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Periodontal Disease
Periodontal Disease: What is it?
Periodontal disease, also referred to as gum disease, is very common and treatable. But do not underestimate it, it is the leading cause of tooth loss in adults. Today, we will go over what periodontal disease is and the relationship between it and diabetes.
To begin, you must first understand what periodontal disease is exactly. By definition, it is an inflammation and infection of the area surrounding a tooth. This inflammation can lead to gum recession, bone loss, or a total loss of the tooth. There are several different stages and warning signs to look for.
The Stages
There are several stages and signs of gum disease, the first stage being gingivitis. Gingivitis is described as being a mild form of periodontal disease and can be easily reversed at the periodontal office. The signs include inflammation, an irritation in the gums, redness and/or swelling. If not properly cared for, it can develop into periodontitis. It is, at this stage, that the tissue and bone begin to suffer. If it continues to go untreated, the periodontitis will wear away the bone to the point of loosening the teeth; leading to tooth loss or the need for extraction.
Additionally, some warning signs include: a change in your bite, bad breath, loose teeth, gums pulling away from teeth, bleeding, sensitivity, or signs of infection.
Stages of Periodontitis
The Correlation with Diabetes
Diabetes and gum disease go hand in hand; one affects the other. Having diabetes can cause a more severe case of gum disease and extend the process. In addition, having gum disease can make it more difficult to keep your blood glucose, sugar, levels under control. Periodontal disease can cause these levels to rise in people with or without diabetes; potentially leading to Type II diabetes.
Glucose can be found in the saliva in your mouth. If the levels are too high this can cause harmful bacteria to develop. The bacteria that forms, when combined with food, creates plaque. Plaque is the word we are all too familiar with hearing at our dental visits. Plaque is described as being a sticky, colorless film that continuously grows on your teeth; this is what we are always fighting by brushing and flossing several times a day. If not properly removed, plaque mineralizes into tartar, which can only be removed at the dental office. Tartar, when not properly removed, may lead to gum disease. Therefore, you should always keep up with with your dental visits.
As shown above, periodontal disease is not to be taken lightly, especially considering the risk of developing other illnesses such as diabetes. Many people think it is nothing to be concerned about if you find that your gums are bleeding when brushing or flossing when it is quite the contrary. As described on the Colgate website, if your hands bled every time you washed them, you’d be concerned!
The Value of Dental Implants
Finding this article is an enormous first step! As you probably already know, you are not alone. Did you know that there are approximately 178 million Americans that are missing at least one tooth? That is enough people to fill Heinz Stadium 2,602 times! But of all those people, how many of them get dental implants? How many of them continue to lose teeth?
Dental implants are not a new concept. They have actually been in existence for thousands of years, dating all the way back to ancient times! There have been many variations of the procedure that have been performed throughout the centuries until discovering the technique we use today. With the use of modern science, we now use titanium or ceramic posts to fuse with jawbone to create a stable base for a crown. Before reaching this milestone, various other metals were tested as dental implants, some of which include: gold, shells, stone and bone.
A cosmetic, temporary device will be created to fit over the implant during the wait time for a crown – healing process, before the crown can be placed. Placing an implant does so much more than just fill a missing space. It preserves the bone, the tissue, and prevents any type of movement and displacement of the surrounding teeth.
One of the most enticing factors of dental implants is that, not even your own family or friends will be able to tell that you have implant. If you are missing a front tooth and you have an implant placed with a permanent crown, only you would know. That’s the magic of Periodontics.
Tooth human implant. Dental concept. Human teeth or dentures. 3D rendering
The process of getting the implant is easy too! You’ll find the procedure itself is the biggest fear for someone. Considering the way dentistry used to be, you can understand why so many people have become fearful of visiting their dentist or periodontist. The procedure of placing an implant is not very long or painful. Honestly, the hardest part is having to bare bad daytime TV in the waiting room. If you can survive that, then you can survive anything!
It is not hard to see the positive attributions that come from dental implants. But it is hard to see the true value when focused purely on the cost perspective. Don’t misunderstand, the cost factor is important, but do not let it blind you from other key factors that will increase your confidence. You will no longer have to hide your smile or be overly self-aware, you can be free and let loose! If appearance is not your main concern, then know that dental implants not only look like natural teeth, but they will feel like it too. You will no longer have trouble eating or speaking.
Dental implants are an investment in your overall health and wellness. This is something that will last you a lifetime. It is never cheaper to pay for something twice than it is to have it done right the first time. You need to research for your doctor. An experienced doctor makes all the difference with your dental needs. Don’t be afraid to ask him/her what experience they have with providing your dental care.
I Keep Hearing About Dental Implants
A dental implant is actually an artificial tooth root that is placed in the jaw bone. It is then used to support a single crown, bridge or denture. Dental implants are the standard of care for tooth replacement today for people who have lost teeth due to injury or gum disease.
What needs to be done before I get an implant?
Whether a tooth needs to be extracted or has previously been extracted, bone will likely need to be added to the socket. This will preserve the contour of the jawbone and provide support for the implant. The implant may be placed at the same time. However, there may be a waiting period for the bone to mature before the implant can be placed. This is usually a 3-6 month wait.
If there is extensive bone loss, a “ridge augmentation” may be necessary. This procedure adds a large amount of bone. This may require a longer maturation period, usually 6-12 months.
If the tooth to be replaced sits below the sinus cavity on the upper right or upper left of the jaw, a “sinus lift procedure” may be necessary. During this procedure, the sinus floor is raised and bone is added to provide adequate support for the implant. There is usually a 9-12 month wait before implants can be placed after a sinus lift.
During the healing phase of implant placement, temporary teeth can be worn to fill the empty space. This will prevent other teeth from shifting and provide proper aesthetics. The temporary teeth are provided the day of extraction, so the patient can leave the office that day with tooth replacement.
What is the benefit of getting dental implants?
Dental implants are the most natural form of tooth replacement. Not only do they replicate the look, feel and function of natural teeth, but they also prevent the jaw bone from “melting away”. Bridges are prone to dental decay. An implant cannot get a cavity. Dentures often move, causing speech issues or sore spots, and certain foods become difficult if not impossible to eat. Dental implants can eliminate these denture problems and provide a long lasting answer to missing teeth.
Gum Disease and Its Link to Diabetes
According to the American Diabetes Association, 30 million Americans are diabetic. Sadly, diabetes is connected to problems not limited to the world of medicine. There are studies reporting a major association between diabetes and gum disease. A diabetic is significantly more likely to develop gingivitis or periodontitis.
Some studies show that having gum disease on any level can negatively affect a patient’s ability to keep their blood sugar under control. Also, many experts believe that diabetes negatively affects a patient’s oral health, as high blood sugar increases the patient’s susceptibility to infection.
Neglecting diabetes can lead to serious consequences. Patients with diabetes and any stage of gum disease have been connected to serious health problems such as heart disease and kidney disease, as well as a higher risk of strokes.
Given proper attention, diabetes is manageable. The sooner patients are aware of their disease, the sooner they can make changes in their lifestyle to control the disease.
Many people never get their glucose tested. However, many are likely to visit their dentist twice a year for cleanings as recommended. These routine dental appointments could be an opportunity for patients to learn about diabetes and their health.
Although dental and medical professionals don’t always want to extend advice outside their area of expertise, there is an easy way to approach the diabetes/gum disease dilemma. Today, more and more dental professionals are offering diabetes testing right in their offices. Often, patients learn of their prediabetes/diabetic situation for the first time. A study in Amsterdam indicated that patients with advanced gum disease were unaware or unprepared for a diabetes diagnosis – 10 percent had full Type 2 diabetes.
An easy finger stick and glucose test could be life changing for many dental patients. Don’t be surprised if sometime in the near future, your dentist or periodontist offers you this test.
Oral Cancer Screening at the Dentist Can Save Your Life
Statistics show that 30,000 – 50,000 Americans are diagnosed each year with some form of oral cancer. It has also been cited that only about ½ will survive longer than five years. That is unfortunate considering that there is an 80 – 90 percent survival rate when the cancer is caught early!
Oral cancer can invade any part of the oral cavity including lips, cheek, tongue, gums, throat, tonsils and palate. Early detection of oral cancer can improve the chance of successful treatment. It cannot be stressed enough, the importance of your dentist or hygienist performing an oral cancer screening on at least an annual basis. An oral cancer screening takes only a few minutes.
The ADA News announced that April is Oral Cancer Awareness Month. The American Dental Association has a website, MouthHealthy.org that provides information for patients about oral
cancer.
There are risk factors associated with oral cancers. The American Cancer Society says that men have a higher occurrence of oral cancer, attributed to higher usage of alcohol and tobacco. Oral cancer is more prevalent in patients 55 years and older, except in the cases of HPV-related oral cancers which occur at an earlier age.
Smoking cigarettes/pipes or chewing tobacco increases the risk of oral cancer significantly.
Smoking also increases the risk of cancer in other parts of the body as well.
According to the American Cancer Society, eight out of ten patients with oral cancer are heavy drinkers. Heavy drinking as defined by the American Center for Disease Control is two or more drinks per day for men and one or more drinks per day for women. If a patient smokes and drinks heavily, the risk is even more significant.
The human papilloma virus (HPV) is now associated with cancers of the head and neck. These cancers are found predominately in younger, non-smoking patients.
The sun is a contributing factor in oral cancer of the lips. Using a sunscreen in a lip balm can help. Believe it or not, a diet lacking in fruits and vegetables can also be a contributing factor!
Eliminating these factors can help patients to avoid oral cancers. If your dentist does not provide an oral cancer screening at your visit, ASK! It could save your life!
Dental News Tidbits
Word is that last year’s Tooth Fairy survey, provided by Delta Dental, discovered that cash for teeth under the pillow has skyrocketed to an all-time average high of $4.66. This is an increase of $.75 from the 2015 survey. Delta Dental reports that the tooth fairy has forked out in excess of $250 million for lost teeth in 2016. This is approximately a 13.5% increase over 2015. Delta Dental emphasizes that visits from the tooth fairy can provide a great opportunity to talk to children about good oral habits, as well as lessons on finance!
In spite of a story last year questioning the benefits of flossing, the American Dental Association and the Centers for Disease Control and Prevention continue to encourage people to floss. The Los Angeles Times (2/23, Ravn) included flossing on their list of ways to help people live a healthier life. Flossing cleans between the teeth and removes build-up of plaque (bacteria) where a toothbrush cannot reach. If you think your dentist won’t notice if you don’t floss – think again!
Studies suggest that the presence of periodontal disease may be an early warning sign of type 2 diabetes. If this is indeed the case, screening for diabetes in the dental or periodontal office may be helpful in detecting diabetes and pre- diabetes. All it takes is a simple finger stick test performed at regular dental visits.
Periodontal Disease: Differences between Men and Women
There is generally no argument that there are many differences between men and women, mentally, physically and behaviorally, so how do these differences relate to periodontal disease? There is evidence to support some significant differences.
The Journal of Periodontology relates that women are more proactive in maintaining their dental health than men. As a matter of fact, women are twice as likely to visit their dentist on a regular basis, and exhibit lower incidence of dental plaque than men. The Journal’s findings also suggest that women have a better overall understanding of dental health, as well as a more positive attitude when it comes to seeing the dentist.
The American Academy of Periodontology reports that women are 26% more likely than men to floss on a regular basis. 74% of women would be embarrassed to have missing teeth, compared to 57% of men.
44% of women are aware that a periodontist can help to maintain overall good health, compared to 33% of men.
Certain hormonal fluctuations for women throughout life stages can affect their periodontal health. They may be, at times, more susceptible to periodontal disease, including:
1. Puberty: Studies indicate that the increase in hormone levels may lead to an increase in
sensitivity to gum inflammation and can cause the gum tissue to become swollen, red and tender.
2. Menstruation: During menstruation, some women may exhibit gingivitis, which may cause bleeding
gums, redness and inflammation of gum tissue between the teeth.
3. Menopause: Hormonal changes at this time may cause mouth pain including a burning sensation in
the gum tissues or mouth sores.
Men also have certain issues in regard to periodontal health. Studies have shown that men with gum disease are more likely to develop:
1. Kidney cancer
2. Pancreatic cancer
3. Blood cancer
4. Prostate cancer
Men and women alike should strive for good periodontal health by brushing twice a day, flossing once a day and visiting their dentist every year. Visit for more information on health and gum disease.
Marijuana – Another Risk Factor in Gum Disease
The AAP Journal is reporting a connection between gum disease and frequent use of marijuana.
Cigarettes and cigars are not the only culprits! Research has shown that regular smoking of recreational cannabis, (marijuana, hashish and hash oil), may elevate the risk of gum disease. It appears that even use of marijuana once a month for a year will increase indicators of mild, moderate and severe periodontal disease.
In studies of the relationship between frequent use of cannabis and gum disease, users demonstrated a significant increase in pocket depths. Pockets are the measurement of the space between a tooth and surrounding gum tissue. Pocket depths in healthy individuals should measure 4mm or less. Measurements exceeding 4mm indicate the presence of infection, and can range from moderate to severe. Studies done by the American Academy of Periodontology and the Center for Disease Control have shown that nearly half of all U.S. adults, age 30 and above have some level of periodontal disease.
Now that many states are considering legalization of marijuana, users need to be aware of the possible effect it can have on their periodontal health. Patients should inform their dentist and periodontist about their use of cannabis.
Gum disease is caused by inflammatory response to bacteria below the gum line. It can cause bleeding, swelling of the tissues, bad breath, recession and ultimately tooth loss. The best defense against gum infection is effective brushing and flossing on a daily basis, regular dental or periodontal checkups, and eliminating or limiting the use of cannabis products. Following these preventive measures can protect the health of the gums and teeth and add years of life to a healthy smile. Fortunately, periodontal disease is treatable and often reversible with appropriate care at the periodontist.
For more information on the relationship between cannabis and gum disease, visit the AAP at www.perio.org.
Your Smile
“Smile in the mirror. Do that every morning and you’ll start to see a big difference in your life”.
~Yoko Ono
A smile can show the world a person’s happiness, contentment, sincerity, confidence or even love. When you look in the mirror and smile, do you like what you see? Many people don’t and often refrain from smiling or cover up their smiles because they are self-conscious about what they see in the mirror.
Some common concerns are:
• Gummy smile
• Missing teeth
• Recession
Fortunately, periodontists can work in conjunction with your dentist to offer solutions to these and other cosmetic issues.
The Gummy Smile
Sometimes a person’s teeth appear to be too short or like baby teeth. The teeth may actually be the appropriate length, but they are buried in too much gum tissue. The periodontist can correct this by doing a procedure called Cosmetic Crown Elongation. Crown elongation exposes more of the natural tooth and can make a world of difference!
Missing Teeth
Missing teeth can cause more issues than just black spaces in the smile. When a tooth is lost and not replaced, other teeth can start to shift in the mouth. This can change not only the appearance of teeth, but also the bite. The jawbone will also start to melt away if there is no tooth root in a space. Bone loss can change the overall facial structure as well.
Partials and bridges are options for tooth replacement, but both neither of these options prevents bone loss. A partial often contributes to loosening of other teeth or to dental decay. In order to place a bridge, healthy teeth have to be cut down to nubs and crowned to support the bridgework. The most effective and conservative way to replace teeth today is with Dental Implants. Dental implants look, feel and function like natural teeth. And they will never decay!
Recession
Gum recession is most often caused by overly vigorous brushing! A periodontist can fix this problem with Root Coverage Grafting. Tissue from the roof of the mouth or from a donor source can be used to cover the receded area, restoring a natural gumline as well as providing protection from root decay. You may have heard the expression “long in the tooth” referring to the cosmetic changes we see with recession.
HIDDEN DENTAL INFECTION AND HEART DISEASE
You could have a dental infection and and not even know it!
A dental infection in the root of a tooth can increase your chances of heart disease, even if you don’t have any symptoms. These types of hidden dental infections are extremely common. Infections often go undetected until routine dental x-rays are taken and the infection is apparent. Most commonly, a root canal is indicated. Sometimes, the tooth is beyond repair and is recommended for extraction.
Dr. John Liljestrand, from the University of Helinski reports that “acute coronary syndrome is 2.7 times more common among patients with untreated teeth in need of root canal treatment than among patients without this issue.” This study was done at the Department of Oral and Maxillofacial Diseases of the University of Helsinki and published in the Journal of Dental Research.
Cavities are the most common culprit in tooth root infection or infection of the dental pulp. Researchers are finding more and more evidence that connects dental infection to other chronic systemic disorders. For example periodontitis is an inflammatory disease causing low-grade inflammation. This inflammation is considered a risk factor for diabetes, coronary artery disease, low-weight births, rheumatoid arthritis and even certain types of cancer. Root tip infections in teeth appear to cause low-grade inflammation as well. Root canal treatment can eliminate the infection and hence the inflammation.
Heart disease causes more that 30% of deaths world-wide. With a healthy diet, exercise, weight control and not smoking, heart disease may be prevented. Treating oral infections can also add to this preventive regimen. Seeing your dentist on a regular basis and review of full mouth x-rays every 3-5 years can also be added to this preventive approach.
If you are seeing a physician for heart issues or planning for any kind of surgery, make sure you have clearance from your dentist or periodontist ruling out any evidence of dental infection. Often, doctors will delay surgery until any or all dental infections are cleared up.