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Bleeding Gums

If you have bleeding gums, you may have periodontal disease. We're learning more about this common infection all the time. Below are some of the latest findings. It should help you understand why it's so important that you take action with your periodontist to eliminate periodontal disease, the sooner the better.

Some patients think swollen gums aren't as critical as tooth decay, but that's just not so. Periodontal disease begins as a minor infection and, if it doesn't show signs of stabilizing, is bound to get worse. Untreated, it can eventually result in tooth loss.

Type I periodontitis (gingivitis) consists of tender gums and a little bacteria-filled pocket between your tooth and gum. The disease is very treatable at this point. But if the infected pockets are allowed to enlarge, the inflammation extends to the bone beneath, which begins to erode.

There's another reason to take periodontal disease seriously. The Journal of the American Dental Association recently reported on a study of nonsmokers. Researchers found that periodontal disease was a stronger risk factor for heart disease than such typical symptoms as high cholesterol or high blood pressure. Also, periodontitis in pregnant mothers has been linked to premature and low birth-weight babies.

Your periodontist's concerns for your health don't stop with your teeth. That's why it's important, if you're suffering from gingivitis, that you schedule an appointment and get it treated. When you do, make sure you let your dentist know if you are also being treated for heart disease by your medical doctor.

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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