PERIODONTAL DISEASE: YOUR COMPLETE GUIDE

WHAT IS PERIODONTAL DISEASE?

Periodontal (perry-o-DON-tal) disease is an infection that affects the tissues and bone that support your teeth. It is also called gum disease.

Periodontal disease can become a very serious problem if it’s not treated early.

This booklet is your complete guide to gum disease and can help you learn about:

• the causes of gum disease
• the stages of gum disease
• how gum disease is diagnosed
• how gum disease is treated
• how to keep your mouth healthy after treatment

WHAT CAUSES PERIODONTAL DISEASE?

A surprisingly wide variety of bacteria live in your mouth. This is normal. When certain types of bacteria outgrow the others, you may begin to develop gum disease.

Plaque is a sticky film that is always on your teeth. When plaque is left on your teeth and gums, it can harden. Hardened plaque is also called tartar (TAR-ter). Bacteria that live in the plaque can make your gums red, puffy and swollen. Tartar on your teeth makes it hard for you to keep your teeth and gums clean on your own.

When your gums are healthy, your gum tissues tightly hug each of your teeth. When you have gum disease, your gums pull away from your teeth and may become red, puffy and swollen. Spaces called pockets can form, and these pockets collect more bacteria. If the infected pockets are not treated, the disease will get worse.

As the gum disease gets worse, the tissues and bones that support your teeth can become damaged. Over time, your teeth may fall out or need to be removed.

STAGES OF PERIODONTAL DISEASE

Periodontal disease can get worse if it’s left untreated. It can lead to serious infection, bone loss and you may even lose teeth.

Healthy Gums – No Disease

Your teeth are held in place by gums, bone and connective tissues. Your gums hug your teeth tightly and there is little or no buildup of plaque and tartar on them.

Gingivitis

The bacteria in plaque make your gums red, tender and swollen. Your gums might bleed at this stage. You also can have gingivitis and not notice any of these signs. Gum disease at this stage is usually reversible and can be treated by a dentist or dental hygienist during a regular cleaning and with daily brushing and flossing.

Periodontitis

In time, as plaque and tartar build up where your teeth and gums meet, the gum tissues and bone around your teeth begin to break down. Periodontitis affects about 42% of adults over age 30 in the United States.

Advanced Periodontitis

Your teeth may become loose and fall out or need to be removed by your dentist. This stage is very serious and may require surgical treatment.

AM I AT RISK?

Anyone can get periodontal disease, but some things can raise your chances of getting it. Factors that can increase your risk of getting
periodontal disease include:

• Not taking care of your teeth and gums. This includes not brushing twice a day and not cleaning between your teeth daily.
• Using tobacco of any kind. You are more likely to have gum disease if you smoke, chew or dip tobacco.
• Diseases that lower your body’s ability to fight infections may increase your risk for gum disease.
• Many medications, such as steroids and blood pressure drugs, can affect your gums.
• Pregnancy, use of birth control pills or changes in female hormone levels. These can increase your risk of gingivitis and may cause your gums to swell and bleed.
• Family history. If you have a family history of tooth loss, be aware and pay close attention to changes in your gums.

PERIODONTAL DISEASE AND OTHER HEALTH ISSUES

Periodontal disease has been linked to some other diseases. People with diabetes or heart disease are more likely to get gum disease.

It is important to talk to your dentist if you suffer from any long-term health problem.

WARNING SIGNS

• gums that bleed when you brush or floss
• gums that are red, swollen, puffy or tender
• gums that no longer hug your teeth tightly
• bad breath that doesn’t go away
• pus between your teeth and gums
• feeling that your teeth are loose
• a change in the way your teeth fit together when you bite
• a change in the way your partial dentures fit

You may notice one or some of these warning signs, or you may not notice any warning signs at all. Sometimes the only way to know for sure is by getting regular dental checkups. That way, if you do have gum disease it can be caught and treated early.

HOW DOES MY DENTIST CHECK FOR PERIODONTAL DISEASE?

Periodontal Probe

At your dental appointment, your dentist will use an instrument called a periodontal probe to gently measure how deep the pockets are around each of your teeth. When your teeth are healthy, the pocket should be no deeper than 3 millimeters. Typically, the worse the disease, the deeper the pocket. This means the bacteria have more room to grow and cause serious damage to your gums and bone, loosening your teeth. Very deep pockets are a sign of advanced periodontal disease.

Periodontal probe of healthy gums.

Periodontal probe showing a pocket forming between the tooth root and the gums.

Dental X-Rays

Dental x-rays can be taken to check for the amount of bone that is supporting your teeth. If low bone levels are spotted, it could be a sign of damage from gum disease.

Healthy gums have bone that supports the teeth.

Gum disease can create bone loss.

HOW IS PERIODONTAL DISEASE TREATED?

Your periodontal disease treatment will depend on several factors, including your personal health history and the stage of your gum disease.

Your dentist may also refer you to a periodontist — a dentist who specializes in the treatment of gum disease. A periodontist is well versed in the surgical treatment of gum disease.

PROFESSIONAL CLEANING

In the very early stages — when it is gingivitis — you may just need a professional cleaning from your dental team. They can also give you tips on how you can keep your teeth and gums healthy.

DEEP CLEANING — SCALING AND ROOT PLANING

If your gum disease is beyond gingivitis, you may need a special deep cleaning called scaling (SCAY-ling) and root planing (PLAY-ning). This treatment may be done over more than one visit, depending on your diagnosis.

During scaling, your dentist or dental hygienist will carefully remove plaque and tartar down to the bottom of each pocket.

The next step is root planing, which is cleaning and smoothing your tooth’s root surfaces. Smoothing the surfaces helps your gums heal and reattach to the tooth, shrinking the pocket depth.

You will need to schedule another dental visit within a few weeks or months after your scaling and root planing treatment has been completed. At this visit, your dentist or hygienist will check your gums to see how they have healed. They will measure the periodontal pockets again. Scaling and root planing may be only a first step in periodontal treatment.

Scaling removes plaque and tartar from below the gumline.

Root planing smothes the tooth root and helps the gums reattach to the tooth.

Healed pocket after treatment.

PERIODONTAL SURGERY

Sometimes, scaling and root planing isn’t enough treatment on its own. If the pockets do not heal enough after scaling and root planing, gum surgery may be needed. Surgery can help repair bone and gum damage or help to shrink pocket depth and make it easier for you to keep your teeth clean.

FLAP AND OSSEOUS (BONE) SURGERY

One type of procedure is flap surgery, which allows your dentist to remove plaque and tartar from hard-to-reach areas below the gum. A small incision is made in the gums and the gum tissue is pulled back to allow the area to be cleaned. Then, your gums are stitched into place to tightly hug your teeth.

Probe shows pockets due to gum disease. Gums are inflamed and bone loss has occured.

The bone is contoured and any remaining tartar is removed.

Healed site after periodontal surgery.

BONE GRAFT AND GUIDED TISSUE REGENERATION

If bone has been damaged or lost by gum disease, you may need surgery to rebuild or reshape the bone in your mouth. This kind of surgery is called a bone graft.

A bone graft holds your loose teeth in place and natural or synthetic bone is placed to help support regrowth of bone.

Your dentist may place a membrane layer at the surgical area to help your gums stay in place while the tooth root reattaches to the supporting bone tissues. This is called guided tissue regeneration.

To help you heal after surgery, your dentist may apply a protective dressing over your teeth and gums and recommend or prescribe a medicated mouthrinse. You may also be given a prescription to treat infection or for pain relief.

Diseased tissue is removed from the pocket. In some cases, the bone may be reshaped.

Bone has been reshaped.

Grafting material is placed over the bone.

After the healing period.

KEEPING GUMS HEALTHY AFTER TREATMENT

Once your gum disease is brought under control, it is very important that you get dental care on a consistent basis. The type of professional cleanings recommended after your treatment are called periodontal maintenance care. These cleanings are more extensive than the standard cleaning and will help you keep your gums healthy.

You will need to clean your teeth and gums every day at home, but that is not enough to control your gum disease. Professional care is also needed to help make sure that your mouth continues to heal and get healthy. Your periodontal maintenance involves cleanings that are deeper than a normal cleaning in the dental office. These cleanings lower the amount of plaque bacteria so inflammation gets better, pockets shrink and gums become healthier. Periodontal maintenance appointments are typically every 3 to 4 months, depending on your condition.

Once your gums are healthy, periodontal maintenance cleanings can help keep them infection-free. Your dentist will determine a maintenance schedule based on your clinical evaluations.

PLAN FOR MORE VISITS TO THE DENTIST

You will need to see your dentist more often than other people. The pockets and other issues from your gum disease will make it harder for you to clean plaque from your teeth.

Your dentist will talk to you about a treatment plan that works best for you, and he or she will recommend a maintenance care schedule that is based on your personal case. Over time, fewer appointments may be necessary.

It’s important to follow your periodontal maintenance care. You have a better chance of keeping your teeth if you do. Your gum disease may get worse if you don’t!

MEDICATION

You may also need special medications that can help control the infection or help your gums heal. The medicine could be a pill, a special mouthrinse or a medication that your dentist places right into the pocket after you have a deep cleaning.

GUM DISEASE WON’T GO AWAY ON ITS OWN

Keep Up Your Oral Care at Home

It is very important that you brush and floss every day — especially if you are healing
from gum disease.

• Brush two times every day for two minutes each time. Use a toothpaste with fluoride (FLOOR-eyed). Fluoride is a mineral that can help keep your teeth strong.
• Clean between your teeth every day to remove plaque and bits of food from in between your teeth. If your gums have pulled away from your teeth, it may be best to use special tiny brushes, picks or wider types of floss.
• Your dentist may also recommend you use a specific mouthrinse.

Look for the American Dental Association Seal of Acceptance on all of your dental care products. The ADA Seal means these products have met ADA standards for safety and effectiveness.

Remember, it’s possible that you may not feel any pain or see any signs that your gum disease is getting worse.

You may have sensitive teeth and gums after your treatment. Sensitive or sore teeth and gums may make you want to skip cleaning the treated areas in your mouth — but don’t! It is important that you keep brushing your teeth gently and flossing to remove plaque. If you don’t remove the plaque, your gum disease may get worse and you may increase your risk of cavities.

Ask your dentist or dental hygienist about special toothpastes or other treatments that can lower your tooth sensitivity.

ADDITIONAL INFORMATION

Don’t use tobacco! If you smoke, chew or dip tobacco, it is very important you quit. Using tobacco in any form slows down your healing and raises your chances of getting gum disease again or it getting worse if you already have it. Talk to your dentist or doctor about ways you can quit.

WILL YOUR TREATMENT BE COVERED BY YOUR INSURANCE?

Be sure to check your benefits plan when you are planning your treatment with your dental office. However, treatment should be decided by you and your dentist and not by your benefits plan.

If your treatment plan is not fully covered by insurance, ask if your dental office has a payment plan to cover the rest of the amount. Keep in mind that having treatment now may cost less than having to replace one or more teeth lost to gum disease later on.

PREVENTION IS THE BEST MEDICINE!

In general, it costs much less to keep your teeth and gums healthy than to wait until you have a problem.

These healthy habits can help:

• Brush your teeth twice a day with a fluoride toothpaste for two minutes each time.
• Clean between your teeth every day, using floss or another between-the-teeth cleaner.
• Use a germ-fighting mouthrinse or other products
  if your dentist or hygienist recommends them.
• Eat a healthy diet and limit snacks. Learn more online at www.choosemyplate.gov.
• Visit your dentist regularly.

YOUR TREATMENT PLAN

Every patient is different, so talk to your dentist about the information in this guide and what it means for your personal treatment plan.