Periodontal disease is a blanket term that refers to any disease of the gums. Gum disease is extremely common. Up to 80% of Americans have some form of gum disease at any given time. Gum disease is caused by a buildup of bacteria in your mouth, which can form from a combination of food and your own saliva. If caught early, periodontal disease is very treatable, but if undetected or not treated early, it can lead to tooth loss or the need for invasive gum surgery.
Most people are familiar with the term gingivitis, which refers to the inflammation of the gums which can often indicate periodontal disease. Though not all cases of gingivitis progress to periodontal disease, anyone who experiences gingivitis should seek treatment from their dentist. Doing so will prevent the bacteria from spreading any further. If it does progress, more advanced periodontal disease needs to be evaluated by an experienced periodontist.
Symptoms of Periodontal Disease and Gingivitis
The symptoms of gingivitis include red and swollen gums, which often bleed during brushing and flossing. If gingivitis is caught at this stage—before it progresses to the tooth or other bone, it is very treatable. If the gingivitis progresses, however, the person may develop periodontitis, where the gums begin to recede from the teeth. The now open spaces between the teeth and gums are especially prone to infection, and eventually, toxins can begin to break down the gums, teeth, bone, and other tissues in the area, as a result of the combination of bacteria and the body’s own enzymes as they try to fight the infection. Teeth can become loose and fall out, and chewing can become incredibly difficult or painful. At this point, the damage to the teeth is irreparable; the teeth must either be filled in with a dental implant, porcelain crowns, or dental bridges, but will never be able to heal naturally.
Treatment Options including Oral Surgery
When Dr. Zadeh, who is a former USC Clinical Professor & Lecturer of 14 years and Beverly Hills periodontist, diagnoses a patient with periodontal disease, he follows one of several possible courses of treatment, depending on how advanced the disease has become. For less severe cases, non-surgical treatments will be attempted first, in order to eliminate infection, reduce swelling, and promote healthy re-growth of receded gums.
For mild cases of periodontal disease, Dr. Zadeh will recommend the least invasive treatments. Usually, this includes an extremely thorough and deep cleaning, which cleans the surfaces of not just the tooth, but the gum pockets and the root as well. This is known as scaling and root planing. If an infection is already present or there is a threat of infection, Dr. Zadeh will prescribe antibiotics. With very mild cases, scaling and root planing will suffice, but more advanced cases may require the patients to return for additional treatments or cleanings.
For more advanced stages or forms of periodontal disease, surgery may be required. Dr. Zadeh performs four different types of periodontal surgery; pocket reduction, regenerative grafts, crown lengthening, and soft tissue grafts. For a pocket reduction, Dr. Zadeh will reduce gum recession and pockets by deep-cleaning the gums and removing any infected areas or areas that are filled with bacteria, so that the gums can re-attach to your teeth and the pockets can be filled.
For regeneration, Dr. Zadeh will perform the same steps as in a pocket reduction surgery, but will also use bone grafts or tissue proteins in order to promote healthy re-growth of the gums. A crown lengthening procedure reveals more of your natural tooth, allowing Dr. Zadeh to repair teeth to which the infection has spread. This process makes fillings, crowns, or bridges available to the tooth.
Soft tissue grafts are the opposite of crown lengthening procedures. Instead of exposing more of the tooth so that it can be repaired, tissue from elsewhere in your mouth is grafted to your infected gum area, in order to reduce the appearance of receding gums or to cover exposed tooth roots.
Gingivitis and the resulting periodontal disease can result from a number of factors. Plaque build-up due to improper dental hygiene (regular brushing, flossing, and dental cleanings) is the leading culprit, though other causes are possible. Hormonal changes, illnesses, certain medications, smoking, and family history of dental illness can all make a person more susceptible to infections and diseases of the gums and teeth; they should take extra precautions by brushing and flossing after every meal and by visiting their dentist three or four times a year.
The symptoms of periodontal disease include the following:
- Red, swollen, tender gums, as with gingivitis
- Gums that bleed during brushing, flossing, or chewing, as with gingivitis
- Persistent halitosis (bad breath) or bad taste in the mouth, often metallic
- Receding gums (gums that pull away from the teeth)
- Pockets between the teeth and gums
- Loose or movable teeth
- Changes in the bite
Gum disease can affect the entire mouth, or just certain areas or teeth, so it is important to pay attention to all of your teeth, and to notice any changes in your mouth, even if it is only surrounding one tooth.
To properly diagnose a patient, Dr. Zadeh will examine the gums first, checking for tenderness, bleeding, swelling, firmness, recession, and/or pockets. He will then examine teeth for movement or sensitivity. Finally, he will take an x-ray to see if your jawbone or the portions of the teeth that lie beneath the gums have been affected. If it is determined that you do have periodontal disease, Dr. Zadeh will discuss with you the severity and progression of the disease, and your options for treatment.
Maintaining your Healthy Smile
While periodontal disease is very treatable, the best way to avoid gum surgery is to prevent gum disease before it happens. This includes all the normal activities associated with proper dental hygiene—brushing at least twice a day, flossing daily, and visiting the dentist at least twice a year (if not three or four times!). However, there are other things that we can do in order to keep our gums and teeth healthy.
Smokers are five to ten times more likely to develop gum disease than non-smokers, and those who smoke have a lower chance of success after gum surgery. In addition to contributing to gum disease, smoking can result in severe discoloration of your teeth.
Secondly, a well-balanced and nutritious diet will provide your body with the vitamins and minerals it needs to be strong. This includes both calcium to strengthen your teeth, as well as vitamins C and E in order to boost your immune system to fight off infections or gingivitis. Antioxidants are not only great at preventing illness and infection, but also a great way to help your body fight off existing conditions.
Thirdly, clenching and grinding your teeth can impact your gums as well as your teeth. The excess force can lead to the destruction of tissues around the teeth, and can force bacteria deep into the grooves between your teeth and gums.
Finally, though many only relate stress to heart disease, stress can affect your dental health as well. Your immune system is directly linked to your stress level, and cannot fight off dental infection or gum disease if it is being impaired by stress.
Periodontal disease is highly genetic, and tends to run in families, so those who have a family history of periodontal disease should take extra care to follow these preventative tips.
Grafting and Repairing The Damage
Grafting is the process of taking real or artificial skin tissue and using it to replace thin or receded gums. Thin gums are the most common symptom of periodontal disease, especially gingivitis, and when gums start to recede, potentially serious complications may arise. If the gums continue to recede without being treated, the roots of your teeth may eventually become exposed, which is both painful and dangerous for the life of the tooth.
In order to thicken gums and protect the exposed roots of the teeth, healthy tissue is grafted from another part of your mouth to the receded part. The gum that grows around the root of the tooth is hard tissue, so the grafted gum must be hard tissue as well. Dr. Zadeh usually chooses to graft tissue from the palate (the roof of the mouth), as this tissue is usually healthy and unaffected by periodontal disease.
The following pages detail several of the grafting procedures that Dr. Zadeh offers.
If you suspect you might have gingivitis or periodontal disease, please call us at (310) 273-2020 or email our appointment coordinator for a consultation today. Dr. Zadeh and his staff will be happy to evaluate your dental health and provide a diagnosis for periodontal disease or any other condition you may have.