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Gingivitis and Gum Disease Basics

It afflicts as many as nine in ten adults at some point in their lives, as well as teenagers and children as young as five or six years of age. Yet, many suffer from it without even suspecting anything is wrong.

"It" is periodontal disease, or gingivitis - in the minds of most dentists, Public Enemy Number one for teeth.

Only for the last 30 years have researchers understood that gum disease is an infectious disorder, caused by many different species of bacteria. But even today, there is no cure. Fortunately, we have learned a good deal about what periodontal disease is and what can be done about it.

Behind the scenes

The culprits in gum disease are the bacteria that thrive in the crevices between gums and teeth, accumulating in the form of plaque, a hard, colorless film. Plaque produces toxins that not only irritate gums and cause bad breath, but can eventually attack connective tissue, bone and teeth.

These crevices become "pockets" where the bacteria lodge and begin to erode the tissues that connect gums with teeth. If periodontal disease isn't checked, the pockets deepen. The havoc spreads. Eventually, the bone around the teeth and roots is destroyed - and the teeth soon follow.

Sounding the alarm

How can you tell if you have a periodontal problem?

If you have bleeding gums or if you have swollen gums, gingivitis may be the reason why. But mouth disease can strike silently, without any pain or obvious signs.

Any bleeding from your gums should be a tip-off. Make sure you're doing a thorough but gentle job of brushing and flossing every day. If bleeding persists, it's time to see your periodontist. Different people have different levels of susceptibility to periodontal disease, and some forms - including those that affect children and adolescents - can develop quite rapidly.

Not everyone who has gingivitis disease goes on to develop more serious periodontal problems. Some people manage to reverse the disease or stop the progress of chronic gingivitis when it flares up.

Until there's a cure, the fundamentals of gum disease prevention - regular professional care and careful brushing and flossing at home - are still the best line of offense for good dental health.

Ways to fight back

• Periodontal disease can be checked and often reversed with simple preventive measures: brushing, flossing and professional cleaning to remove plaque and stimulate gum circulation.
• If the problem has become more serious, the dentist may do what's called scaling and planing - deep scraping of plaque from under the gum line, and smoothing of root and tooth surfaces so gum tissues have a better chance to reattach.
• Promising new gum disease treatment is already on the horizon: antiseptic or antibiotic drugs placed at the site of infection. And new chlorhexidine mouthwashes that may help prevent the formation of plaque.

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Periodontics: Uses of Periodontic Dental Lasers

Since their introduction in the 1960's, laser use in medicine and dentistry has increased steadily, and it's been no different in Periodontics. The CO2 and the Nd:YAG lasers have both received Food and Drug Administration (FDA) approval for soft tissue surgery and are the most commonly used lasers in dentistry. A dental laser work by delivering concentrated beams of light strong enough to cut through tissue.

Pros & Cons of Dental Lasers

The popularity of lasers results from claims that dental laser gum treatment is painless. Although the FDA has not permitted the manufacturer of any laser to make that claim, the general experience described by patients is that there is less pain and swelling after laser treatment compared to conventional oral surgery. Local anesthesia for pain control is still required during laser surgery.

Another advantage of the laser is that it causes less bleeding in the area of surgery than traditional oral surgery techniques. This is especially helpful in the oral cavity, which has an abundant blood supply. The laser decreases bleeding by sealing the blood vessels at the surgical wound. On the flip side, this can delay healing and create a less stable wound.

Application of Lasers in Periodontal Treatment

The application of lasers in periodontal treatment is restricted to the removal of gum tissue to reduce pocket depth, or for some minor periodontal plastic surgery procedures. These surgeries can be easily performed with traditional instruments without the additional high cost of dental laser treatment.

More recently, lasers have been evaluated for use in scaling and root planing. But in a research study recently published in the Journal of Periodontology, laser therapy appeared to be less effective than traditional scaling and root planing treatment. In fact, research has not conclusively shown that laser therapy is effective in removing the tartar that has accumulated under the gum line and can actually damage the surfaces of teeth and the bone. This damage could delay healing and the ability of the gum tissue to reattach to the root surface.

For all these reasons, the American Academy of Periodontology is concerned about misleading claims regarding the use of lasers in periodontics. It is important to remember that laser treatment in periodontics is limited to soft tissue (gum) for periodontal surgery and that the laser beam should not touch the tooth or bone. Anesthesia is required during dental laser treatment, and dental laser treatment may be more expensive than traditional surgical procedures.

By Laura Minsk, DMD