With 70 percent of people over the age of 36 showing signs of periodontal disease, dental professionals must consistently communicate to their patients the significance of prevention or halting gum disease in its early stages. Over the past few decades, the dentistry profession has made significant progress in eliminating cavities. However, gum disease remains a significant, but preventable and treatable health threat to the public (1, 12).
Prior to the onset of periodontal or gum disease, many patients experience gingivitis. Gingivitis represents a “mild form of gum disease” and starts as inflammation of the gums. Typically, the patient has red or swollen gums, which may bleed when the person brushes his or her teeth. Although some people may experience gum irritation, the teeth remain tightly rooted in the sockets.
Gum disease starts with the accumulation of bacteria in the mouth. Bacteria mix with mucus, food particles and other organic matter, which cause a build-up of plaque. Failure to remove plaque, by brushing and flossing, results in the material hardening into calculus or tartar. The person cannot remove tartar by brushing. The condition requires a deep cleaning by a dental hygienist or dentist.
When left untreated, gingivitis becomes progressively worse and may escalate into periodontitis. Periodontal inflammation affects the ligaments and bones, which surround the teeth and provide support. When teeth lose their support, they become loose and fall out (2).
TheraBreath recommends our PerioTherapy Oral Rinse formula, which attacks anaerobic bacteria associated with the initial stages of gum disease. Many patients combine the PerioTherapy Oral Rinse with Periotherapy toothpaste treatment and use of a Hydrofloss for a highly effective three-prong approach to preventing gum disease.
According to Jansson, “periodontal disease is an infectious disease initiated by microbial plaque, which accumulates on the tooth surface at the gingival margin and induces an inflammatory reaction. The function of the inflammatory process is to protect the host; however, the process may also contribute to tissue destruction. Most individuals show gingival inflammation, but only a limited number suffers from periodontitis, i.e. loss of attachment. Without treatment, periodontitis will result in tooth mobility and subsequent tooth mortality. Independent of ethnicity, 10%-15% of an adult population will develop severe periodontitis (3.)”
Three of the most common types of periodontal disease include:
- Aggressive Periodontitis - Patients with this kind of gum disease have the signs of a clinically healthy individual. Periodontitis occurs in the sulcus or gap located between the gum and tooth. This type of periodontitis is divided according to whether the onset occurs before or after puberty. Known causes of aggressive periodontitis include immunodeficiency and genetic associations. Detection and treatment in the early stages can mean a positive prognosis for the patient. When allowed to become severe, periodontal disease increases the risk of bone destruction, familial aggregation of infections and tooth mortality (4, 5).
- Chronic (Adult) Periodontitis – Chronic periodontitis may begin in adolescence, but becomes of clinical importance by the time an adult reaches his or her mid-30s. The disease may persist throughout the patient’s life and materializes as pocket formations and/or recession of the gingival. It commonly starts out with the gradual progression of attachment, which may then escalate into a rapid progression of attachment. Instead of a chronic, persistent malady, some researchers believe the condition propagates and diminishes based on the patient’s immune system (4, 5).
- Acute Necrotizing Ulcerative Gingivitis (ANUG) – Malnutrition, immunosuppression, and HIV infection have been linked to Necrotizing periodontal disease. Characterized by inflamed gums, mouth ulcers and severely damaged gingival tissues, ANUG has been around since the Second World War. Other signs of ANUG include inflammation of a periodontal ligament, which envelops and supports the tooth and alveolar bone (4, 5).
Left untreated, periodontitis not only affects oral health, but is also associated with other health problems, including rheumatoid arthritis, type two diabetes, heart disease and cancer (3, 9, 13).
General Symptoms of Gum Disease
When performing examinations, look for healthy, firm pale pink gums. Puffy, dusky red and swollen gingival warn of gum disease. If the patient complains of bleeding gums during flossing or brushing, it may signify periodontal disease. Some other signs to look for include loose teeth or pus, gums separated from the teeth, and gaps between the gums and teeth. In addition, periodontitis symptoms also include improper fit of the patient’s dentures, lesions, pain or bad breath (6, 7, 8).
Periodontitis represents the major cause for tooth loss in adults. Although the disease does not occur with any degree of frequency in childhood, it can occur in adolescence. Patients with gum disease have increased risks for a variety of complications, such as diabetes, cardiovascular disease, infective endocarditis, pulmonary disease and pre-term low birth-weight infants.
Treatment of Gum Disease
The treatment protocol for periodontitis depends on the extent to which the disease has entered the bone. Periodontitis treatment starts with the elimination of biofilm deposits and sub-gingival calculus. Conventional treatments consist of scaling and root planning which promotes healing of the gums. Some stages of gum disease require treatment with medications like an antimicrobial mouth rinse.
Studies have proven that “Rinsing with essential oil anti-plaque/anti-gingivitis mouth rinse can have significant antimicrobial activity against sub gingival periodontopathogens” (10). The essential oil contains chlorhexidine; an antimicrobial that controls bacteria for the treatment of gingivitis, and often is often prescribed to patients who have undergone periodontal surgery (10).
TheraBreath mouthwash does not contain alcohol, saccharin, sodium lauryl sulfate or benzalkonium chloride. Patients who have problems with canker sores or suffer from diabetes can also use this product. Click here to view the available mouthwash products from TheraBreath.
Another common medication called antibiotic microspheres refers to the “direct application of minocycline into the diseased periodontal sulcus (2, 10).” This medication releases minocycline over a specific duration, which helps to treat periodontal disease.
When cleaning your teeth and prescription medication fail to remedy the inflammation and deep periodontal pockets, patients have two surgical options. These options are Flap surgery and Bone or Tissue grafts. Flap surgery removes calculus deposits and reduces the periodontal pocket. Sometimes, it becomes necessary to perform bone and tissue grafts to regenerate lost gum or bone tissue (2, 10).
TheraBreath offers an excelled line of products for Periotherapy. These products have been specially developed to help prevent gum disease. Click here to learn more about TheraBreath PerioTherapy products.
Dental professionals have an important role in encouraging their patients to reach for higher benchmarks as it relates to oral health. Discuss probiotics with your patients and explain how they work. Click here to read an article on oral care probiotics.
Noel Kelsch (RDHAP) wrote an article about adding probiotics to oral health care, where he recommends the introduction of probiotics “as part of a medical and wellness model, which begins with the diagnosis and treatment of a condition, such as gingivitis (12).”
TheraBreath’s BLIS K-12 and BLIS M-18 probiotics promote the growth of the natural beneficial bacteria which eliminate: biofilm, plaque, halitosis, tooth sensitivity, enamel erosion, and periodontal disease. Click here to view the probiotic products by TheraBreath.
American Academy of Periodontology, “Women Winning the Battle of the Sexes When It Comes to Periodontal Health.”
National Institute of Dental and Craniofacial Research Periodontal (Gum) Disease: Causes, Symptoms, and Treatments
Jansson H. Studies on periodontitis and analyses of individuals at risk for periodontal diseases”.
http://www.ncbi.nlm.nih.gov/pubmed/16838563. Swed Dent J Suppl. 2006
University of Maryland Medical Center, Periodontal disease – Introduction
American Academy of Periodontology, Types of Gum Disease
American Academy of Periodontology Symptoms of Gum Disease
Needleman IG, Worthington HV, Giedrys-Leeper E, Tucker RJ. Guided tissue regeneration for periodontal infra-bony defects.
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD001724.
Mayo Clinic , Symptoms
Mayo Clinic, Complications
Fine DH, “Effect of rinsing with an essential oil-containing mouthrinse on sub gingival periodontopathogens.”
http://www.ncbi.nlm.nih.gov/pubmed/18062115. J Periodontol, October 2007.
Noel Kelsch, RDHAP. “Understanding Advances in Naturally Occurring Probiotics—Their Role in a New Daily Oral Health Care Regimen.”
http://www.dentalaegis.com/special-issues/Sunstar/2011/10/understanding-advances-in-naturally-occurring-probiotics. AEGIS Communications, October 2011.
Dominique S . et al., “Periodontal Disease, Tooth Loss and Cancer Risk in a Prospective Study of Male Health Professionals.”