Periodontal Disease

What is Periodontitis?

So, most of us have probably heard about gingivitis because it’s talked about on commercials on tv all the time. Periodontitis would be that condition, gingivitis, getting worse and creating more disease and other problems in people’s mouths. So it would be a progression of the gingivitis disease to the point where we call it gum disease and there is a distinction there.

What are the warning signs of periodontal disease?

There can be several! A few could be bad breath, bleeding gums, although gums can bleed slightly even with gingivitis, and pain or discomfort in the gums whether it’s after brushing or after eating. There can even be full on tooth aches that happen because of periodontitis and swelling in the mouth if it gets to that point.

When should you see a dentist if you are suspicious you may have periodontal disease?

The answer to that is as soon as possible! Periodontal disease goes at different rates for different people. A lot of that has to do with the fauna and flora that we all individually have, and we all have our own unique profile almost like a fingerprint! If your profile is bad or the bacteria is aggressive, periodontitis could go really fast or really slow, but it’s not worth taking a chance because the consequences can be really severe.

What role does the immune response have in periodontal disease?

A lot and it can be very complicated so we will try to stick to the basics. The immune response obviously doesn’t want the bacteria to deepen the pockets. It doesn’t want the bacteria there at all so it will fight that. Unfortunately, what often happens is that as the gum disease progresses and works its way down the tooth, that 3mm pocket becomes 4mm and then 5mm and then 6mm and so on. As that happens the body attacks that bacteria that’s setting up infection in our mouths, and the collateral damage of all these little explosions of the immune system is bone. And when we start to lose bone around our teeth, the teeth will become mobile and start to move around because we don’t have as much bone and foundational support holding them in our jaw anymore. So, sometimes the amount of immune response we have can even hurt us if there is a lot of inflammation and things of that nature. The immune system can fight so hard, it can make the damage go faster! Ultimately though, without any immune response, the bacteria would be allowed to progress unchecked and the bacteria themselves would eat away at the bones. So, ideally, our immune system will  help to keep periodontal disease at bay and not allow it to progress super rapidly, to where we lose our teeth faster than we can actually deal with the disease process. But it’s a mixed bag sometimes with the immune response.

How does periodontal disease progress if left untreated?

I alluded to that a little bit earlier with the previous question, but our pocket depths increase and as they increase, bacteria can get down the side of the tooth even further. And as it moves down the tooth it can even set up gum infections and we can start getting swelling and pain in our mouth and eventually we lose bone, and we lose gums. This is called gum recession. Gum recession is ultimately the response often to gum disease. If we lose bone, the gums follow that bone. And if you don’t have enough bone supporting things, the gums shrink back, and we end up seeing long teeth in people. This is where the expression “Long in the tooth” comes from! As we live longer, it’s more likely that we have some gum disease. Now, you can sometimes halt that gum disease and slow down the progression, but after you have lost gums and have recession, you will have that length in the tooth.

What is a Periodontal Cleaning?

Well, it can go by a couple of different names. One is a Deep Cleaning and one is called SRP, or Scaling and Root Plaining. But a periodontal cleaning is meant to describe a cleaning that goes all the way down to the base of deep pockets. Healthy pockets are less than 3mm deep. So, if the pockets are 4mm or 5mm or 8mm deep, we will go down to that depth between the tooth and the gums to clean out the bacteria and tarter, because bacteria in this case start to grab calcium from our saliva. That bacteria doesn’t like to get washed off of our teeth, it wants to set up a home. Calcium is something that it can use to deposit on the side of our teeth to give them a better home. But once we get that calcium off, the tarter, or calculus, which is another name for it, it becomes much harder for the bacteria to stay there. So that’s the whole purpose of a periodontal cleaning, to get rid of the home and disrupt the bacteria’s lifestyle so that we can keep bacteria levels much lower. Also, to try and select for our mouths a healthier breed of bacteria. That’s essentially what happens every time we brush our teeth. The more we brush our teeth, the less we allow bad bacteria to get a hold in our mouths. We can never completely sterilize a mouth and get rid of all the bacteria, but the whole goal would be to get good bacteria that out-compete the bad ones.

Can you get crowns with periodontal disease?

The answer is yes you can, but the bigger answer is that it’s not a great idea to spend money fixing teeth that are already in very bad condition. If you have lots of gum disease and you have a very loose tooth and it’s very unlikely that you will keep the tooth for an extended period, we don’t recommend that you spend money keeping it. Gum disease can get to the point where if there is enough damage we start recommending removing those teeth to get rid of the disease process, and then we start recommending dentures.

What treatments are available for periodontal disease?

We mentioned those a little earlier we have deeper cleanings. Regular cleanings are for people that have normal and healthy gums that have less than 3mm pocket depths. When you get beyond that, 4mm, 5mm, 6mm, 8mm, even 10mm pockets, you need a deeper cleaning. We actually will numb your mouth because that can be a little uncomfortable to clean, and then we will go down and clean that out. For the very deep pockets, we can do something called Gingival Flap procedures to get in there with a laser or even sometimes with a blade to pull gums out of the way and help us clean the side of the tooth more effectively. And then there is the ultimate treatment for gum disease that has gone too far, and that is extraction. We remove the bad and diseased teeth and replace them whether it be with implants, dentures, or other options.

Can periodontal disease be cured?

The technical answer is no. Once you have periodontal disease you will never be back to the original place that you were when you just had gingivitis. After having periodontal disease, any gum disease will be considered periodontal disease. It can however be halted or dealt with to the point of holding it where it is so that it will not go back to the previous level of disease. The regular way that we go about it at our practice, Integrity Dental, is to see you every 3 months for a year. We do the deep cleaning the first time around where we numb your mouth and go in and clean all the bad stuff off and do a lot to get you back to a healthy oral state. And then you as the patient are responsible for the next 3 months to clean your mouth well whether it be just with cleaning and flossing, or we have additional things like prescription strength mouth rinses or peroxide gel and things of that nature to help you start reconditioning and cleaning the mouth and lowering the bacteria levels. Then we bring you back every 3 months to check your progress. Nobody is going to get all of their deep pockets and go back to a 3mm pocket in one visit, but we are trying to help them make progress. At the one-year mark, we want to go back and remeasure the pockets and see how much progress you have made. If you have gotten rid of all of your 5mm and 6mm pockets, for example, and we are back to 1mm, 2mm, 3mm, maybe even a 4mm pocket, we will then consider you relatively healthy and your gum disease to be relatively under control. Then we can go back to an every 4 month or an every 6 month schedule for your cleanings. But you will always be more susceptible to getting active gum disease once you have had periodontal disease.

How can I schedule a dental appointment today?

Whether you are dealing with gum disease or any other issue you have dealing with your mouth, here at Integrity Dental, we don’t want you to wait. Your mouth is so important to your overall well-being and your overall quality of life. So, if you are concerned that you have some dental needs going on, please don’t hesitate to call us at 719-545-2468. You can look us up at our website, Facebook page, or Instagram. We would be happy to set you up with an initial visit whether it is just a consult or coming in for your initial exam. We are very good here at getting people back  to a healthy oral state. We love doing it. That’s what makes it worth getting up in the morning for us dentists, for us to see go from an unhealthy state to a state of healthy and thriving. So give us a call today!