necessary.
An X-ray film may be taken of the tooth and the jaw. This helps your dentist plan the best and safest way to remove the tooth.
The method of extraction will vary depending on the tooth, its roots and its position in the mouth. Some teeth are relatively easy to remove, while others can be difficult.
Difficult extractions are usually due to:
- Extensive decay and/or large fillings in the tooth
- Adjacent teeth having crowns or large fillings
- The tooth being in an abnormal position, affecting neighboring teeth
An unerupted or impacted tooth, or a tooth that is fused to the jaw (ankylosis) - The tooth being positioned close to a nerve
- The tooth having roots that are large or curved, or that penetrate deeply into the jaw
In difficult cases, the tooth may have to be surgically segmented so it can be removed safely and easily.
After an extraction:
- Ensure you rest at home and do not perform any physically demanding tasks for up to 48 hours
- Do not smoke for 48 hours to reduce the risk of dry socket
- Avoid drinking alcohol for 48 hours
- Eat soft foods such as soups, blended/pureed vegetables for the first two days
- Painkillers may be beneficial in reducing any post-operative discomfort
- Ice packs can be used to reduce any swelling or pain
It is important to discuss with your periodontist about any concerns you may have. It is also crucial to inform your periodontist of your complete medical and dental history as they may affect your treatment.