The Challenges of Dentistry Part 5

I’ve been talking about different aspects of my job and how they can be both fun and challenging at the same time. The first parts of this blog have dealt with decay and tooth sensitivity.  Today I’ll discuss periodontal disease which many people call gum disease.

Periodontal disease is caused by bacteria. Periodontal bacteria is different from the bacteria that causes tooth decay.  Cavity causing bacteria attack teeth.  Gum disease causing bacteria attack the gums and bone supporting the teeth.  If left untreated, periodontal disease will destroy the bone around the teeth to the point where the teeth become loose and can even fall out.  Fortunately, we know enough about periodontal disease to keep it under control.

Like decay bacteria, periodontal bacteria need plaque to grow. If plaque is allowed to set on the gums and teeth, they become irritated and inflamed.  This is called gingivitis.  Gingivitis is red swollen gums that often bleed when you brush.  Once the gums become inflamed and swollen, the bacteria can get into the crevice between your gums and your teeth.  This is called a periodontal pocket. The bacteria sitting in this pocket starts to grow.  The pocket becomes more inflamed.  Infection can start as the body tries to fight the bacteria.  Soon the pocket is deeper and more irritated.  The plaque hardens into calculus, also known as tartar.  This causes more irritation.  Bone destruction begins. You now have periodontal disease.

The progression of gum disease differs in each person. Sometimes it is aggressive and bone loss is a steady process.  Other times it is episodic, which means it goes in spurts.  In these cases, bone loss may be minimal for a long period of time and then suddenly become rapid.  The bottom line is; it you have periodontal pockets and periodontal bacteria, you have periodontal disease and bone loss will occur.

So what should you do? If you have regular appointments at our office you have had a periodontal charting.  This is where we poke around each tooth and read off numbers that are placed in your computer chart.  What we are doing is looking for periodontal pockets.  Normally, the place between your gum and tooth (where the popcorn husks get caught) is 1 to 3 millimeters deep and does not bleed when we probe it.  If these spaces reach 4 millimeters or more in depth and they bleed, you have an active periodontal pocket.

Periodontal disease is a gradient that goes from gingivitis to severe bone loss and loose or missing teeth. Where you are on the gradient and also depending on the number of perio pockets you have will help us with recommending a treatment.  Treatment ranges from a simple improvement in home care to periodontal surgery.  In most cases, the calculus build up needs to be removed in a procedure known as scaling and root planning.  With this treatment we meticulously clean each and every tooth.  We remove calculus and bacteria from every pocket and try to leave the root surfaces smooth and clean.  Our goal is healthy gum tissue and stable pockets.

The worse thing about periodontal bacteria is that you can never get rid of it. But, with diligent home care and regular dental visits we can keep the bacteria levels down and the periodontal destruction minimal.  So, the next time you are getting a routine check-up and the hygienist says “It’s time for your yearly periodontal charting” open your ears and listen to the numbers and be thankful that we treat gum disease aggressively so that you can maintain that beautiful smile.

Thanks for reading,

Dr. Bruce