Signs and Symptoms
Periodontal disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Then one day, on a visit to your dentist, you might be told that you have chronic gum disease and that you may be at increased risk of losing your teeth.
Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. They include:
Even if you don't notice any symptoms, you may still have some degree of gum disease. Some people have gum disease only around certain teeth, such as those in the back of the mouth, which they cannot see. Only a dentist or a periodontist--a dentist who specializes in gum disease--can recognize and determine the progression of gum disease.
The American Academy of Periodontology (AAP) says that up to 30 percent of the U.S. population may be genetically susceptible to gum disease. And, despite aggressive oral care habits, people who are genetically predisposed may be up to six times more likely to develop some form of gum disease. Genetic testing to identify these people can help by encouraging early treatment that may help them keep their teeth for a lifetime.
During a periodontal exam, your gums are checked for bleeding, swelling, and firmness. The teeth are checked for movement and sensitivity. Your bite is assessed. Full-mouth X-rays can help detect breakdown of bone surrounding your teeth.
Periodontal probing determines how severe your disease is. A probe is like a tiny ruler that is gently inserted into pockets around teeth. The deeper the pocket, the more severe the disease.
In healthy gums, the pockets measure less than 3 millimeters--about one-eighth of an inch--and no bone loss appears on X-rays. Gums are tight against the teeth and have pink tips. Pockets that measure 3 millimeters to 5 millimeters indicate signs of disease. Tartar may be progressing below the gumline and some bone loss could be evident. Pockets that are 5 millimeters or deeper indicate a serious condition that usually includes receding gums and a greater degree of bone loss. Following the evaluation, your dentist or periodontist will recommend treatment options. Methods used to treat gum disease vary and are based on the stage of the disease.
The goal of periodontal treatment is to control any infection that exists and to halt progression of the disease. Treatment options involve home care that includes healthy eating and proper brushing and flossing, non-surgical therapy that controls the growth of harmful bacteria and, in more advanced cases of disease, surgery to restore supportive tissues.
Although brushing and flossing are equally important, brushing eliminates only the plaque from the surfaces of the teeth that the brush can reach. Flossing, on the other hand, removes plaque from in between the teeth and under the gumline. Both should be used as part of a regular at-home, self-care treatment plan. Some dentists also recommend specialized toothbrushes, such as those that are motorized and have smaller heads, which may be a more effective method of removing plaque than a standard toothbrush.
John J. Golski, D.D.S., a Frederick, Md., periodontist, says that the rationale behind flossing is not "just to get the food out." From the periodontal standpoint, Golski says, "You're flossing to remove plaque--the real culprit behind gum disease," adding that proper brushing and flossing techniques are critical.
During a typical checkup your dentist or dental hygienist will remove the plaque and tartar from above and below the gumline of all your teeth. If you have some signs of gingivitis, your dentist may recommend that you return for future cleanings more often than twice a year. Your dentist may also recommend that you use a toothpaste or mouth rinse that is FDA-approved for fighting gingivitis. In addition to containing fluoride to fight cavities, Colgate Total--the only toothpaste approved by the FDA for helping to prevent gingivitis--also contains triclosan, a mild antimicrobial that has been clinically proven to reduce plaque and gingivitis if used regularly. A chlorhexidine-containing rinse, also approved to fight plaque and gingivitis, is available only with a prescription.
If your dentist determines that you have some bone loss or that the gums have receded from the teeth, the standard treatment is an intensive deep-cleaning, non-surgical method called scaling and root planing (SRP). Scaling scrapes the plaque and tartar from above and below the gumline. Root planing smoothes rough spots on the tooth root where germs collect and helps remove bacteria that can contribute to the disease. This smooth, clean surface helps allow the gums to reattach to the teeth.
A relatively new drug in the arsenal against serious gum disease called Periostat (doxycycline hyclate) was approved by the FDA in 1998 to be used in combination with SRP. While SRP primarily eliminates bacteria, Periostat, which is taken orally, suppresses the action of collagenase, an enzyme that causes destruction of the teeth and gums.
Periodontal procedures such as SRP, and even surgery, are most often done in the office. The time spent, the degree of discomfort, and healing times vary. All depend on the type and extent of the procedure and the person's overall health. Local anesthesia to numb the treatment area usually is given before some treatments. If necessary, medication is given to help you relax. Incisions may be closed with stitches designed to dissolve and may be covered with a protective dressing.
Susan Runner, D.D.S., chief of the Dental Devices Branch in the FDA's Center for Devices and Radiological Health, says that devices have been approved both for diagnosing gum diseases and promoting regeneration of periodontal tissue. "Periodontal membranes, along with bone-filling material, are used in treatment of the condition to help repair damage resulting from periodontal disease," Runner says. "Tissue engineering devices mimic the biological characteristics of the wound-healing process, and may help stimulate bone cells to grow."
Opinions about which treatment methods to use vary in the periodontal field. For some people, certain procedures may be safer, more effective, and more comfortable than others may be. Which treatment your dentist or periodontist chooses will most likely depend on how far your disease has progressed, how you may have responded to earlier treatments, or your overall health. "Generally, we all have the same goals, but the methods for getting to them may be different," says Golski. "One size doesn't fit all." Professional treatment can promote reattachment of healthy gums to teeth, reduce swelling, the depth of pockets, and the risk of infection, and stop further damage.
"But in the end," Golski says, "nothing will work without a compliant patient."