Gum Disease...

Dr. Pietrini writes a monthly column for Fra Noi, an Italian newspaper. Articles related to the topic of Gum Disease are featured below. Click here to view this month's article

The Barnacle by Dr. Pietrini
Several years ago in the movie "Summer Rental", the late John Candy bought an old boat called the "Barnacle." The mineral deposits found on the bottom of boats are known as "barnacles." They are similar to the deposits found on the teeth, which we refer to as calculus or tartar. Calculus can be found throughout the mouth, but it is usually found in heavier amounts on the cheek side of the upper molars and behind the lower front teeth where the deposits flow out of the salivary ducts. The amount of buildup varies from patient to patient.

As part of a comprehensive oral examination, the dental team will use various tests and criteria to determine the patient's periodontal condition. Visual examination and x-rays will give an indication of the location and the extent of the calculus buildup as well as evidence of gum recession and bone loss. Initially the dentist or hygienist may perform a "periodontal screening and recording" (PSR). As hard deposits and dental plaque accumulate on the teeth, the gingival tissues (gums) will become red and swollen and will start to separate from the underlying bone around the teeth creating periodontal pocketing. If the PSR indicates that significant pocketing is occurring, then a full mouth probing and charting might be necessary. This will aid the dental team in diagnosing if there has been any "loss of attachment" of the periodontal tissues. A zone of healthy tissue must be present around the teeth and bone, which is capable of withstanding the abrasion caused by foods, brushing and flossing. The patient's health history is reviewed to determine if there are any underlying factors or medications, which might affect the periodontal condition and could contribute gum recession and bone loss.

The earliest stage of periodontal disease is called gingivitis. It is usually characterized by red, swollen gums accompanied by a moderate to heavy buildup of calculus with minimal gum recession or bone loss present. Brushing and flossing or gentle probing of the tissues will cause bleeding to occur. Generally the patient will not experience any discomfort at this stage of the disease process. At this time, the dental staff will recommend a treatment plan, which usually begins with thorough scaling and root planing of the teeth using ultrasonic scaling devices and hand instruments. At times, nitrous oxide and/or local anesthetic may be utilized to minimize discomfort. Oral hygiene instructions are reviewed and occasionally antibiotics and/or antimicrobial mouth rinses are prescribed.

Periodontal patients are generally seen at three-month intervals for re-evaluation and treatment. Studies indicate that after thorough scaling and root planing or following surgery, plaque and bacteria begin to aggressively organize during the next ninety-day period. With the patient's assistance in maintaining good oral hygiene on a daily basis and with thorough follow-up scaling and polishing, periodontal health can be stabilized.

In next months article, I will discuss more advanced periodontal problems and the variety of treatments available. To all of our readers-BUON NATALE!

A Very Sticky Situation by Dr. Pietrini
Several years ago, a patient ran into my office in a state of panic. She had planned to repair a broken vase with Crazy Glue™. Unwisely; she made the mistake of attempting to remove the cap with her teeth. As she pulled the cap off, she accidentally squeezed the tube and squirted glue all over her teeth and gums. It took some effort on my part to get her out of this "very sticky situation." Normally the dental team spends its time cleaning tartar and plaque from the teeth and gums, although several years ago there was a dental product that was impregnated with tetracycline inserted between the tooth and gum and sealed with a glue to hold it in place for several days.

As I stated last month, periodontal (gum) disease is the number one cause of tooth loss for adults. Periodontal disease starts when bacteria become trapped in plaque and calculus (tartar) attached to the tooth surface. Eventually it causes the gums to become red and swollen (inflamed), causing the gum tissue to be separated from the tooth and bone, forming pockets. The body tries to fight off insult to the gums by sending infection-fighting white blood cells to the inflamed sites, which release enzymes that breakdown the bone and gum tissue surrounding the teeth. The earliest form of this disease is known as gingivitis. Untreated, this may eventually lead to an advanced stage of disease known as periodontitis. Once gum recession and bone loss have occurred, it is often irreversible and requires treatment to slow down the progress of the disease.

Depending on the severity of the disease, the most common periodontal treatment starts with a soft tissue management program. Your dental office may choose to provide this treatment or they may refer you to a periodontitis, who specializes in treating gum disease. Usually the dentist or hygienist will perform scaling and root planing, which removes the plaque and calculus from the surfaces of the teeth-above and below the gumline. This is often accomplished with the use of hand instruments and ultrasonic cleaners. Today, many offices use lasers to increase the effectiveness of the treatment. The laser help to remove the diseased lining from within the wall of the periodontal pocket and has been shown to reduce certain types of harmful bacteria. Lasers can be used to remove and recontour gum tissue when necessary-they also help to reduce the amount of post-operative pain, swelling and bleeding. In more advanced cases, other surgical procedures might be advisable, such as gum or bone grafts or dental implants to replace teeth that cannot be saved.

Your dentist may choose to prescribe medications such as antibiotics or antimicrobials to help eliminate bacteria. Your dentist or hygienist may choose to rinse the treated sites with chlorohexidine, which can also be dispensed as a mouth rinse. Dissolvable antimicrobial chips can be placed into the gum pocket. Recently, the Food and Drug Administration (FDA) approved the use of PeriostatTM a form of the antibiotic doxycycline. When this medication is used in conjunction with periodontal therapy, it helps to prevent the enzymes produced by bacteria from destroying gum and bone tissue.

Consult with your dental team about which treatment or medications are most appropriate for your specific needs. Remember that all these treatments and medications will not be effective unless you help yourself with proper brushing and flossing and continue with necessary follow up dental care.

Break A Leg by Dr. Pietrini
Before going on stage, actors are often told to "break a leg," a somewhat unusual way to wish someone good luck. I would like to relate to you a different twist (pun intended) to breaking a leg. A few years ago a patient and family friend, Nancy Jo was walking towards me with a cast on her leg. When I asked her what had happened, she told me that while on vacation, she decided that before going to bed that she wanted to floss her teeth. On her way down a flight of stairs, she fell and twisted her ankle. Undeterred, she limped into the bathroom brushed and flossed her teeth and then crawled up the stairs to bed. It wasn't until the next day that she realized that she had broken her ankle. Now that's what I call a conscientious dental patient.

Patients often ask me if they have to floss all of their teeth. My response is, "only floss the teeth you want to keep." In the best selling book, Real Age, the author makes the bold statement that flossing your teeth can add more than six years to your life. Periodontal (gum} disease is the number one cause of tooth lose for adults. In the U.S., one in every three adults suffers from periodontitis, the most serious form of gum disease. Recent studies have shown the relationship between periodontal diseases and several serious heath problems such as diabetes, stroke, heart disease and babies born prematurely with low birth weight. Researchers have discovered that moderate to advanced gum disease makes it more difficult for people with diabetes to maintain proper blood sugar levels. Other studies show that people with gum problems are twice as likely to have a fatal heart attack and nearly three times more likely to suffer a stroke. The risk is seven times greater that pregnant women with periodontal disease will give birth to a low-weight or pre-term baby.

Here are some interesting facts obtained from a recent survey:

· Two-thirds of adults did not know that gum disease is associated with serious medical conditions.
· 80% did not know it is the leading cause of tooth loss in adults.
· 60% of adults are not familiar with periodontal disease.
· 40% of adults do not visit a dentist on a regular basis.

Patients are often unaware of their symptoms or experience little pain until the disease has reached a more advanced stage. Symptoms can include swollen or tender gums that bleed when you floss or brush, receding gums, bad breath, loose or shifting teeth and formation of deep pockets between teeth and gums. The earliest stage of disease is called gingivitis and can be easily treated. If left untreated deep pocketing and bone loss make the treatment more complicated and can lead to tooth loss. A number of factors can increase your chances of developing periodontal disease and related serious health problems. While you cannot control your family history, by changing your behavior, you may be able to reduce your risks by:

· Brushing your teeth well at least twice a day.
· Floss and clean between your teeth daily.
· Eat a well balanced diet.
· If you are a smoker, attempt to quit-people who smoke can have a seven-fold increased risk of suffering from periodontal disease.
· See your dentist on a regular basis for treatment and maintenance.

Next month I will discuss treatment options and medications available to help patients control and prevent periodontal disease.