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Medical Health | Dental Health | Medical Alerts | Creating That Perfect Smile | Diseases In Dentistry | Info |  |
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| Most people would say that they don't have periodontal disease, but 75% of those over 35 do have symptoms of it. In an age when cavities are almost a thing of the past, periodontal disease persists. It isn't usually painful in itself, but it is the leading cause of tooth loss in adults. Several recent studies have suggested a link between gum disease and heart disease. This is still under investigation, but it may be that the bacteria that cause gum disease can enter the bloodstream and promaote blood clots or damage the heart muscle. And it's now known that if a woman develops severe periodontal disease during pregnancy, she is more likely to give birth to a low-birth-weight infant. But periodontal disease is preventable and can be successfully treated. The most important factor, however, is you, and the care you take of your teeth. From the point of view of your teeth, your appearance, and your general health, it's worth being informed about gum disease and taking steps to prevent it. WHAT IS PERIODONTAL DISEASE? WHAT CAUSES IT? "Periodontal" means "around the tooth." Periodontal disease, or periodontitis (also called pyorrhea), is caused by an acid generated by bacteria in the mouth. These bacteria live in a thin, sticky film, known as PLAQUE, that coats the surfaces of teeth and the tongue, and they act mainly on certain carbohydrates in foods. Plaque eventually hardens into TARTAR around the gum line, a hard mineral shell that erodes healthy gum tissue. GINGIVITIS is the first stage of gum disease. In advanced gum disease, gums recede and pockets form below the gum line, where millions of bacteria move in. Supporting bone may be eroded, and teeth lost. This is not inevitable, though. WHAT SYMPTOMS SHOULD I WATCH FOR? The first sign is gums that bleed when you brush your teeth, and red, swollen gums. That usually indicates gingivitis. If the condition worsens, you may develop chronic bad breath and more bleeding. With severe periodontal disease, teeth may loosen, and you may notice gums pulling away from teeth. Your bite may change, and if you have partial dentures, they may no longer fit. But you shouldn't wait for symptoms to develop. Regular dental visits--ideally every six months--should catch periodontal symptoms early. DOES EVERYBODY GET PERIODONTAL DISEASE? Some people never do, even though they don't take care of their teeth and never see a dentist. But it's not worth gambling on being one of those lucky people. About one-third of the population is thought to have a genetic susceptibility to gum disease, and there's now a test to detect this. But even if your test is negative, you can still develop gum disease and still need to take the same care of your teeth. ASIDE FROM POOR DENTAL HYGIENE AND GENETICS, WHAT PROMOTES GUM DISEASE? One of the major risk factors is smoking. The chemicals in tobacco smoke and chewing tobacco have harmful effects on the gums and teeth. A poor diet is also a factor, especially a diet high in sugars and other sticky or gummy carbohydrates(as in dried fruit or potato chips). Hormonal changes, particularly in women, can also affect your gums adversely. Oral contraceptives may increase a susceptibility to gum disease. During puberty, pregnancy, menstruation, and menapause, women may find themselves more prone to gingivitis. Constant emotional and psychological stress may wear down your ability to fight infection, or may simply promote poor eating habits or cause you to neglect dental hygiene. Because saliva helps wash away foods as well as bacterial toxins, anything that decreases saliva production (certain medications, breathing through your mouth at night) can make gum disease worse. Diabetes, AIDS, and other chronic diseases lower resistance to infection and can also play a role; the chronically ill need to be particularly careful about dental care. HOW CAN I PREVENT PERIODONTAL DISEASE? In addition to regular dental care, thorough, daily flossing aand brushing are crucial. See 'WHAT YOU NEED TO DO' for details. WHICH TOOTHBRUSH IS BEST? Choose a soft-bristled brush, because hard bristles can damage your gums. However, the shape of the handle, the cut of the bristles, and the angle at which the head is attached don't matter. Buy by price, and always keep two or three new brushes around. Don't get too fond of your toothbrush--it will need replacing every three to four months. If you have some condition that limits your dexterity, if you particularly like high tech gadgets, or if you are trying to motivate a child to brush, you might want to invest in an electronic or sonic toothbrush. They are expensive and don't really do a better job than hand brushing. Your technique matters more than the tool. [My own observation is that if you have toothbrush abrasion from brushing too hard, an electric toothbrush will allow you to brush these areas properly without having further damage. Also children undergoing orthodontics may benefit from the use of electronic toothbrushes.] WHAT'S THE BEST FLOSS? Any floss you prefer, waxed or unwaxed, flavored or plain. If the spaces between your teeth are tight, you might prefer a waxed floss, which is less likely to catch and fray in tight spots. If your teeth are very tight, you might like a brand such as Glide or Precision, made of a teflon-like, shred-proof material. WHAT'S THE BEST TOOTHPASTE? DOES A TARTAR-CONTROL TOOTHPASTE REALLY CONTROL TARTAR? For the moment, any fluoridated paste that carries the seal of the American Dental Association (ADA) is fine, though a new entry in the field(see related article regarding new anti-gingivitis toothpaste) may prove to be the best option. A tartar-control paste may be a good choice, but no paste controls tartar below the gum line. Brushing with any toothpaste(or even without paste) will help control tartar by removing plaque, but eventually you'll need a professional cleaning. A baking soda toothpaste is as good as any other as long as it contains fluoride. The same is true of plain baking soda--a good tooth cleaner, but you should probably use a fluoride rinse along with it. Toothpastes with "natural" ingredients are okay, too, as long as they have fluoride and the ADA seal. In spite of their claims, they offer no special benefits for dental hygiene. WHAT ABOUT STIMULATORS, RUBBER TIPS, INTERDENTAL BRUSHES, FLOSS HOLDERS, TOOTHPICK HOLDERS, IRRIGATORS? You'll find a huge range of gizmos and appliances for sale to help you with home dental care. If any of these appeal to you, or solve specific problems, or if you have been advised by your dentist to purchase and use any of these items, they are fine. Before using rubber tips and stimulators, or any item that poses a risk of gum injury if improperly used, it's a good idea to ask the dentist or hygienist for instructions. But none of these things can substitute for toothpaste, toothbrush, floss, and elbow grease--and regular dental care. WHAT ABOUT MOUTHWASH? As we said in our September issue, no mouthwash can take the place of regular brushing and flossing. If you want one to frehen your breath temporarily or because you like the taste, any mouthwash will do. The only over-the counter mouthwash with ADA seal in the battle against plaque and gingivitis is Listerine (there are generic versions of it). If you have periodontal disease, your dentist may prescribe either Peridex or Perioguard mouthwashes, which contain the antibacterial ingredient chlorohexidine.[With patients with root caries, abrasion, or sensitivity I recommend Phosfluor Mouthwash which, when used on a daily basis, can be highly successful]. WHAT SHOULD I EXPECT MY DENTIST TO DO IN A ROUTINE VISIT? The dentist should carefully evaluate the state of your teeth and gums. Periodic X-rays, [Bitewings every 12 months, Full Mouth Series every 5 years], depending on your oral health, are essential, and thr dental exam should include some probing of the gums. The dentist or dental hygienist should scale and plane your teeth: this usually includes scraping the tartar off your teeth at and below the gum line with a sharp metal instrument. The dentist may also use an ultrasonic or sonic scaler with a vibrating tip to dislodge tartar. This may be followed by a cleaning with a mild abrasive. WHAT'S THE BEST TREATMENT FOR PERIODONTAL DISEASE? Depending upon the stage of the disease, you may need a prescription mouth rinse, oral irrigation with an antibiotic solution, general antibiotic treatments, more thorough removal of tartar below the gum line, or surgery. Your regular dentist will probably refer you to a periodontist. A wide range of treatments are now available. |
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