What Causes Gum Disease?
Periodontal (gum) disease is an insidious infection that affects virtually everyone with teeth. This group of diseases originates with bacteria that grow in a sticky matrix commonly called plaque, which grows back and should be removed daily using toothbrushing and flossing.
Mechanical removal of plaque can accomplish just so much, however, since the oral bacteria responsible for periodontal disease are natural residents of the mouth that reattach to teeth immediately after plaque is removed. Some people are more susceptible to periodontal disease than others. Factors such as heredity (where a family has a history of periodontal disease) and lifestyle (such as tobacco and alcohol use) can influence the overgrowth of certain oral bacteria.
This overgrowth can damage soft and hard tissues unless it is brought under control and the tissues are allowed to heal. As the gum tissue is damaged, it begins to detach from the tooth exposing the roots. In more advanced stages, this recession results in “pockets” being formed. This detached gum tissue is an ideal living space for the bacteria that cause periodontal disease – and it allows the disease to destroy the underlying bone to which your teeth are anchored.
If gingivitis goes untreated, oral bacteria will continue to overgrow and may reach the supporting structures of the teeth in individuals who are susceptible. If these supporting structures deteriorate it can lead to teeth becoming loose. This destruction is painless, however, it usually represents severe periodontal disease – and it presages the loss of the tooth.
Early detection of periodontal disease can literally save teeth, but the process can be performed only by a dental professional who employs techniques that can measure the depth of the separation of gum and tooth with an instrument called a periodontal probe. This measurement should always be part of your routine cleaning and check-up at your dentist’s office. Detected in early stages, periodontal disease is easily treatable, but later stages of the disease require more advanced forms of therapy.
Preventative Solutions for Gum Disease
The best way to fight gum disease is to stop it before it destroys gum and bone tissues. Brush and floss daily and have regular checkups done at least once a year by your dentist.
- If your dentist finds that you have gingivitis, you may need your teeth professionally cleaned.
- Tartar (calculus) is often found on your teeth when you have gingivitis. This hardened plaque should be removed by a dental professional since it can harbor plaque and irritate the gums. Patients who have gingivitis should have their teeth cleaned, on average, twice a year.
- Professional treatment in areas of bone loss is aimed at cleaning the exposed tooth root surface so that the surrounding soft tissues can reattach. Two types of treatment can facilitate restoring health, repair and re-growing bone.
Treating Gum Disease
Scaling and Root Planing
Most people, over time, build up tartar around their teeth at the gum line. Some people naturally form more tartar than others, but everyone has it. Effective daily oral hygiene can minimize that buildup by removing the bacterial plaque that influences tartar formation, since tartar is an encrustation on the teeth formed by salivary secretions, food residue, and various minerals ( such as calcium carbonate or phosphate). This hard mineral substance, which cannot be effectively removed at home once it forms, makes it far easier for disease-causing bacteria, and the food debris they feed on, to attach and remain impervious to brushing and flossing. Tartar below the gum has been removed by scraping the root surface without seeing seeing the deposit. Today, we understand that this “blind” approach can leave bacteria and tartar at the tooth, which in turn can prevent the gum from reattaching to the tooth and lead to re-infection.
Osseous surgery, sometimes referred to as pocket reduction surgery or gingivectomy, refers to a number of different surgeries aimed at gaining access to the tooth roots to remove tartar and disease-causing bacteria.
Osseous surgery is used to reshape deformities and remove pockets in the alveolar bone surrounding the teeth. It is a common necessity in effective treatment of more advanced periodontal diseases. The ultimate goal of osseous surgery is to reduce or eliminate the periodontal pockets that cause periodontal disease. Despite the word surgery the procedure is reported to feel more like a thorough cleaning. The specific goals of surgery include:
- Reducing Bacterial Spread:
Bacteria from the mouth can spread throughout the body and cause other life-threatening conditions such as heart disease and respiratory disease. Removing deep tartar and thereby bacteria can help reduce the risk of bacteria spreading.
- Preventing Bone Loss:
The immune systems inflammatory response prompted by periodontal bacteria can lead to bone loss in the jaw region, and cause teeth to fall out. Osseous surgery seeks to stop periodontal disease before it progresses to this level.
- Enhancing the Smile:
Mouths plagued with periodontal disease are often unsightly. Brown gums, rotting teeth, and ridge indentations can leave a person feeling depressed and too self-conscious to smile. Fortunately, osseous surgery can help reduce bacteria and disease and thereby restore your mouth to its former radiance, while restoring confidence at the same time.
- Facilitating Home Care:
As the gum pocket deepens, it can become nearly impossible to brush and floss adequately. Osseous surgery reduces pocket size, making it easier to brush and floss, and thereby prevent further periodontal disease.
What does the procedure entail?
A local anesthetic will be used to numb the area prior to surgery. The gum tissue is gently removed to provide access to the bone and roots of the teeth. After the roots have been thoroughly cleaned through scaling, the bone is reshaped to restore contours that are conducive to health. Bone grafting is also used to fill in large defects.
After the procedure, small sutures allow the tissue to heal in a healthy manner. The site will also be covered with a bandage (periodontal pack) or dressing.
Re-growing lost bone
In cases where we choose to regenerate (regrow) bone that has been lost to periodontal disease, the surgical access makes it possible to regrow bone that was previously damaged. When combined with the application of biomaterials that encourage the regeneration of soft and hard oral tissues, such as enamel matrix derivatives (see below), the surgical result is more predictable and more comfortable, usually with far less gum recession.
Enamel Matrix Derivatives (Emdogain)
Enamel matrix derivatives (EMD’s) are naturally occurring proteins found in all humans that help regulate the formation of our teeth. Like a multitude of proteins throughout our bodies, EMD’s are building blocks within the body cells. Similar proteins are found around the developing teeth of all mammals. First isolated in the 1980s, EMD’s have also been found to generate new bone around teeth and a new periodontal ligament that attaches the bone to the teeth. Those regenerative properties have made EMD’s quite valuable in the restoration of health around teeth ravaged by periodontal disease.
The EMD’s used in periodontal treatment have a porcine origin. They are isolated, processed, and prepared for “on-time” delivery during the therapy itself. Their use for treating periodontitis (bone loss from gum disease) and gum recession has been approved by the U.S. Food and Drug Administration.
Before EMD’s can be applied, the affected teeth are given a through cleansing to remove tartar and bacterial plaque using the endoscope. The tooth root surface is then cleaned with a preparatory material and the proteins are placed. These proteins quickly form an interactive yet invisible layer on the teeth which, in our experience, has significantly augmented healing following treatment of gum disease and implant placement.