Local Dental Care - Periodontal Gum Disease

Periodontal Disease: Preventing Tooth And Bone Loss

The best way to control periodontal disease and to help prevent tooth loss is with early detection and treatment. Three out of four people are afflicted by periodontal disease at some point in their lives, so everyone should be tested. After reviewing a patient's dental and medical history, the dental care provider or periodontist will conduct a thorough clinical intraoral exam called a periodontal charting.

This consists of taking a series of measurements around each tooth. Unless the gums are very inflamed and sensitive, the periodontal charting causes minimal discomfort.

The space between the gum and the tooth is measured using a periodontal probe. This space is called the probing or pocket depth. In a healthy mouth, this space should be between 0 and 3 millimeters.

The amount of recession or loss of gum around each tooth is measured. In healthy mouths, the gum tissue should be at the junction of where the crown of the tooth meets the root. The two measurements (pocket depth and recession) are then added to calculate the amount of attachment loss around each tooth. The greater the amount of attachment loss, the more advanced the periodontal disease.

While completing the periodontal charting, a dentist will evaluate the conditions of an individual's gums. Healthy gums are pale pink, firm, and immobile. The gums should not bleed during the probing exam. Bleeding gums during this exam are a sign of gum inflammation, gingivitis or periodontitis.

The dentist will also measure tooth mobility. Under normal functional conditions, teeth should not move. Tooth mobility is a sign that there has been bone loss around the teeth or that the biting forces are too strong. If so, the dentist may also assess a patient's occlusion, or bite. If the bite has changed or if the forces on the teeth are too strong, there may be an acceleration of bone loss around the teeth.

A full mouth series of X-rays (approximately 20 films) are also indispensable in a periodontal examination.

In addition to identifying areas with cavities, bone infection, tumors, or developmental abnormalities, X-rays help reveal if bone loss has resulted from periodontal disease. The crest of the teeth's supporting bone is normally 2 mm below where the crown of the tooth meets the root. A greater distance indicates a history of bone loss.

Although bacterial samples are not usually taken for diagnosis of periodontal disease , under certain circumstances, it may be necessary to take a bacterial culture from a plaque sample. This is especially valuable to help detect sites at high risk for disease progression or if conventional treatment is not working.

The culture is analyzed in a laboratory for the presence of certain bacteria that are known to contribute to gum disease. Actually, of the more than 300 different types of bacteria normally found in the mouth, there are only about 13 that are known to be associated with causing periodontal disease. After identifying the specific disease-causing bacteria, the laboratory can test to determine what antibiotics they are susceptible to.

Depending on the risk factors (see article " Risk Factors for Periodontal Disease") involved and a person's specific situation, other tests may also be required. Under certain circumstances, a dentist may require diagnostic casts (molds of one's teeth), medical laboratory tests, medical consultation, or genetic testing.

After completing the periodontal examination, the dentist will be able to discuss with the patient the diagnosis, treatment alternatives, potential complications, and expected results. The key to long-term periodontal health is early diagnosis and treatment. Because everyone is at risk of developing periodontitis, everyone should be routinely tested.

By Laura Minsk, DMD

Gum Disease and Preterm, Low Birth Weight Babies

Is there a link between maternal periodontal disease and premature, low birth-weight babies?

The Journal of Periontology published a special supplement in October 1996 to introduce an important study, "Periodontal Infection as a Risk Factor for Preterm Low Birth Weight." This study establishes just such an association.

Periodontal disease is a chronic infection of the oral cavity that can worsen without treatment, especially during pregnancy. This study is one of the first of its kind to suggest maternal periodontal disease as a possible risk factor for premature, low birth-weight babies, according to The American Academy of Periontology.

In order to substantiate these results, more studies are needed. We'd also benefit from determining whether intercepting maternal periodontal disease will reduce the risk of premature delivery.

Until we learn the results, the American Academy of Periontology urges that any periodontal infection during pregnancy should be treated seriously. If a woman has been diagnosed with periodontal disease, she and her obstetrician - with consultation from a periodontist - should follow the best plan of treatment.

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