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
Periodontitis and Gum Disease Treatment
It's natural to want to lump people together in some Big Category. Natural, but wrong. Like, "Baby Boomer." President Clinton and home run slugger Mark McGwire are both "Boomers." But are these two guys exactly alike?
It's the same in health and dental care. Your oral chemistry is as unique as your thumbprint. Yet magazine stories claim "you" need only one dental appointment a year to stay healthy. They don't know you. They're referring to an "average" patient. Dental insurance plans also tend to believe in this mythical "average patient" and may not pay for more than a biannual visit.
Sure, two visits are fine for many patients, even most. But some mouths build up more tartar than others. Others are naturally decay-prone. Still others - and this is critical - may be showing signs of periodontal (gum) disease.
Bleeding gums need to be taken seriously. They're signs of an infection that can be a significant risk factor for heart disease, and, in fact, many serious illnesses. If you had a bleeding sore on your hand that didn't heal you'd get to a doctor for a checkup, right? Type I periodontitis (gingivitis) consists of tender gums and a little bacteria-filled pocket between your tooth and gum. It's easily treatable at this point. But if the infected pockets are allowed to enlarge and you get swollen gums, that inflammation can extend to the bone beneath and erode it.
Your periodontist's concern is for your health and your teeth, not whether you've made the standard number of appointments for this year. He or she wants the chemistry to be right in your mouth... and between the two of you.
+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.