September 29, 2011

Periodontal Disease: Dangerous to Your Health

The World Health Organization reports that 85% of the USA population has some kind of periodontal disease.  A small portion is due to genetics, but most is contributed to ineffective oral hygiene and a high sugar diet.

Periodontal Disease: A group of diseases that affect the bone and tissues that support the teeth. What this really means is gum disease that causes pockets and bone loss around the teeth.  You need four things to have gum disease: tooth, bacteria, sugar, time. These are the same factors that cause cavities.

Everyone has bacteria in their mouths that can cause gum disease.  When we eat sugar and don’t remove it in a timely manner the calcium rich saliva can harden the resulting plaque into tartar (calculus). In the below picture you see an example of both tooth decay and calcified plaque called calculus.  This periodontal disease is so severe it is causing a periodontal abscess. The bone loss is deep down along the side of this tooth and has made it get loose enough to need extraction.  This patient has not had their teeth examined or cleaned for several years. Remember, once bone loss has happened, it is very difficult if not impossible to regenerate.

Treatment for Gum Disease:

  • Gingivitis– This can be found around the teeth before periodontal disease forms pockets.  It is when the gums first start to get red and bleed.  It is cause by plaque staying too long around the necks of your teeth. The treatment for this is a good cleaning every 6 months and home oral hygiene instructions. The prognosis is good with treatment.
  • Mild Periodontal Disease– This is when gingivitis has been around your teeth too long.  Pockets (>4mm) are beginning to form around the necks of the teeth.  It maybe hard to distinguish from gingivitis on x-rays and any aggressive treatment is usually refused by dental “allowance” companies so they will not have to pay for your treatment.  Scaling and root planing is usually prescribed for this condition and is very effective in treating it.  Following the scaling and root planing is a maintenance appointment every 3-4 months with a good cleaning and home oral hygiene instructions.  This removes not only the calcified plaque above the gum line, but also the tartar below.  Removing the calcified plaque below the gum line is key to arresting this stage of periodontal disease. This tartar cannot be removed with a toothbrush and floss alone.  Only a professional cleaning can help. Perio Protect can be used with good success, but you have to use it all the time for it to work. Laser debridement is very effective as well.  The prognosis for this phase of the disease is fair with treatment.
  • Moderate Periodontal Disease– Bone loose can be clearly seen on the radiographs and pocket depths of 5-6mm are found around the necks of the teeth.  Scaling and root planing is a common treatment plan.  However, new treatments such as laser therapy is growing in popularity.  Some patients are referred to the periodontist for treatment which can include scaling and root planing in conjunction with some form of surgery. The prognosis is guarded with treatment.
  • Severe Periodontal Disease– Bad news! Bone loss and pockets >6mm deep.  There is no way a patient can clean their teeth properly without professional assistance.  If you are referred to a periodontist at this point they may want to consider extractions and implants.  Patient who do not want to be referred to the specialist can go into compromised maintenance therapy.  This is where the hygienist cleans out you pockets as well as she can with scaling and root planing.  This will not ever cure your disease, but it may slow it down greatly.  Eventually, the bone loss will become so severe that the tooth gets loose and may fall out. The prognosis is poor.
  • End Stage Periodontal Disease– This is not an actual category of this disease, it is simply the stage I call it when periodontal disease is so bad, teeth are falling out by themselves. The only treatment is extraction.  There are a variety of ways to restore lost teeth. Those ways are explored in more depth in other blogs on this website.  The prognosis for end stage periodontal disease is hopeless.

Why is Periodontal Disease dangerous to Your Health?

When bacteria lives deep under your gum line bleeding is common. Every time you stimulate bleeding with your toothbrush or floss or eating you have the chance to cause bacteria to enter your bloodstream.  This near constant flow of bacteria into your bloodstream is not good.
  • Cardiovascular Disease– Periodontal disease is considered an independent risk factor for atherosclerosis which can contribute to cardiovascular diseases.  A few years ago there was a well know syndicated humorist called Louis Grizzard who famously died at the young age of 47 from cardiovascular disease and possibly dental neglect.
  • Diabetes– is a very complicated metabolic disease causing high blood sugar.  Not enough insulin is produced or cells cannot use the insulin anymore.  In a nut shell, diabetes makes it harder to fight infection.  This can lead to rapidly advancing gum diseases.
  • Cerebrovascular Disease– is a condition that results from problems with the bloodstream inside the brain. It is very similar to the complications due to cardiovascular disease.  Bacteria from periodontal disease can accumulate inside the blood vessels and contribute to the formation of atherosclerotic plaques which can either block oxygen to certain parts of the brain (stroke) or cause them to weaken enough to pop (cerebrovascular hemorrhage).
  • Osteoporosis– Clearly this condition of the bone is linked to periodontal disease.  It is just unclear which is influencing which.
  • Liver and Lung abscesses– Periodontal disease sheds bacteria throughout the body through the bloodstream and where the blood is filtered or narrowed into a capillary bed (liver/lung) it can get lodged and in certain instances grow into a local nidus of infection called an abscess.
  • Pancreatic Cancer– Although it has not been proven, nitrosamines produced by periodontal disease bacteria may be responsible for causing cancer in the body, including the pancreas.
  • Alzheimer’s– The link between periodontal disease is not well understood.  It may be similar to how other bacteria such as syphilis makes to to the brain.
  • Pregnancy Complications– Although the data is inconclusive, low birth weight and periodontal disease is continuing to be studied.
The Perio Protect Method of treatment is catching on as a hopeful overall painless treatment for periodontal disease and ramped caries.


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