Periodontics & Systemic Disease FAQ

A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease, and in the placement of dental implants. Periodontists are also experts in the treatment of oral inflammation. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school. They are familiar with the latest techniques for diagnosing and treating periodontal disease, and are also trained in performing cosmetic periodontal procedures. During the first visit, the periodontist usually reviews the patient’s complete medical and dental histories. It is extremely important for the periodontist to know if any medications are being taken or if the patient is being treated for any condition that can affect periodontal care, such as heart disease, diabetes, or pregnancy. The periodontist examines the gums, checks to see if there is any gum line recession, assesses how the teeth fit together when biting, and checks the teeth to see if any are loose. The periodontist will also take a small measuring instrument called a probe and place it between the teeth and gums to determine the depth of those spaces, known as periodontal pockets; this helps the periodontist assess the health of the gums. X-rays may also be taken to observe the health of the bone below the gum line.

Who should see a periodontist?

Some patients’ periodontal needs can be managed by the general dentist. However, as more and more patients are exhibiting signs of periodontal disease, coupled with research that suggests a relationship between periodontal disease and other chronic diseases of aging, periodontal treatment may necessitate a greater understanding and increased level of expertise by a trained specialist. Patients who present with moderate or severe levels of periodontal disease, or patients with more complex cases, will be best managed by a partnership between the dentist and periodontist.

Untreated periodontal disease can eventually lead to tooth loss and other health problems.

Gingivitis

The mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care. Factors that may contribute to gingivitis include, diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medication use.

Periodontitis

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed. There are many forms of periodontitis. The most common ones include the following.

• Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
• Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
• Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
• Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

The main cause of periodontal (gum) disease is plaque, but other factors affect the health of your gums.

Age

Studies indicate that older people have the highest rates of periodontal disease. Data from the Centers for Disease Control and Prevention indicates that over 70% of Americans 65 and older have periodontitis.

Smoking / Tobacco Use

Tobacco use is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems. Tobacco users also are at increased risk for periodontal disease. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.

Genetics

Research has indicated that some people may be genetically susceptible to gum disease. Despite aggressive oral care habits, these people may be more likely to develop periodontal disease. Identifying these people with a genetic test before they even show signs of the disease and getting them into early intervention treatment may help them keep their teeth for a lifetime.

Stress

Stress is linked to many serious conditions such as hypertension, cancer, and numerous other health problems. Stress also is a risk factor for periodontal disease. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases.

Medications

Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can affect your oral health. Just as you notify your pharmacist and other health care providers of all medicines you are taking and any changes in your overall health, you should also inform your dental care provider.

Clenching or grinding your teeth

Clenching or grinding your teeth can put excess force on the supporting tissues of the teeth and could speed up the rate at which these periodontal tissues are destroyed.

Other systemic diseases

Other systemic diseases that interfere with the body's inflammatory system may worsen the condition of the gums. These include cardiovascular disease, diabetes, and rheumatoid arthritis.

Poor nutrition and obesity

A diet low in important nutrients can compromise the body's immune system and make it harder for the body to fight off infection. Because periodontal disease begins as an infection, poor nutrition can worsen the condition of your gums. In addition, research has shown that obesity may increase the risk of periodontal disease.

Gum disease is often silent, meaning symptoms may not appear until an advanced stage of the disease. However, warning signs of gum disease include the following:

• Red, swollen or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or eating hard food
• Gums that are receding or pulling away from the teeth, causing the teeth to look longer than before
• Loose or separating teeth
• Pus between your gums and teeth
• Sores in your mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

The American Academy of Periodontology's risk assessment test will help you see if you are at risk for having or developing periodontal (gum) disease. Millions of people don't know they have this serious infection that can lead to tooth loss if not treated.'

Periodontal disease, also known as gum disease, is caused when bacteria in plaque (a sticky, colorless film that forms in the mouth) builds up between the gums and teeth. When the bacteria begin to grow, the gums surrounding the tooth can become inflamed. If left untreated, this inflammation can cause the gums and supporting bone structure to deteriorate. This can lead to gum recession or even tooth loss. In addition, research has shown that gum disease may be associated with other diseases, such as diabetes and heart disease. Luckily, periodontal disease can be preventable. Adding these habits to your daily routine can help. Brush your teeth. Brushing after meals helps remove food debris and plaque trapped between your teeth and gums. Don’t forget to include your tongue, bacteria loves to hide there. Floss. Flossing at least once a day helps remove food particles and plaque between teeth and along the gum line that your toothbrush can’t quite reach. Swish with mouthwash. Using a mouthwash can help reduce plaque and can remove remaining food particles that brushing and flossing missed. Know your risk. Age, smoking, diet and genetics can all increase your risk for periodontal disease. If you are at increased risk, be sure to talk with your dental professional. See a periodontist. Get an annual comprehensive periodontal evaluation (CPE) to look at your teeth, plaque level, gums, bite, bone structure and other risk factors for periodontal disease. Identifying symptoms of gum disease early is key to protecting your teeth and gums.

Research has shown that periodontal disease is associated with several other diseases. For a long time it was thought that bacteria was the factor that linked periodontal disease to other disease in the body; however, more recent research demonstrates that inflammation may be responsible for the association. Therefore, treating inflammation may not only help manage periodontal diseases but may also help with the management of other chronic inflammatory conditions.

Diabetes

Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications. People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk. Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar. Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications.

Heart disease

Several studies have shown that periodontal disease is associated with heart disease. While a cause-and-effect relationship has not yet been proven, research has indicated that periodontal disease increases the risk of heart disease. Scientists believe that inflammation caused by periodontal disease may be responsible for the association. Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

Stroke

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

Osteoporosis

Researchers have suggested that a link between osteoporosis and bone loss in the jaw. Studies suggest that osteoporosis may lead to tooth loss because the density of the bone that supports the teeth may be decreased, which means the teeth no longer have a solid foundation.

Respiratory disease

Research has found that bacteria that grow in the oral cavity can be aspirated into the lungs to cause respiratory diseases such as pneumonia, especially in people with periodontal disease.

Cancer

Researchers found that men with gum disease were 49% more likely to develop kidney cancer, 54% more likely to develop pancreatic cancer, and 30% more likely to develop blood cancers.