Recently, a healthy man in his forties shows up at the dental office for a dental emergency. A swelling around a loose front tooth is causing some pain. On examination, the dentist discovers that several teeth are loose. There is a strong odor. The X-ray examination shows that most of the bone is missing from around the roots of all of the patient's teeth. This man who expects to keep his teeth for a lifetime, will loose many of his teeth to the gum disease, periodontitis. Gum disease is also known as periodontal disease. It 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 and ANUG (Acute Necrotizing Ulcerative Gingivitis). All of these conditions are treatable if there is enough bone left to support the teeth.
The American Academy of Periodontology lists these symptoms of gum disease on their web site:
Do you ever have pain in your mouth?
Do your gums ever bleed when you brush your teeth or when you eat hard food?
Have you noticed any spaces developing between your teeth?
Do your gums ever feel swollen or tender?
Have you noticed that your gums are receding (pulling back from your teeth) or your teeth appear longer than before?
Do you have persistent bad breath?
Have you noticed pus between your teeth and gums?
Have you noticed any change in the way your teeth fit together when you bite?
Do you ever develop sores in your mouth?
If you answer "yes" to one or more of these questions, consult a dentist for an accurate diagnosis.
Some health conditions make people more likely to have periodontal disease. Smoking is the most preventable factor. Diabetics are more likely to have gum disease, and periodontitis may make it more difficult for diabetics to control their blood sugar. Pregnancy causes the gingiva (gums) to be more sensitive to bacteria. Periodontitis is known to contribute to low birth weight. Medications that control blood pressure may affect the gingiva. Gum disease may affect coronary (heart) health
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. It is not possible to remove calculus 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.
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. Bone loss differentiates periodontitis from gingivitis. This is a very slow process. It may take years to loose a quarter of an inch of bone height. Only about a half inch of bone anchors teeth, so the loss of a quarter of an inch of bone is a significant amount. 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.
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). A general dentist alone may complete this treatment, or a team including a general dentist, periodontist (gum specialist) and a dental hygienist may work together. The most important factor in the successful treatment of periodontal disease is proficient home care including brushing, flossing, and the use of prescription mouth rinses and other medications.
Periodontal abscesses occur when bacteria, food, or other items become lodged in the pocket or sulcus around the tooth. Patients will notice a swelling that may be uncomfortable. Usually, the swelling is full of pus. Early, 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 may cause rapid bone loss. When the abscess destroys enough bone, the tooth will be lost. 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 not be salvageable.
Acute Necrotizing Ulcerative Gingivitis or ANUG is also known as "trench mouth". This unsavory disease was common 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. Dentists know ANUG by three main characteristics: severe pain, the points of gum between the teeth look as if they have been removed, and there is a strong odor. Fortunately, this disease is easy to treat. The dentist will prescribe an antimicrobial rinse such as Peridex for a 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.
Periodontitis causes little or no pain. Sometimes, the only way to know if you have it is to ask a dentist to examine your teeth. Early gum disease is easy and inexpensive to treat. Later, the cost of treatment may seem prohibitive. Finances force some patients to consider removing their periodontally involved teeth, replacing them with dentures. The most effective prevention for gum disease is regular brushing and flossing, and visiting your dentist at least twice a year.
Dr. David Leader is the Chairman of the Health Advisory Committee of the Lynnfield Schools, a member of the Professional Advisory Committee of Tri-CAP Head Start, and is a member of the Mass Dental Society Council on Dental Care and Benefits Programs.