If you have been told you have periodontal (gum) disease, you're
not alone. An estimated 80 percent of American adults currently have some form
of the disease.
Periodontal diseases range from simple gum inflammation to serious disease that
results in major damage to the soft tissue and bone that support the teeth. In
the worst cases, teeth are lost.
Gum disease is a threat to your oral health. Research is also pointing to
possible health effects of periodontal diseases that go well beyond your mouth
(more about this later). Whether it is stopped, slowed, or gets worse depends a
great deal on how well you care for your teeth and gums every day, from this
What causes periodontal disease?
Our mouths are full of bacteria. These bacteria, along with
mucus and other particles, constantly form a sticky, colorless "plaque" on
teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed
can harden and form bacteria-harboring "tartar" that brushing doesn't clean.
Only a professional cleaning by a dentist or dental hygienist can remove tartar.
The longer plaque and tartar are on teeth, the more harmful
they become. The bacteria cause inflammation of the gums that is called
"gingivitis." In gingivitis, the gums become red, swollen and can bleed easily.
Gingivitis is a mild form of gum disease that can usually be reversed with daily
brushing and flossing, and regular cleaning by a dentist or dental hygienist.
This form of gum disease does not include any loss of bone and tissue that hold
teeth in place.
When gingivitis is not treated, it can advance to "periodontitis"
(which means "inflammation around the tooth.") In periodontitis, gums pull away
from the teeth and form "pockets" that are infected. The body's immune system
fights the bacteria as the plaque spreads and grows below the gum line.
Bacterial toxins and the body's enzymes fighting the infection actually start to
break down the bone and connective tissue that hold teeth in place. If not
treated, the bones, gums, and connective tissue that support the teeth are
destroyed. The teeth may eventually become loose and have to be removed.
- Smoking. Need another reason to quit smoking?
Smoking is one of the most significant risk factors associated with the
development of periodontitis. Additionally, smoking can lower the chances of
success of some treatments.
- Hormonal changes in girls/women. These changes can
make gums more sensitive and make it easier for gingivitis to develop.
- Diabetes. People with diabetes are at higher risk
for developing infections, including periodontal disease.
- Stress. Research shows that stress can make it
more difficult for our bodies to fight infection, including periodontal
- Medications. Some drugs, such as antidepressants
and some heart medicines, can affect oral health because they lessen the
flow of saliva. (Saliva has a protective effect on teeth and gums.)
- Illnesses. Diseases like cancer or AIDS and their
treatments can also affect the health of gums.
- Genetic susceptibility. Some people are more prone
to severe periodontal disease than others.
Who gets periodontal disease?
People usually don't show signs of gum disease until they are
in their 30s or 40s. Men are more likely to have periodontal disease than women.
Although teenagers rarely develop periodontitis, they can develop gingivitis,
the milder form of gum disease. Most commonly, gum disease develops when plaque
is allowed to build up along and under the gum line.
What can I do to prevent gum disease?
Here are some things you can do to prevent periodontal
- Brush your teeth twice a day (with a fluoride toothpaste)
- Floss every day
- Visit the dentist routinely for a check-up and
- Eat a well balanced diet
- Don't use tobacco products
How do I know if I have periodontal
Symptoms are often not noticeable until the disease is
advanced. They include:
- Bad breath that won't go away
- Red or swollen gums
- Tender or bleeding gums
- Painful chewing
- Loose teeth
- Sensitive teeth
Any of these symptoms may signal a serious problem, which
should be checked by a dentist. At your dental visit:
- The dentist will ask about your medical history to
identify underlying conditions or risk factors (such as smoking) that may
contribute to periodontal disease.
- The dentist or hygienist will examine your gums and note
any signs of inflammation.
- The dentist or hygienist will use a tiny ruler called a
'probe' to check for periodontal pockets and to measure any pockets. In a
healthy mouth, the depth of these pockets is usually between 1 and 3
- The dentist or hygienist may take an x-ray to see whether
there is any bone loss.
- The dentist may refer you to a periodontist, a specialist
who treats gum diseases.
How is periodontal disease treated?
The main goal of treatment is to control the infection. The
number and types of treatment will vary, depending on the extent of the gum
disease. Any type of treatment requires that the patient keep up good daily care
at home. Additionally, modifying certain behaviors, such as quitting tobacco
use, might also be suggested as a way to improve treatment outcome.
Deep Cleaning (Scaling and Root Planing)
The dentist, periodontist, or dental hygienist removes the
plaque through a deep-cleaning method called scaling and root planing. Scaling
means scraping off the tartar from above and below the gum line. Root planing
gets rid of rough spots on the tooth root where the germs gather, and helps
remove bacteria that contribute to the disease.
Medications may be used with treatment that includes scaling
and root planing, but they cannot always take the place of surgery. Depending on
the severity of gum disease, the dentist or periodontist may still suggest
surgical treatment. Long-term studies will be needed to determine whether using
medications reduces the need for surgery and whether they are effective over a
long period of time. Here are some medications that are currently used:
||What is it?
||Why is it used?
||How is it used?
|Prescription antimicrobial mouthrinse
||A prescription mouthrinse containing an antimicrobial
||To control bacteria when treating gingivitis and
after gum surgery
||It's used like a regular mouthwash
||A tiny piece of gelatin filled with the medicine
||To control bacteria and reduce the size of
||After root planing, it's placed in the pockets where
the medicine is slowly released over time.
||A gel that contains the antibiotic doxycycline
||To control bacteria and reduce the size of
||The periodontist puts it in the pockets after scaling
and root planing. The antibiotic is released slowly over a period of
about seven days.
||Tiny, round particles that contain the antibiotic
||To control bacteria and reduce the size of
||The periodontist puts the micro-spheres into the
pockets after scaling and root planing. The particles release
minocycline slowly over time.
||A low dose of the medication doxycycline that keeps
destructive enzymes in check
||To hold back the body's enzyme response -- If not
controlled, certain enzymes can break down gum tissue
||This medication is in pill form. It is used in
combination with scaling and root planing.
Flap Surgery. Surgery might be necessary if
inflammation and deep pockets remain following treatment with deep cleaning and
medications. A periodontist may perform flap surgery to remove tartar deposits
in deep pockets or to reduce the periodontal pocket and make it easier for the
patient, dentist, and hygienist to keep the area clean. This common surgery
involves lifting back the gums and removing the tartar. The gums are then
sutured back in place so that the tissue fits snugly around the tooth again.
Bone and Tissue Grafts. In addition to flap surgery, your
periodontist may suggest bone or tissue grafts. Grafting is a way to replace or
encourage new growth of bone or gum tissue destroyed by periodontitis. A
technique that can be used with bone grafting is called guided tissue
regeneration, in which a small piece of mesh-like fabric is inserted between the
bone and gum tissue. This keeps the gum tissue from growing into the area where
the bone should be, allowing the bone and connective tissue to regrow.
Since each case is different, it is not possible to predict with certainty which
grafts will be successful over the long-term. Treatment results depend on many
things, including severity of the disease, ability to maintain oral hygiene at
home, and certain risk factors, such as smoking, which may lower the chances of
success. Ask your periodontist what the level of success might be in your
Getting a Second Opinion About Treatment
When considering any extensive dental or medical treatment
options, you should think about getting a second opinion. To find a dentist or
periodontist for a second opinion, call your local dental society. They can
provide you with names of practitioners in your area. Additionally, dental
schools may sometimes be able to offer a second opinion. Call the dental school
in your area to find out whether it offers this service.
Can periodontal disease cause health problems beyond
Maybe. But so far the research is inconclusive. Studies are
ongoing to try to determine whether there is a cause-and-effect relationship
between periodontal disease and:
- an increased risk of heart attack or stroke,
- an increased risk of delivering preterm, low birth weight
- difficulty controlling blood sugar levels in people with
In the meantime, it's a fact that controlling periodontal
disease can save your teeth -- a very good reason to take care of your teeth and
National Institute of
Dental and Craniofacial Research
National Institutes of Health
Bethesda, MD 20892-2190
Nutritional and Herbal Therapy for
- Vitamin C (1,000 mg a day) helps heal and protect
gum tissue. To relieve gum inflammation and bleeding, try brushing with
vitamin C powder.
- Vitamin E (400 IU a day) acts as an antioxidant
and can protect gum tissue.
- Folic Acid ( 800 mcg once a day) helps heal gum
tissue and reduces gum inflammation and bleeding.
- Calcium (1,000 to 1,200 mg a day) in order
to maintain and protect the health of your teeth.
- Rub a small amount of Superior Sore Throat Powder
on your gums to relieve inflammation and promote healing.
- The Chinese herbal patent formula,
Huang Lien Shang Ching Pian, is excellent for gum inflammation and pain. It can also
protect against infection.
Chuan Xin Lian can help fight infection of
the gums as well.