Periodontal Disease

Periodontal disease is a bacterial infection of the soft tissue of the mouth that can cause loss of bone that supports the teeth. In advanced cases, teeth are lost because the jawbone supporting the teeth is eaten away by toxins.

Periodontal disease is associated with an increased risk of heart attack or stroke. It can also be a factor in premature birth for pregnant women with the disease. Research is showing that the bacteria from the disease can enter the bloodstream and can cause a buildup of plaque in areas such as the carotid and coronary arteries.

We frequently see both members of a couple with periodontal disease. It is possible for bacteria responsible for periodontal disease to be passed to a spouse or partner of a periodontal patient, particularly if the significant other person displays poor oral hygiene and/or poor resistance to the bacteria that cause the disease.

There are different stages of the disease. Below is a description of these stages.

  1. Gingivitis - At this stage, there is no detectable bone loss, but soft tissue is inflamed; there is gum tenderness when being cleaned and gums may bleed easily. Gingivitis occurs when home care is inadequate, when dental cleaning visits are infrequent, or when stress allows bacteria to take hold in the mouth. Improved home care and more frequent dental visits will generally clear up this condition. If a patient has this condition, we would advise to have teeth cleaned at three month intervals until the condition is eliminated. We may also prescribe an antimicrobial rinse for use at home and may use an antimicrobial solution during a dental cleaning to reduce the bacterial populations.
  2. Isolated Areas of Infection - This stage may include some bone loss. At this stage, it is important for the patient to be particularly careful in keeping these areas flossed, and to schedule an additional cleaning in three months to monitor the situation. We may also place an antibiotic powder or gel in the pocket to reduce the bacterial population.
  3. Moderate Periodontal Disease – There is some generalized bone loss at this stage, less than six millimeters. At this point it appears that the bone loss is not too severe and the disease is treatable with periodontal scaling, antimicrobial treatment, and careful home care. A patient at this stage must have his or her teeth scaled and then follow up with antimicrobial irrigation administered at this office every three months. We may also use an antibiotic powder or gel to reduce pocket depths. At this stage, periodontal disease does not go away, it can only be controlled to keep it from advancing.
  4. Advanced Periodontal Disease, Isolated Deep Pockets – At this stage there are isolated pockets, with some bone loss greater than six millimeters. With advanced disease, we may not be able to remove the hardened calculus and toxins without surgery. The treatment at this stage is periodontal scaling to eliminate as much calculus as possible and possible placement of an antibiotic powder or gel in the worst pocket areas. Periodontal surgery may be indicated as well. Surgical procedures are designed to specifically remove diseased tissue. After treatment, we follow up in six weeks to determine future needs.
  5. Advanced Periodontal Disease, Widespread – When periodontal disease becomes advanced, there can be widespread bone loss, greater than six millimeters. The disease at this stage is a serious infection, and can lead to tooth loss and affect overall health. There are new chemotherapeutic treatment modalities that involve the application of bactericidal agents in custom fitted oral trays that is showing promise in the treatment of advanced and stubborn periodontal infections. We may advise referral to a periodontist if the aforementioned treatment modalities are not effective.

Several recent studies have established a link between periodontal disease and systemic diseases such as cardiovascular disease, diabetes, and pregnancy complications. Periodontal disease bacteria have been shown in some studies to increase the presence of C reactive protein and other mediators of inflammation. Some recent studies have demonstrated that in patients with cardiovascular disease, endothelial dysfunction, a sign of early pathology in atherosclerosis, was reduced with periodontal treatment for patients with severe periodontitis. Bacteria that are associated with periodontal disease have been found in the carotid artery and there is a correlation between stroke and periodontal disease. Several studies shown that premature birth is a complication of pregnancy associated with periodontal disease. There are also concerns about periodontal conditions affecting surgical procedures such as joint replacement or cardiovascular procedures, and it is not uncommon for surgeons to insist on consultation with the dentist before proceeding with surgery.