Local Dental Care - Gum Cancer

Risk Factors For Gingivitis and Periodontitis

It is well established that the main cause of gingivitis, or periodontal disease, is bacterial plaque. But not everyone responds the same to the same bacterial infection. There are many factors that can contribute to making someone more or less susceptible to the progression of periodontitis. These factors are called risk factors. They can increase the risk, severity, and speed at which the disease develops. Some risk factors can be modified. If they are, gum disease and tissue destruction can be controlled and maybe even prevented with periodontal treatment.

There are several factors that can put individuals at greater risk for gingivitis or periodontal disease.

2. Crowded Teeth: Crowded teeth can contribute to plaque retention and interfere with oral hygiene. If this becomes a problem, it may be necessary to reshape the teeth or move them to a better position with the use of dental appliances or braces.

3. Poor Fitting Dentures, Fillings, or Crowns: These factors also may contribute to plaque retention and interfere with oral hygiene methods. If this is the case, the restorations may need to be reshaped, polished, or even replaced.

4. Occlusion (the way the teeth bite or come together): The forces created by an unbalanced bite, by clenching, or by grinding of the teeth, can accelerate the progression of bone destruction and periodontal disease. These forces can also contribute to excessive wear of the teeth, fractures, temporomandibular joint (TMJ) problems, or root canal problems. People who clench or grind their teeth may not be conscious of it, but may experience sore jaw muscles, TMJ problems, headaches, and neck or shoulder pain. Most people are more susceptible to clenching or grinding during periods of high stress. These habits can be controlled and treated with specially made dental appliances (night guards), braces, reshaping of the biting surfaces of the teeth, exercises, medications, or a combination of the above.

5. Tobacco: People who smoke or chew tobacco are more likely to have periodontitis. They also are more likely to have a poorer and slower response to periodontal treatment. The risk of acquiring periodontal disease decreases after smoking cessation and former smokers and non-smokers respond the same to treatment from a periodontist. Smoking cessation is beneficial to periodontal and overall health.

6. Poor Nutrition: Although periodontal disease is not caused by nutritional deficiency, a diet low in nutrients can diminish the effectiveness of the body's immune system. This reduces the resistance to infections such as periodontitis. To aid in the body's capacity to fight infections, maintain a well-balanced diet and avoid fad diets that exclude entire food groups and limit nutrients.

7. Stress: Stress reduces the immune response and makes it hard for the body to fight infection. A study has shown that people who are under financial stress and have poor coping ability have a two-fold increase in the incidence of periodontal disease.

8. Pregnancy and Female Hormonal Changes: The hormonal changes that occur during pregnancy, puberty, and menstruation can make the gums more sensitive to bacterial plaque and increase the risk for periodontal disease. Pre-existing periodontal problems can become more severe if plaque is not controlled. So an efficient and consistent plaque control program is essential in maintaining periodontal health through pregnancy and all stages of life.

9. Systemic Diseases: Certain systemic (general body) diseases, such as AIDS and diabetes, may decrease the body's ability to fight infection and can result in more severe periodontal disease. Always keep your dental care provider informed of changes in medical status.

10. Medication: Drugs such as birth control pills, immunosuppressants, anti-depressants, and some heart medications can also increase the risk for periodontal disease. Patients should inform their dental care provider of any changes in the medications that they may be taking.

11. Genetics: Up to 30% of the population may have a gene that is linked with an increased susceptibility to periodontal disease. Although genetics is not modifiable, knowing one's genetic profile puts individuals in a proactive position regarding dental health. Through proper home care, periodontal maintenance visits, modification of known risk factors, and early intervention, individuals have an excellent chance of keeping their teeth for a lifetime.

By Laura Minsk, DMD

Periodontal Disease Treatment Slows Periodontitis

One of the goals of periodontal disease treatment is to arrest and control the progression of the bacteria that cause gingivitis and periodontal disease. As the bacteria infect the gum tissues, they release toxic substances that trigger the breakdown of gum and bone. The gum then separates from the teeth, forming a gap that is called a periodontal pocket. These spaces are inaccessible to daily oral hygiene techniques. Bacteria settle in these pockets and continue to accumulate and reproduce, creating further gum and bone destruction.

Periodontal disease treatment such as scaling and root planing involve the removal of the irritants and bacterial deposits (plaque and tartar) that have accumulated above and below the gum line in the periodontal pockets. The root surfaces of the teeth are planed (smoothed) to promote healing and to help prevent future bacterial reattachment. At the same time, gingival (gum) curettage can be done to remove the infected soft tissues that line the periodontal pockets.

Most of the time, scaling and root planing is done in two to four visits. For patient comfort, the gums can be numbed by the periodontist using a local anesthetic. One-quarter of the mouth is usually treated at the time and treatment of each quarter can take 45 minutes to an hour (three to four hours for the entire mouth). Most patients report minimal discomfort during these periodontics treatments.

During scaling and root planing appointments, the dental care provider will review oral hygiene techniques that are aimed at improving the person's ability to control plaque and to help avoid bacteria from re-infecting the pockets. Patients also will receive advice on the modification of certain risk factors associated with periodontal disease.

In some circumstances, the dental care provider may recommend the use of adjunctive products for periodontal treatment. To be effective, antimicrobial products such as Chlorhexedine, PerioChip, and Atridox should be used in combination with scaling and root planing. Periostat is also a product that can be used as an adjunct to scaling and root planing in order to impede further tissue breakdown and promote healing.

Several weeks after completion of scaling and root planing, a periodontal re-evaluation should be completed. The purpose of this exam is to assess the response to treatment and determine if there is a need for further treatment.

The best way to stop the progression of periodontal disease is to mechanically remove the bacterial plaque and tartar that have accumulated in the periodontal pocket. Daily oral hygiene and supportive periodontal treatment (see article "Supportive Periodontal Treatment") is key to the success of scaling and root planing. Without treatment, the tartar and plaque buildup underneath the gums will continue to cause periodontal tissue breakdown, progression of periodontal disease, and eventually tooth loss and/or systemic (general) complications.

By Laura Minsk, DMD