Gum disease (periodontal disease) is an insidious disease that attacks the supporting structures of the teeth. You can have great teeth—no cavities, terrific enamel, all lined up straight, and yet lose them to gum disease as you age. This is actually the primary reason that as an adult you need to stay regular with your dental visits, so that a licensed dental hygienist can keep your teeth clean and monitor the health of your gums. Most people who lose their teeth lose them to periodontal disease. Take it seriously!
The warning signs of gum disease
If you notice any of the following signs, you probably have gum disease and need treatment:
- Gums (gingivae) that bleed easily.
- Red, swollen or tender gingivae.
- Gums that have pulled away from the teeth.
- Pus between the teeth and gingivae when the gingivae are pressed.
- Persistent bad breath or bad taste.
- Permanent teeth that are loose or separating.
- Any change in the way your teeth fit together when you bite.
- Any change in the fit of partial dentures.
(source – American Dental Association)
What is periodontitis?
Early gum disease is called gingivitis. It involves inflammation of the soft gum tissues only. When it progresses to affect the bony support of the teeth, it is called periodontitis. Periodontitis is a chronic inflammatory disease, like arthritis, only it causes the supporting structures of your teeth to dissolve away. It can go on for years before you ever notice any symptoms, and the first symptom may be loose teeth. At that point, it may be too late to treat the disease and you may have to just have your teeth extracted.
One of the saddest stories I know about periodontitis was a patient who came to me complaining that his teeth were loose. It turns out he had not been to the dentist in decades. He told me that while he was in the service and they checked his teeth he was told that he had perfect teeth and therefore would not need to come back for years. He followed their advice. Now, at the age of about 50, he noticed that his teeth were starting to feel loose. I examined him and found that indeed he had perfect teeth–no cavities, in spite of not having been to the dentist for so long. But he had lost so much bone support from periodontitis that it was not possible now to save his teeth. If he had only come in and had his teeth cleaned every six months, he would likely not have lost his teeth.
Treatment for gum disease
If you have periodontal disease, and you want to keep your teeth, it’s going to require some treatment and some slight changes in lifestyle. Here’s the outline of what you need to do:
- Initially, you need to get a deep cleaning, called “scaling” or “root planing” that goes under your gum and removes all of the calculus (tartar) and microbial debris from the tooth surface. This cleaning can take hours, and is usually spaced out over two to five appointments, and is done with anesthetic.
- The initial treatment may also include some medications. This is a developing area of knowledge, but, in the cases of some patients, periodontitis is responding to light doses of a tetracycline to help resist the bone destruction and also antimicrobial irrigation under the gums.
- You will need to have great home care habits. Where before you may have been able to get away without flossing daily, this habit now takes on great importance.
- You will need to have a professional tooth cleaning more often. Rather than having this done every six months, you will now need to have it done every two, three, or four months. Additionally, more time will likely need to be allotted for this cleaning, and your hygienist will have to have more than the ordinary level of expertise to handle your case. This means that each tooth cleaning will cost more—probably about double. And, to add to the burden, many dental insurance companies will decline to pay for this extra care. They do this as a cost-saving measure. Remember that insurance companies are not benevolent societies, they are businesses whose objective is to make money. Don’t let their lack of caring for your long-term health cause you to not get appropriate care—do what you need to do for yourself, and accept gratefully what benefits you may be able to receive from them.
A note about the use of Peridex®: Often dentists will prescribe Peridex® mouthrinse during periodontal disease treatments. This mouthrinse is very effective at killing bacteria, but has a nasty side effect in that it can cause an ugly brown stain on the teeth. Cosmetic dentists recommend a special toothpaste called Supersmile® while you are using Peridex®, which will help prevent these stains from forming.Please see our Supersmile® whitening toothpaste page for more information and a link in case you are interested in purchasing this toothpaste. We also have another page with more general information about whitening toothpaste. While we’re talking about toothpaste, there are also antibacterial agents in bad breath toothpaste, if you’re interested in learning about that.
Find out what is the best toothbrush.
Sometimes cosmetic dentists perform what is called gum contouring to improve the appearance. This is not usually done to treat disease, but is done for aesthetics.
Read about the use of Vizilite in screening for oral cancer.
This content was written by Dr. David Hall