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Gum Disease: Prevent Periodontitis and Tooth Loss

Regularly visiting your dentist is important for a number of reasons. Not only does your dentist help you take care of cavities right away, but (s)he also can identify the early signs of gum disease (also known as periodontitis) and gingivitis. In fact, the sooner you notice it, the easier it is to treat.

Gum disease progresses from gingivitis, an irritation of the gum tissue around the crown or the visible part of the tooth, to periodontitis, gum disease that causes the loss of bone around the roots of the teeth.

Other periodontal problems include periodontal abscess (infection at the site where the tooth meets the alveolar bone) and ANUG (Acute Necrotizing Ulcerative Gingivitis). All of these conditions are treatable if there is enough bone left to support the teeth.

Symptoms of Gum Disease
The American Academy of Periodontology lists the following as symptoms of gum disease: 

• a change in the way your teeth fit together when you bite
• bleeding gums when you brush your teeth or when you eat hard food
• missing bone from the roots of the patient's teeth
• mouth sores 
• new spaces developing between teeth 
• pain in the mouth 
• persistent bad breath 
• pus between your teeth and gums 
• receding (pulling back from your teeth) gums
• swollen or tender gums
• teeth feel loose
• teeth may appear longer.

If you are experiencing one or more of these symptoms, consult a dentist for an accurate diagnosis. The presence of some health conditions or the persistence of risk factors can make people more likely to contracting periodontal disease.

How to Prevent Gum Disease
Maintaining proper dental hygiene is one of the best ways to prevent gingivitis and periodontitis. Plaque buildup is the most common cause of gingivitis. Plaque is a coating of bacteria that sticks to teeth. Brushing and flossing teeth removes plaque.

Dentists and dental hygienists treat gingivitis by cleaning the teeth (prophylaxis), and by teaching the patient to brush and floss more effectively. Gingivitis will resolve about two weeks after dental prophylaxis when the patient brushes and flosses well.

Plaque that is left on teeth for many hours hardens into tartar or calculus that can't be removed by brushing or flossing. Some toothpastes and mouth rinses help to slow the formation of calculus.

However, once calculus forms on teeth, only a dentist or hygienist can remove it. People grow calculus at different rates. Your dentist or hygienist will advise you how often you should have your teeth cleaned. Generally, dentists recommend that you have your teeth cleaned every six months.

Lifestyle and Genetic Factors That Contribute to Gingivitis
Along with dental hygiene, you may also be vulnerable to periodontitis based on your lifestyle or genetics. Those who are more susceptible to gum disease include:

• diabetics
• pregnant women (Gum disease contributes to low birth weight).
• smokers
• those who take medications that control blood pressure.

When Gingivitis Becomes Periodontitis
If calculus is collects on teeth, gingivitis worsens. As the gums swell and the pockets in the gum around the teeth deepen, the bone may move away from the roots of the teeth, causing periodontitis. While both gingivitis and periodontitis are marked by the same symptoms, it is the bone loss that differentiates periodontitis from gingivitis.

The process of losing bone is a very slow, potentially taking years to loose a quarter of an inch of bone height. Because only about a half inch of bone anchors teeth, the loss of a quarter of an inch of bone is significant. At this point, teeth that have lost half of their supporting bone will feel loose. Teeth affected by periodontitis are treatable until they have lost more than half of the supporting bone.

Treatment for Periodontitis
The treatment for periodontitis may include removing calculus from the roots of the teeth (scaling or root planing) and gum surgery (gingivectomy or flap surgery). While your dentist can perform this procedure in office, it may also be done with the help of a periodontist (gum specialist) and a dental hygienist.

The most important factor in the successful treatment of periodontal disease is proficient home care, including regular brushing, flossing and the use of prescription mouth rinses and other medications.

Periodontal Abscesses
If you notice an uncomfortable swelling (this may or may not be oozing pus), then you likely have a periodontal abscess. In this case, consult a dentist immediately, as this is a clear sign of periodontitis.

These abscesses are easy to treat. The dentist numbs the area, cleans the pocket and drains the pus. Some dentists prescribe antibiotics or antimicrobial mouth rinses to help the area heal more quickly.

Two complications may arise when patients avoid treating periodontal abscesses. The abscess starts to cause rapid bone loss. As soon as the abscess destroys enough bone, the tooth will fall out. In addition, a periodontal abscess may cause the nerve or pulp of the tooth to die. If that happens, the tooth will require root canal treatment and may have to be extracted.

ANUG
Acute Necrotizing Ulcerative Gingivitis (ANUG) is also known as "trench mouth" because its prevalence in the trenches of World War I. People are more prone to contract ANUG when they have a poor diet, live an unhealthy lifestyle and are in close contact with others who are affected by the disease.

The three primary symptoms of ANUG include: 

• absence of the points of the gums that lie between teeth
• severe pain
• strong odor.

Fortunately, this disease is easy to treat. Dentist prescribe an antimicrobial rinse, such as Peridex, for a about week. When the patient returns, they invariably feel better. Then, the dentist or hygienist cleans the patient's teeth. It is unusual for ANUG to reoccur.

The most effective prevention for various types of gum disease is regular brushing and flossing, along with regular visits to your dentist at least twice a year.