Local Dental Care - Periodontal Disease Treatment

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

The Lowdown on Gum Disease

Dentistry has surely shifted its focus from cavity control, thanks to fluoride and early dental care. Now we are learning more about periodontal disease, and for good reason. These days, tooth loss is the likely result of gum disease.

Q. I used to come in twice a year for cleanings. Now the dental hygienist says I need more attention, more often. My insurer limits coverage to six-month visits. What's up?

A. First, we know more about diagnosing the disease and have come upon some very dangerous systemic relationships to other conditions. That is, if you have heart problems, diabetes, or you're expecting a baby, we'll have to watch you closer than the next patient. Ongoing treatment for advanced mouth disease (periodontitis), too, should be scheduled more often.

Q. OK. What will periodontal treatment cost? I want to keep all the teeth I have.

A. You'll have to contact your periodontist's office for specific pricing but to treat a light case of gingivitis - the very first stages of disease - is the least expensive. Deep pockets around teeth and apparent bone loss - a complex case - will cost more. Periodontitis that requires surgery, and maybe the services of a specialist, costs much, much more. A good argument for early gum disease treatment and prevention.

Q. When you're done with me, am I cured?

A. Periodontal and gum disease prevention is the best defense because nobody walks away from it. Unfortunately, periodontal disease is incurable. But with your help, we can keep it under control. So much of your tissue health depends on how much work you're willing to put in. There's nothing magical about brushing and flossing. You just have to do it.

+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.